summary Flexible Pes Planovalgus, also known as Flexible Flatfoot, is a common idiopathic condition, caused by ligamentous laxity that presents with a decrease in the medial longitudinal arch, a valgus hindfoot and forefoot abduction with weight-bearing. Diagnosis can be made clinically with a foot that is flat with standing and reconstitutes with toe walking, hallux dorsiflexion, or foot hanging. Treatment is usually observation, and stretching with majority of cases resolving over time. Rarely, surgical management is indicated for patients with progressive deformities that do not resolve with nonoperative management. Epidemiology Incidence unknown in pediatric population 20% to 25% in adults Etiology Pathoanatomy generalized ligamentous laxity is common 25% are associated with gastrocnemius-soleus contracture Classification Hypermobile flexible pes planovalgus (most common) familial associated with generalized ligamentous laxity and lower extremity rotational problem usually bilateral associated with an accessory navicular correlation is controversial Flexible pes planovalgus with a tight heel cord Rigid flatfoot & tarsal coalition (least common) no correction of hindfoot valgus with toe standing due limited subtalar motion Presentation Symptoms usually asymptomatic in children may have arch pain or pretibial pain Physical exam inspection foot is only flat with standing and reconstitutes with toe walking, hallux dorsiflexion, or foot hanging valgus hindfoot deformity forefoot abduction motion normal and painless subtalar motion hindfoot valgus corrects to a varus position with toe standing evaluate for decreased dorsiflexion and tight heel cord Imaging Radiographs indications painful flexible flatfoot to rule out other mimicking conditions rigid flatfoot recommended views required weightbearing AP foot evaluate for talar head coverage and talocalcaneal angle weightbearing lateral foot evaluate Meary's angle weightbearing oblique foot rule out tarsal coalition optional plantar-flexed lateral of foot rules out vertical talus (where a line through the long axis of the talus passes below the first metatarsal axis) AP and lateral of the ankle if concerned that hindfoot valgus may actually be ankle valgus (associated with myelodysplasia) findings Meary's angle will be apex plantar angle subtended from a line drawn through axis of the talus and axis of 1st ray Differential Tarsal coalition Congenital vertical talus Accessory navicular Treatment Nonoperative observation, stretching, shoewear modification, orthotics indications asymptomatic patients, as it almost always resolves spontaneously counsel parents that arch will redevelop with age techniques athletic heels with soft arch support or stiff soles may be helpful for symptoms orthotics do not change natural history of disease UCBL heel cups may be indicated for symptomatic relief of advanced cases rigid material can lead to poor tolerance stretching for symptomatic patients with a tight heel cord Operative Achilles tendon or gastrocnemius fascia lengthening indications flexible flatfoot with a tight heelcord with painful symptoms refractory to stretching calcaneal lengthening osteotomy (with or without cuneiform osteotomy) indications continued refractory pain despite use of extensive conservative management rarely indicated technique calcaneal lengthening osteotomy (Evans) with or without a cuneiform osteotomy and peroneal tendon lengthening sliding calcaneal osteotomy corrects the hindfoot valgus plantar base closing wedge osteotomy of the first cuneiform corrects the supination deformity Prognosis Most of the time resolves spontaneously
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ10.13) The Evans lateral calcaneal lengthening osteotomy is the surgical procedure most appropriate for which pediatric foot deformity? QID: 3101 Type & Select Correct Answer 1 Talipes equinovarus 9% (236/2496) 2 Cavus foot 15% (373/2496) 3 Flexible pes planovalgus 70% (1756/2496) 4 Juvenile hallux valgus 1% (34/2496) 5 Kohler's disease 3% (84/2496) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ10.232) A 12-year-old boy has 2 years of right foot pain that prevent participation in athletic activities and is symptomatic with walking. He has attempted UCBL and custom made orthoses for 1 year with no relief of symptoms. His hindfoot is supple and he has full dorsiflexion. Clinical images of the foot are shown in Figures A and B. A lateral radiograph is shown in Figure C. A surgical plan to address the deformity would most appropriately include which of the following? QID: 3331 FIGURES: A B C Type & Select Correct Answer 1 Lateral calcaneal slide osteotomy 18% (490/2735) 2 Transfer of the peroneus longus to the peroneus brevis 6% (162/2735) 3 1st metatarsal dorsiflexion osteotomy 9% (241/2735) 4 Calcaneal neck lengthening osteotomy 53% (1458/2735) 5 Posterior tibial tendon transfer to dorsum of the foot 13% (358/2735) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (2) Podcasts (1) Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Foot & Ankle Surgery Midfoot Driven Atypical Flatfoot: Michael Clare, MD (CSFA #20, 2017) Pediatrics - Flexible Pes Planovalgus (Flexible Flatfoot) A 5/15/2017 464 views 4.8 (5) Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Foot & Ankle Surgery Flatfoot with Deltiod Insufficiency: Bruce Cohen, MD (CSFA #19, 2017) Pediatrics - Flexible Pes Planovalgus (Flexible Flatfoot) B 5/15/2017 485 views 4.2 (5) Pediatrics ⎪Flexible Pes Planovalgus (Flexible Flatfoot) Orthobullets Team Pediatrics - Flexible Pes Planovalgus (Flexible Flatfoot) Listen Now 14:0 min 4/18/2020 1061 plays 5.0 (2)