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Pes planus is one of the most common deformities.
For years the military would disqualify basic trainees for just walking in with flatfeet. During my time in the military,
you realize that most people with flatfeet who will have problems have had problems since they were a child or as a teenager.
One only has to look at the NFL and NBA to realize that flatfeet are not as problematic. In the long run, flatfeet
can become a symptomatic deformity that can range from tendonitis, tendon tear, and eventual DJD.
Treatment options
can range from inserts to flatfoot reconstruction. The only soft tissue procedure that truely makes a difference is lengthening
the achilles. Whether it be percutaneous, open or gastroc recession, the achilles is a major deforming force.
So often
patients want to know why there are so many surgical options, simply because not every flatfoot is the same. Flatfeet have
three major planes of deformity: frontal, transverse and sagittal. As a result, each and every individual requires at the
minimum an achilles lengthening procedure. Depending on the ratio of planal dominance and the extent of DJD, will determine
the variety of osseous procedures.
Despite their popularity, tendon transfers, medial column osteotomies and fusions
have questionable relevance. Rearfoot procedures are just so powerful. One of the most overused procedures is arthroresis.
Subtalar arthroresis implants are very simple and fast. They are extremely powerful in correcting ONLY frontal plane deformities;
however, they are so powerful in jacking open the subtalar joint that they may actually advance subtalar joint DJD specifically
at the middle facet.
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Transverse plane dominance
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This foot is so flat that you can see the talar head bulging through the foot
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Majority of severe flatfeet starts at birth. Hereditary
factors surely play a role, but so does intra-uterine pressure. Calcaneovalgus is a deformity at birth. Essentially, the
foot is pinned against the uterine wall. Often, calcaneovalgus can be seen on the opposite foot that has metadductus.
Calcaneovalgus
can go unnoticed as long as the child isn't walking. Once walking, the foot becomes extremely unstable and noticeable. Too
often it is at this point that parents bring children in. Unfortunately, there are just as many children that are allowed
to progress until they are teenagers. More often these are the teenagers that have difficulties with gym/PE and stop playing
sports. Moral of the story catch these kids early as possible.
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Right foot is noticeably abducted and everted - calcaneovalgus
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Calcaneovalgus feet can literally sublux out of the talonavicular joint allowing the foot to dorsiflex
to the tibia - hallmark of this deformity
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Calcaneovalgus is a flexible deformity which is easily distinguished from a vertical talus. This
xray shows the talus with increased talar declination and increased talocalcaneal angles.
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This is how a toddler can progress to a worse deformity
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Talar declination is the key radiographic finding
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Again, if allowed, the deformity will keep getting worse and become permanent as the bones ossify
and joints mature
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Pretty impressive standing AP view
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