Flatfeet

Flat feet (also called pes planus or fallen arches) is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. An estimated 20–30% of the general population have an arch that simply never develops in one or both feet.Lateral X-ray of a flat foot with C-sign, which is a bony bridge between the talar dome and sustentaculum tali, in combination with a prominent inferior border of the sustentaculum tali. This represents a talocalcaneal coalition, which is an abnormal connection between the talus and calcaneus, and is thought to cause the flat foot deformity in this case.Dorsoplantar projectional radiograph of the foot showing the measurement of the talonavicular coverage angle.Weight-bearing lateral X-ray showing the measurement of calcaneal pitch, which is an angle of the calcaneus and the inferior aspect of the foot, with different sources giving different reference points. A calcaneal pitch of less than 17° or 18° indicates flat feet.Same lateral X-ray showing the measurement of Meary's angle, which is the angle between the long axis of the talus and first metatarsal bone. An angle greater than 4° convex downward is considered a flat foot, 15° - 30° moderate flat foot, and greater than 30° severe flat foot. Flat feet (also called pes planus or fallen arches) is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. An estimated 20–30% of the general population have an arch that simply never develops in one or both feet. There is a functional relationship between the structure of the arch of the foot and the biomechanics of the lower leg. The arch provides an elastic, springy connection between the forefoot and the hind foot so that a majority of the forces incurred during weight bearing of the foot can be dissipated before the force reaches the long bones of the leg and thigh. In pes planus, the head of the talus bone is displaced medially and distal from the navicular bone. As a result, the Plantar calcaneonavicular ligament (spring ligament) and the tendon of the tibialis posterior muscle are stretched, so much so that the individual with pes planus loses the function of the medial longitudinal arch (MLA). If the MLA is absent or nonfunctional in both the seated and standing positions, the individual has “rigid” flatfoot. If the MLA is present and functional while the individual is sitting or standing up on their toes, but this arch disappears when assuming a foot-flat stance, the individual has “supple” flatfoot. This latter condition is often treated with arch supports. However, a recent randomized controlled trial found no evidence for the efficacy of treatment of flat feet in children either from expensive prescribed orthotics (i.e., shoe inserts) or less expensive over-the-counter orthotics. Three studies (see citations below in Military performance section) of military recruits have shown no evidence of later increased injury, or foot problems, due to flat feet, in a population of people who reach military service age without prior foot problems. However, these studies cannot be used to judge possible future damage from this condition when diagnosed at younger ages. They also cannot be applied to persons whose flat feet are associated with foot symptoms, or certain symptoms in other parts of the body (such as the leg or back) possibly referable to the foot. Studies have shown children and adolescents with flat feet are a common occurrence. The human arch develops in infancy and early childhood as part of normal muscle, tendon, ligament and bone growth. Flat arches in children usually become high arches as the child progresses through adolescence and into adulthood. Children with flat feet are at a higher risk of developing knee, hip, and back pain. A recent randomized controlled trial found no evidence for the efficacy of treatment of flat feet in children either from expensive prescribed orthotics i.e (shoe inserts) or less expensive over-the-counter orthotics. As a symptom itself, flat feet usually accompany genetic musculoskeletal conditions such as dyspraxia, ligamentous laxity or hypermobility.