Paediatric flatfoot refers to a structural deformity that occurs in children, which involves the lack of a developed arch of the foot. This can further be classified as symptomatic or asymptomatic. In the latter, the child exhibits no symptoms.
Symptomatic flatfeet in children are characterised by pain or tenderness in the foot or leg. There may be an alteration in walking patterns, with a valgus heel and difficulty in wearing shoes. The child may also be perpetually tired; there is a lack of energy to participate in physical activities.
It is important to note that all children start out with little to no arch when they first start walking. As maturity sets in, the medial midfoot plantar fat pad in the foot starts receding leading to the development of a clearly identifiable medial longitudinal arch.
In some children, however, pathomechanical forces acting on the foot cause a host of compensatory movements which affect the child’s gait function. There is marked fatigue of the lower extremity and the child may constantly want to be carried.
Among some of the possible concurrent reasons for the abnormal functioning of feet in children is a genetic predisposition to develop the condition.
Biomechanical factors that could be contributing to the progression of flatfeet in children involve torsional problems in the transverse plane such as an adduction of the metatarsus or femoral and tibial torsion.
Excessive internal hip rotation, rearfoot and forefoot varus, limitations of dorsiflexion, equinus or pseudo torsion at the knee can also lead to acquired deformities of the foot.
A careful musculoskeletal assessment is required to spot anatomical compensations that signal the presence of an abnormal foot position.
The foot needs to be evaluated in both weightbearing and nonweightbearing positions.
Apart from a thorough gait analysis, the physical examination must include a detailed inspection of the areas of tenderness, severity of the deformity, range of motion, muscle strength and spasticity.
Any family history of foot deformities and medical conditions such as neurological disorders also need to be taken into consideration.
Based on the results of such a foot evaluation, an appropriate treatment modality can be constructed.
Supportive foot care devices provide early arthrokinematic care to children to prevent latent disability in adulthood. If not looked into at a young age, the loss of posterior tibialis function can trigger the development of a host of foot conditions as the child grows up.
By supporting the child’s foot in its optimal position, mechanical instabilities are treated at an early stage, whilst improving posture and balance. This also promotes proper growth and development.
Compensatory motions are eliminated and full functionality is restored to the medial arch height whilst maintaining the optimal structural integrity of the foot.
This encourages healthy supination and functional pronation throughout daily activities; it is essential to provide for the constant postural adjustments and readjustments the body undertakes on different terrain during the day.
There is also less expenditure of energy due to the optimal alignment of the muscles, tendons and ligaments; the child is able to engage in physical activities without the constant feeling of lethargy.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.