Abstract
Flexible flatfoot is a normal foot shape that is present in most infants and many adults. The arch elevates spontaneously in most children during the first decade of life. There is no evidence that a longitudinal arch can be created in a child's foot by any external forces or devices. Flexible flatfoot with a short Achilles tendon, in contrast to simple flexible flatfoot, is known to cause pain and disability in some adolescents and adults. Joint-preserving, deformity-correcting surgery is indicated in flexible flatfeet with short Achilles tendons when conservative measurements fail to relieve pain under the head of the plantar flexed talus or in the sinus tarsi area. Osteotomy is the fundamental and central procedure of choice. In almost all cases, Achilles tendon lengthening is required. In some cases, rigid supination deformity of the forefoot is present, requiring identification and concurrent treatment.
Highlights
There are very few foot conditions that remain as poorly understood as the congenital flexible flatfoot, primarily because of the large volume of conflicting and poorly conducted research studies that have been carried out over many decades
Duchenne [16] and others [17,18,19,20,21] believed that coordinated and normal function of the muscles of the foot and ankle was responsible for the maintenance of the longitudinal arch and that sub-clinical muscle weakness was responsible for the flexible flatfoot. This theory was refuted by Basmajian et al, whose electromyographic studies of the muscles of the foot and ankle [22, 23] showed that the height of the longitudinal arch is determined by features of the bone–ligament complex, and that the muscles maintain balance, accommodate the foot to uneven terrain, protect the ligaments from unusual stresses, and propel the body forward
One should differentiate contracture of the gastrocnemius from contracture of the entire triceps surae, because both can cause pain that justifies surgical management, but the surgical technique obviously varies between them. In contrast to these two types of flexible flatfoot is the rigid flatfoot, which was defined by Harris and Beath [1, 15] as being characterized by the restriction of subtalar joint motion
Summary
The true incidence of flatfoot is unknown, primarily because there is no consensual agreement on the strict clinical or radiographic criteria for defining a flatfoot. Duchenne [16] and others [17,18,19,20,21] believed that coordinated and normal function of the muscles of the foot and ankle was responsible for the maintenance of the longitudinal arch and that sub-clinical muscle weakness was responsible for the flexible flatfoot This theory was refuted by Basmajian et al, whose electromyographic studies of the muscles of the foot and ankle [22, 23] showed that the height of the longitudinal arch is determined by features of the bone–ligament complex, and that the muscles maintain balance, accommodate the foot to uneven terrain, protect the ligaments from unusual stresses, and propel the body forward. The term ‘‘flatfoot’’ encompasses all of these multi-site threedimensional deformities and is, a better choice of term
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