Introduction
Pes Planus is a foot deformity opposite to pes cavus. Here, the medial longitudinal arch of the foot is dropped downward; thereby, there is a loss of the spring action causing excessive stress over the whole foot during every step.
Definition
Pes planus is the loss of the medial longitudinal arch of the foot, causing the entire sole to make contact with the ground. It is also known as pes planovalgus or flat foot.
Etiology
The causes of flat feet are diverse and can include:
- Genetic predisposition: Often, the condition runs in families.
- Age: Common in infants and toddlers, often resolving naturally, but can develop in adults due to wear and tear.
- Trauma: Pott’s fracture, crushed injury result in a rigid flat foot.
- Obesity: Increased weight puts more stress on the arches.
- Muscle weakness: Weak tibialis posterior or other intrinsic foot muscles.
- Footwear: Improper or unsupportive shoes can contribute.
- Ligamentous laxity: Overly flexible ligaments can lead to arch collapse.
Signs & Symptoms
Many individuals with flat feet experience no symptoms. However, when present, they may include:
- Foot pain: weight bearing becomes painful.
- Achilles tendonitis.
- Swelling along the inside of the ankle.
- Difficulty with certain activities like standing or running for long periods.
- Antalgic gait.
Investigation
Diagnosis typically involves a physical examination where the clinician observes the foot’s arch while standing and non-weight bearing. Further investigations may include:
- X-rays:X-rays are used to categorise the feet as having normal, slightly flat and moderate arches. In FF this is not routine.
- MRI: In some cases, to evaluate soft tissue structures like ligament,capsule.
- Gait analysis: To observe heel walking patterns and biomechanics in case of children.
Physiotherapy Management
For children younger than 3 years, initial stage C and E heel shoes with medial arch support, and arch support in the footwear should be used at home. Custom prothesis for age group between 3 and 10 years. At late stage, they will need well-moulded orthosis.
- Strengthening exercises: strengthening and endurances exercises to the intrinsics (in warm water).
- Stretching: For tight calf muscles and Achilles tendon.
- Gait retraining: Corrective gait training with orthoses and bearing weight on the lateral border of the foot without orthoses
- Footwear advice: Repetitive toe curling even with shoes on (it provides resistance).
- Arch support and orthotics: Custom or off-the-shelf devices to provide support and improve alignment.
- Manual therapy: To mobilize stiff joints and release tight tissues.
Conclusion
Pes Planus, while common, is a treatable condition. All typically developing infants are born with flexible flat feet, with arch development first seen around 3 years of age and then often only attaining adult values in arch height between 7 and 10 years of age.