One of the most frequent consultations to the pediatric orthopedic surgeon is in relation to the child’s foot support when walking. He does not complain of pain or difficulty in walking, he is active and restless, jumps and runs as much as anyone else, and does a lot of sports in spite of supporting his foot by twisting his ankles. Dr. Cubillo, an expert in traumatology, talks about the causes and treatment of flat feet,
What is flat feet?
The normal support of the adult foot is like a tripod: head of the first metatarsal, head of the fifth metacarpal and heel, are the areas of the foot that support more weight, although it is also supported and thus it draws the normal footprint, in the central metatarsals and in the external edge of the foot. In addition, seen from behind – the foot – the heel does not rest on the verticality of the straight line. The normal foot does it a little in valgus (the ankle inward and the heel outward).
When the foot supports the internal edge it is a flat foot of different degrees according to that support and it is valgus when that vertical line of the heel goes outwards more than normal. Generally both things go together.
Valgus flat foot: causes
- Infantile flatfoot valgus; it is presented in the child during its first infancy. The adult foot is structured around the age of seven. Until then, most children have flat feet and valgus.
- Idiopathic valgus flatfoot. It is the one that persists in the adult. There is no obvious cause. It is flexible. In many of these cases there is a family flatfoot.
- Associated to the scaphoid corneal or prominent; the foot presents a bony prominence in the internal border of the foot; it is an anomalous scaphoid, although they do not always associate the flat foot.
- Flat foot associated with a tarsal coalition. This is a congenital malformation in which two tarsal bones of the foot are fused together. The most frequent is the union between the calcaneus and the scaphoid and it is usually painful. In most cases this union requires surgical resection.
- Flatfoot sequelae of more serious processes of the foot, or neurological diseases or myopathies. This much more complex pathology should be analyzed in another topic.
Valgus flatfoot: evolution
The infantile flatfoot valgus evolves in its growth to spontaneous correction without treatment. In its normal activity, the child performs a physical activity that improves the fibromiofascial tone of the foot and corrects it.
On the other hand, flat feet in adults – depending on the degree – can have no or serious repercussions on the foot itself. They can be very painful feet and evolve to an arthrosis in the same one.
Valgus flatfoot: treatment
The effectiveness of corrective insoles is more than debatable: podiatrists put them in, child traumatologists take them out… while they step on the insole they do not deform the footwear, but then, what do we treat the footwear or the foot? Sometimes the child reports pain in the sole of the foot and fatigue during sports practice. In these cases the use of temporary insoles can improve this symptomatology.
In older children, if the foot has not been corrected, if the flat foot is very important and painful, or if there is a history of symptomatic flat feet in the family, surgical correction is recommended, which is performed using less aggressive techniques at around 11 years of age.
Can we avoid adult flat feet with insoles or physiotherapy?
No. A child’s flatfoot that remains so in adulthood will remain so regardless of the attempts at correction that we apply.