Suggested Orthoses

Suggested ORF Modifications

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Pes Planus or Flatfoot

ICD 10 - M21.4

There are two major forms of flatfoot:

• Adult Acquired Flatfoot: This cause of flatfoot is due to the dysfunction of the posterior tibial tendon. Go to that section of the pathology section to review this form of flatfoot.
• Flexible Flatfoot: This form of flatfoot originates in childhood due to the skipped development of the medial longitudinal arch past the age of 5. This condition is known to usually be bilateral and have the arch of the foot return to normal when not in weight-bearing. It’s possible that 20% of adults have flexible flatfoot, but that the condition goes unrecognized due to being asymptomatic.  

Symptoms:

• Pain of the heel, arch or ankle
• Tendency to roll the ankle
• Signs of shin splints due to poor shock absorption
• Toes drifting outward
• Heel rotates outward and the Achilles tendon run inward from the heel
• Lower back, hip and knee pain due to poor biomechanics

Diagnosis:

To diagnose a patient, a clinician will observe the patient’s past family medical history, perform a physical biomechanical examination and possibly order X-rays. It’s possible for flexible flatfoot to be otherwise asymptomatic.

Treatment:

Conservative treatment of flexible flatfoot consists of modifying physical activity, weight loss to decrease physical strain, wearing orthotics, NSAIDs, physical therapy and shoe modifications to allow for soft tissue strengthening and pain alleviation. When conservative treatment is insufficient to alleviate pain and increase functionality, surgery may be considered an option past childhood.

Sources:

https://www.foothealthfacts.org/conditions/flexible-flatfoot 
https://orthoinfo.aaos.org/en/diseases--conditions/flexible-flatfoot-in-children/ 
https://posna.org/Physician-Education/Study-Guide/Flat-Feet-(Acquired-Flexible-Flat-Feet)