The flat foot the most frequent reason for orthopedic visits in children. This physiological condition at birth and in the first years of life. A wider base of support in fact, it facilitates the journey. Often due to the overabundance of plantar fat typical at birth which then tends to reduce over the years. The foot develops in the womb e it reaches full maturity around 13-14 years – he pressed Nicola Portinaro, professor at the University of Milan and head of the Pediatric Orthopedics Operating Unit of the Humanitas Clinical Institute in Milan -. In most cases, in this period of time, it acquires a normal morphology and function, however, it is useful to monitor its development and verify that there are no pathological changes.
What are the characteristics of flat feet?
Flat foot shows up with a reduced internal arch. Also often present too a valgism of the retropiede (valgus pronated foot) in which the heel support is moved outward (valgus) and the inner part of the foot tends inward (pronation). A distinction is normally made between flexible flat foot and rigid flat foot. That flexible the most common and often associated with constitutional laxity of the ligaments. If you evaluate the child on tiptoe, the arch of the foot forms indicating that the foot is still elastic. Generally it does not cause relevant symptoms, however, the child may sometimes experience pain at certain times, especially in the case of pronated valgus. In this case it is good to check that there is no inflammation of the posterior tibial tendon that can be associated with the flat foot as well as a shorter Achilles tendon. The flat foot rigid, as the name suggests, a foot that has lost its elasticity: if the child stands on tiptoe, the foot remains flat. Rigid flatfoot must always be carefully evaluated because it could conceal congenital skeletal anomalies of the hindfoot, in particular the so-called synostoses. These bone changes are due to bridging between neighboring bones that did not separate well during the first few weeks of fetal life.
What can be done to correct this problem?
In case of foot valgus pronated often insoles are used. It is now known that these orthoses are not able to correct flat feet, however they help to improve the biomechanics of walking. In the presence of a Achilles tendon shorter instead they are useful specific rigid insoles that do not allow dorsiflexion of the toes. In this way, while the child walks, the tendon “stretches” with results similar to those that can be obtained with a physiotherapy program.
When is the intervention advisable?
A flat foot that does not cause pain and discomfort it is only kept under observation until the time of complete ripening. Around the age of 12-13 it is reevaluated: if it has matured well and does not cause problems, no action is taken, otherwise one can operate. Depending on the underlying problem, they are proposed different types of intervention. For example, in the case of rigid flat feet with synostosis, it is necessary to remove the parts of bone that have fused. In the case of a painful flexible flat foot, the more commonly used technique is the so-called calcaneus-stop.
How can it be diagnosed?
Even an untrained eye can recognize flat feet. In fact, parents are often the first to notice. For the diagnosis, in addition to the orthopedic visit and the evaluation of any symptoms, some investigations may be useful, starting from the X-ray of the foot under load from different angles. Computerized gait analysis with the use of the force platform is now available.
What is the cavus?
The hollow foot a congenital or acquired malformation of the vault of the foot. much less common than flat foot and as opposed to it occurs with an accentuated plantar arch, which is why the foot support area is limited to the front and the heel. The cavus, especially when asymmetrical, always deserves an evaluation because often associated with neurological diseases of the central or peripheral nervous system (medullary lipoma, spina bifida occulta, meningocele, etc.) – reports Nicola Portinaro, head of the Pediatric Orthopedics Unit of the Humanitas Clinical Institute in Milan -. A careful examination is therefore required not only of the foot, but also of the spine and possibly a neurological examination.
April 19, 2021 (change April 19, 2021 | 21:42)
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