Flatfoot is a clinical situation characterized by the disappearance or non-formation of the plantar arch. Flatfoot shapes can be varied. and fundamentally banal, although some may require surgical treatment.
The most frequent form is flexible flat feet, which is difficult to differentiate from a normal foot, and which improves spontaneously with growth. Other forms of flat feet should be properly differentiated and evaluated, since they may require surgical treatments.
In the first examinations of the baby and in the successive pediatric reviews, the foot is one of the members that are observed to determine if there is any type of anomaly.
Flexible flat foot
As we have advanced, this type difficult to differentiate from the evolution of a normal foot, since in a large percentage of children there is flattening of the longitudinal arch, with normal joint mobility. This type of foot is very common in children, but rare in adults, as there is a progressive improvement with growth.
The plantar fat pad tends to exaggerate the deformity (instead of the bow there is a lump), but it is typical from the beginning of the march and will have disappeared practically in prepubertal times.
Many times, when the child grows up Orthopedic insoles or footwear is recommended, although experts point out that the final evolution of the foot will be the same, regardless of the use of footwear or orthoses.
The feet that are painful or their equivalents of children who are not aware of their pain and tend to gain weight and become less active in sports should be excluded from these cases. These cases can benefit from the use of appropriate templates.
Valgo flatfoot
Are the idiopathic flat feet, which will continue to be so in adult life. The plantar footprint persists flat after six or eight years, unlike the flexible flat foot. There is usually a family history, which is interesting to see the evolution in adults.
They can be occasionally intermittently painful, pain that usually improves with the use of templates, although sometimes they can be removed after a painful stage. The template does not prevent the persistence of flatfoot. Sometimes they need the brace permanently, but many of them practice a normal sporting life.
In those cases in which the painful symptoms persist after an adequate period of use of templates, there may be a surgical indication.
Pie cavo valgo
Occasionally, the child has a cavo foot (it is an arch that rises more than normal) that is suggested by an increase in plantar arch in discharge, but that in the load, when the bow collapsed accompanied by the valgus, acquires the appearance of a flexible valgo flat foot. This type of foot is called "pie cavo valgo" or "second degree flatfoot".
There is usually a history of cavo standing in the family and with growth the plantar vault exceeds normal limits and the valgus persists for a long time. The treatment will depend on the symptomatology.
Flatfoot associated with accessory scaphoid
The tarsal scaphoid is a bone that is located in the inner part of the foot that appears as a secondary ossification center. If this bone fuses completely with the rest of the bone it can form a scaphoid with an abnormally prominent and incurred inner end, this is the "horned scaphoid".
In many cases, the corneal scaphoid, or the presence of an accessory scaphoid, is the cause of a valgus flat foot, either by an anomalous insertion of the tendon or by fractures at the junction of the two bones, which also cause an insufficiency of said tendon.
Also the overload, the prolonged march or the rubbing of the shoe can be cause of pain, in some occasions very disabling, that does not allow the child a physical activity or a normal life. On inspection of the internal area of the foot, where the scaphoid is located, a hard and painful bulge is felt on palpation.
The specialist will determine different treatments and if they were not effective, surgery could be used.
Flatfoot by tarsal coalition
Also called flat foot by bone bar or peroneal spastic flat footIt can be a rigorously normal foot in children's age or with a moderate level. It is produced by fusing certain ossicles of the foot.
In a pre-adolescent period, with the increase in weight and activity, it can become painful intermittently, with a clear limitation of mobility, which in early stages can be corrected if explored with a general anesthesia or a local anesthesia infiltration, since Reactive muscle spasticity is more important than bone fusion in process.
Congenital vertical talus flatfoot
This type of flatfoot is a rare pathology. The foot appears from birth with a clear deformity in talus, valgus and abduct. The deformity is usually rigid and in the internal area of the arch there is a prominence that makes the arch inverted and convex. It is interesting to know it, because it can be confused with a talus foot in the mildest cases.
Treatment should be started urgently with corrective casts, but very often it is a problematic foot and ends up undergoing various surgical procedures.
In short, we see that there are different types of flat feet which must be determined by the pediatrician in the different reviews and examinations, to indicate the appropriate treatment in the necessary cases.
