Pes Planus Deformity

Pes planus is also referred to as flat foot, valgus foot, low arch foot or pronated foot. It is characterized by loss of medial longitudinal arch.

Medial longitudinal arch is formed by calcaneus, talus, navicular, three cuneiform and 1st 2nd 3rd metatarsals. The arch is supported by the following structures:

• Posterior and anterior tibial muscles
• Flexor hallucis longus and brevis
• Plantar aponeurosis
• Plantar ligament
• Deltoid ligament
• Spring ligament

• Flexible pes planus is more common than rigid pes planus
• Men and women ratio is 1:1

1. Congenital (Flexible and Rigid)
2. Acqured (Flexible and Rigid)

1. Congenital

Normally child develops arch by the age of 5 or 6 years old. Absence of arch secondary to the ligamentous laxity and lack of neuromuscular control is common in children. Childhood obesity can cause excess loading on the foot and leads to pes planus deformity.

2. Acquired

It is usually associated with posterior tibial tendon dysfunction. It is commmon in sports such as baskerball, Football and running. Trauma or injury to the supporting structures can cause arch collapse. Also it is secondary to pregnancy and disappears after delivery.

Observation

1. Wet paper test

   Patient is asked to stand on the paper with wet foot. Pes planus can be positive if surface contact of midfoot is higher than normal.

2. Rigid vs Flexible

   Rigid and flexible flat foot can be distinguished by observing foot in weight bearing and non weight bearing positions. Flexible pes planus will have normal arch during nonweight bearing (i.e: supine) and arch collapse during weight bearing (i.e: standing). Rigid foot will have loss arch during all the time.

3. Too many toe sign

   In normal foot, when we observe the foot from backside or posterior, therapist can see only lateral one and half toes. In flat foot, Therapist can observe more than 2 toes from posterior side.

4. Asymmetry

   Above mentioned tests should be performed on both the sides for clear information.

Palpation

Palpation of medial arch supporting structures will give valuable information regarding causative factors.

Range of motion

Hubscher manuever or jack test: it is a passive rom test used to differentiate rigid and flexible flat foot. In this, patient should be in standing position and therapist has to do passive extension or dorsiflexion of big toe. Medial arch is formed If it is flexible flat foot. If there is no change, it is a rigid foot.

Muscle strength

Therapist can check the strength of tibialis posterior by resisted inversion test.

Painful foot in children can be treated by orthotics. sometimes fat pad in the children can mimick flatfoot deformity. so thorough examination is mandatory before the treatment.

Athletes with flat foot should recommended to use motion controlled or stability shoes. It prevent recurrent injuries.

Surgery is indicated for rigid type of flat foot.

1. Marc A. Raj; Dawood Tafti; John Kiel, pes planus., statpearls.
2. JASPER W.K. TONG, PUI W. KONG., Association Between Foot Type and Lower Extremity Injuries: Systematic Literature Review With Meta-analysis (2013).

Creator Details

Name	:	Deva senathipathi
Qualifications	:	Physiotherapist