![]() A comparison should be made to the unaffected foot. The physical exam should consist mainly of inspection, palpation, ROM, muscle strength testing, and gait assessment. Patients who typically overpronate will be at high risk for ankle sprains from chronic “rolling of the ankle.” The patient should be asked about the onset of deformity, timing of symptoms, severity of past and current symptoms, history of trauma, family history, surgical history, and past medical history (including hypertension, diabetes, rheumatoid arthritis, sensory neuropathies, seronegative spondyloarthropathies, and obesity). Patients with more advanced changes may complain of an altered gait pattern. In symptomatic patients, there may be complaints of the midfoot, heel, lower leg, knee, hip, and or back pain. In adults, pes planus may be an incidental finding. In rare instances, flat feet can become painful or rigid, which may be a sign of underlying foot pathology, such as tarsal coalition. Through developmental history, past medical history, past surgical history, family history of pes planus, and activity level (sports participation or avoidance) should be documented. Pes planus is very common in young children and asymptomatic. It develops from the tarsal coalition, accessory navicular bone, congenital vertical talus, or other forms of congenital hindfoot pathology.Įvaluation should be based on the presentation during the clinic visit. It usually develops during childhood, but it can occur at any point in life. It may also result from a tight Achilles tendon or calf muscle. The main factors that contribute to an acquired flat foot deformity are excessive tension in the triceps surae, obesity, posterior tibial tendon dysfunction, or ligamentous laxity in the spring ligament, plantar fascia, or other supporting plantar ligaments. Dysfunction of any portion of the medial longitudinal arch may result in acquired pes planus. ![]() It is supported by the soft tissues of the spring ligament (plantar calcanea navicular ligament), deltoid ligament, posterior tibial tendon, plantar aponeurosis, and flexor hallucis longus and brevis muscles. The medial longitudinal arch is made up of the calcaneus, navicular, talus, first three cuneiforms, and first, second, and third metatarsals. It develops from the tarsal coalition, accessory navicular bone, congenital vertical talus, or other forms of congenital hindfoot pathology. Patients with rheumatoid arthritis or seronegative arthropathies should be considered at higher risk for developing pes planus, especially if poorly controlled. These can be either degenerative or inflammatory. Patients with arthropathies are at higher risk for acquired pes planus. Ligamentous laxity secondary to pregnancy may also cause pes planus but typically corrects itself post-partum. Patients with congenital ligamentous laxity secondary to Down syndrome, Marfan, or Ehlers Danos can present with pes planus. Patients with sensory neuropathy may result in Charcot arthropathy leading to midfoot collapse over time. Other causes include injuries to soft tissues such as plantar fascia or spring ligament. ![]() It occurs more commonly in malunion of those fractures. Patients with trauma to the midfoot or hindfoot resulting in navicular, first metatarsal, calcaneal, or Lis-Franc ligament complex demonstrate an increased risk of developing pes planus. It can also occur in adults with congenital pes planus, especially those who participate in repetitive high impact sports such as basketball, running, or soccer. Posterior tibial tendon dysfunction is most common in females over the age of 40 with comorbidities, including diabetes and obesity. Acquired pes planus is most commonly occurs secondary to posterior tibial tendon dysfunction. The function of the posterior tibial tendon is to support the arch as well as inversion and plantarflexion of the foot. Obesity in children is significantly correlated with the tendency of the longitudinal arch to collapse in early childhood. There is a small percentage of children who fail to develop a normal arch by adulthood. ![]() Flexible pes planus describes a normal arch without bearing weight, which disappears with weight-bearing. Most cases of pes planus in children are flexible. Most children develop normal arches by age 5 or 6. Infants have a fat pad under the medial longitudinal arch, which serves to protect the arch during early childhood. Infants and young children are prone to absent arches secondary to ligamentous laxity and lack of neuromuscular control. ![]() Pes planus can either be congenital or acquired. ![]()
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