“Risk Factors that may adversely modify the natural history of the pediatric pronated foot." Clin Podiatr Med Surg. 2000 Jul;17(3):397-417. Napolitano C, Walsh S, Mahoney L, McCrea J.Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
This article is a nice follow up to the video post from yesterday. The article talks about the flexible and rigid flat foot. In yesterday’s video example we are dealing with a flexible flat foot deformity. When he was non-weightbearing (which wasn’t seen in the video) he formed an arch. As you can see in the video upon weightbearing the arch disappears but you can see that with the correct patterning employed, he can find an arch. This is what we term a flexible flat foot deformity. These types of feet have potential if there is sufficient muscular ability and if hyperlaxity in the ligamentous system can be overcome by neuromuscular support. If not, an orthotic may need to be utilized and be assistive. The rigid flat foot, is one that does not form a competent arch, ever. These feet are what they are, flat. But, keep in mind…… some genetics do render a competent flatter foot. Some of the strongest feet we have seen are on very low arched people / runners. So, flatter does not always mean weak, be careful. What you see is not necessarily what you get, even a rusted out Ford Pinto might have a Ferrari engine in it……. you just don’t know by looking, you have to test the competency of the foot (another example, look at Arnold Palmer’s golf swing, it isn’t the prettiest swing by any means…… but you probably wouldn’t bet a penny against him even these days, if you get our drift.)
As the abstract says. "Normally developing infants have a flexible flatfoot and gradually develop a normal arch during the first decade of life." The key word is NORMALLY. You must consider risk factors that may affect the foot in its overall development. The risk factors include ligamentous laxity, obesity, rotational deformities, tibial influence, pathological tibia varum, equinus, presence of an os tibiale externum, and tarsal coalitions.
Again, this is a nice follow up to our video from yesterday and brings home some additional good points to cogitate over. We knew we had a flexible flat foot with potential. Knowing what you are starting with it vital for your success in treating the problem, and vital in determining long term success.
We are, The Gait Guys ………. and even a bit geeky in neurodevelopmental physiology. (Yes, we have no life.)
Shawn and Ivo
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Abstract of the Journal Article……. the link to the article is at the top of the blog post if you wish to obtain the article for further study.
Here is their abstract:
"Flatfoot is one of the most common conditions seen in pediatric podiatry practice. There is no universally accepted definition for flatfoot. Flatfoot is a term used to describe a recognizable clinical deformity created by malalignment at several adjacent joints. Clinically, a flatfoot is one that has a low or absent longitudinal arch. Determining flexibility (physiologic) or rigidity (pathologic) is the first step in management. A flexible flat foot will have an arch that is present in open kinetic chain (off weight-bearing) and lost in closed kinetic chain (weight-bearing). A rigid flatfoot has loss of the longitudinal arch height in open and closed kinetic chain. According to Mosca, "The anatomic characteristics of a flatfoot are excessive eversion of the subtalar complex during weight-bearing with plantarflexion of the talus, plantarflexion of the calcaneus in relation to the tibia, a dorsiflexed and abducted navicular and a supinated forefoot.” Normally developing infants have a flexible flatfoot and gradually develop a normal arch during the first decade of life. When evaluating an infant for a pronated condition, the examiner must also consider other risk factors that may affect the foot in its overall development. These contributing factors will play a role in the development of a treatment plan. The risk factors include ligamentous laxity, obesity, rotational deformities, tibial influence, pathological tibia varum, equinus, presence of an os tibiale externum, and tarsal coalitions. The authors realize other less significant factors exist but are not as detrimental to the foot as the primary ones discussed in depth. The primary risk factors that affect the pronated foot have been outlined. The clinician should always examine for these conditions when presented with a child exhibiting pronatory changes. A thorough explanation to the parents as to the consequential effects of these risk factors and their effects on the pediatric pronated foot is paramount to providing an acceptable comprehensive treatment program. Children often are noncompliant with such treatments as stretching and orthotic maintenance. The support of the parents is crucial to maintaining an effective treatment program continued at home.“
