Diagnosis of Pes Planus by X-Ray

Abstract

Because of numerous complaints relative to the feet, among the Armed Forces, it was decided at this Station to conduct a survey of foot cases. Letters from officers stationed overseas led us to the conclusion that many men were being shipped out with foot conditions which caused them to become incapacitated, either partially or wholly, thus imposing a burden upon their organization and also sharply reducing their own personal morale. Men with minor symptoms relative to the feet and no gross physical foot deformity have many times been declared fully qualified for overseas duty on the basis of their particular jobs—clerks, technicians, etc.—on the ground that their work would not entail much marching or other physical stress. Owing to unforeseen circumstances, however, soldiers have often had to resort to foot marches when it had been anticipated that their movements would always be motorized. This has caused many with apparently insignificant foot disorders to manifest symptoms, ranging from those of a minor nature to incapacitation. According to Ilfeld (1), approximately 50 per cent of those appearing before the CDD Board at the Station Hospital, Camp Callan, California, came because of orthopedic complaints, and of these one-third were foot complaints. Morton (2) has estimated the incidence of pes planus at as high as 40 per cent of the population. The great need of further information regarding the condition is indicated by this figure and by the known etiologic role of pes planus in the production of legache, backache, and arthritic involvement of the knees, hips, and spine. In view of the above considerations, it was deemed desirable to set up a simple x-ray technic for examination of the feet, both in repose and during weight bearing (Figs. 1 and 2), whereby the actual position of the plantar arch and its deviation from normal could be accurately deter-mined. Accordingly, a simple film holder was constructed for the weight-bearing examination, and pedograms (footprints) were taken in each case, both in repose and during weight bearing, for comparison with the films. To determine the role of tarsal pronation, a weight-bearing anteroposterior view of the foot was also taken by the double-exposure method (Figs. 3 and 4). In each instance a case history was obtained with special reference to antecedent trauma and to rickets and other bone disease. An attempt was made to obtain a normal standard, deviations from which would indicate either pes planus or a pre-pes-planus status. Before describing the actual method of measurement and presenting the results of our survey, a brief review of the salient features of pes planus seems pertinent. Etiologic factors in pes planus include heredity, static defects, infections, occupation, obesity, posture, and injury. Heredity plays an important role and, according to Lewin (3), the paternal parent is usually the one responsible.