Flatfoot

CHAPTER 52

Flatfoot

Introduction/Etiology/Epidemiology

• Flatfoot, or loss of the medial longitudinal arch of the foot, is a common condition.

• Although normal in young children, flatfeet are a common concern among parents.

• The (flexible) flatfoot is normal in children up to 6 years due to

— Increased ligamentous laxity

— Medial fat pad normally present at birth

• Rapid development of the medial longitudinal arch occurs during normal growth from 2 to 6 years of age due to atrophy of the medial fat pad and decline in ligamentous laxity.

• Rigid flatfeet may be associated with an underlying etiology such as tarsal coalition or congenital vertical talus.

Signs and Symptoms

• Medial arch of the foot collapses with weight bearing.

• Physiologic (flexible) flatfoot

— Medial arch is reconstituted when non-weight bearing, with toe raise Jack test, or with toe walking (see Chapter 4, Physical Examination, Figure 4-37).

— Usually asymptomatic

• Nonphysiologic (rigid) flatfoot

— Medial arch is not reconstituted when non-weight bearing, with toe raise Jack test, or with toe walking.

— Passive subtalar motion is limited.

— Patients often report activity-related pain around the midfoot or hindfoot.

• Limited ankle dorsiflexion caused by an associated tight Achilles tendon pulls the hindfoot into valgus and leads to an increased flatfoot deformity.

— Evaluate ankle dorsiflexion with the hindfoot in slight inversion to avoid dorsiflexing through the midfoot.

— Silfverskiöld test evaluates for gastrocnemius tightness versus Achilles tendon contracture

■Patients should be able to dorsiflex the ankle at least 10 degrees beyond neutral while the knee is extended, which should then increase when the knee is flexed.

■Limited dorsiflexion with an extended knee but normal dorsiflexion with a flexed knee suggests gastrocnemius tightness.

■Limited dorsiflexion with both an extended and flexed knee suggests Achilles tendon contracture (see Chapter 4

Only gold members can continue reading. Log In or Register to continue