Pes Planus
also Flatfoot differential dx

• a cause of 'flatfoot'
• familial

Features

• lax soft tissues of foot
• loss of arch
• pronation/eversion of forefoot
• valgus/lateral pointing heel,
• maybe secondary tightness of achilles tendon
• Usually painless; occasional discomfort after long walks or running
• weight bearing XR shows loss of nl longitudinal arch s osseous change
• With rigid flatfoot and no pain, consider congenital vertical talus in the differential

Exam:

• suspend the child, who on weight bearing has a flat foot, by sitting him on a chair or table
  • if the foot assumes a normal arch when suspended, this represents a supple or flexible flat foot and will not require treatment
  • If the suspended, non-weightbearingfoot does not assume a normal arch, then this child may require treatment and should be referred to Ortho.
• may also notice other joints are lax: thumb, elbow, knee
• Flexible flatfeet are occasionally seen with tight heel cords

Treatment: none; corrective shoes with arch supports are of no use unless sx of foot strain are present.

CHLA Board Review 2005