Pes planus

• Pes planus:

  • Flat foot
  • Relatively common foot deformity
  • Loss of medial longitudinal arch of the foot where in contact or nearly contacts the ground
  • Around 20% of adults have pes planus - most of whom lack physiological arch development probably due to ligamentous laxity
  • In the majority of cases their foot remains flexible and are asymptomatic
• Flexible = arch of foot normal when sitting or on tiptoes, but collapses when standing

  Rigid = arch of foot remains flattened despite foot position, can be indicative of a structural issue or misalignment
• In young ages can be caused by abnormal development:

  • Neurological problems e.g. cerebral palsy and polio
  • Bony abnormalities in the feet
  • Ligament laxity e.g. connective tissue disease
• In adults can be acquired due to:

  • OA
  • Inflammatory arthropathies - RA
  • Trauma
  • Diabetes causing neuropathic foot
  • Obesity
  • Poor footwear
• Management:

  • In adults if it has been present a long time, is flexible, bilateral and painless - does not require treatment
  • If symptomatic and/or inflexible may require treatment:

  1. Establish any underlying cause
  2. Conservative - modify activity, review footwear and consider orthotics, specific exercises, analgesia
  3. Surgery