Flat and flat-valgus deformed foot

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Gheorghe Burnei Simona Lacrimioara Gavrilescu Cosmin Gabriel Lală Ionut Daniel Raducan Cristian Burnei


Background Context: All the flat and flat valgus feet with evolutional potential or rigid, excepting the ones without evolutional potential entail static and predominantly dynamic discomfort in idle and locomotive state. A part of these children and teenagers have a hard time in dealing with the discomfort and many of them interrupt their training in athletic carriers due to the enhancement of the symptomatology as they grow older.

Purpose: In order to limit this impact encountered in many children in the ambient environment or in the children who intend to become athletes, the investigation and conceptualisation of the flat and flat valgus foot notions provide the chance of an accurate professional orientation and of a suitable diagnostic and treatment. A special group includes the children with severe forms of rigid flat and flat valgus from cerebral paralysis and arthrogryposis where the management has to ensure the possibility of walking stability and current independence.

Study design: Synthesis of a retrospective observational survey carried out during 45 years of activity.

Outcome measures: The long-term assessment of hundreds of patients with flat and flat valgus foot with evolutionist potential, the comparisons of the pre-operatory and post-operatory state of patients recommended for surgery and the evolution of these patients, professional orientation and their degree of satisfaction.

Methods: All the patients included in the assessment benefitted from differential treatment based on their symptomatology, the type of deformation and the character thereof, i.e. either flexible or rigid. We took into account the etiopathology, the age, the degree of development of the medial arch and the classification referred to in the text.

The majority of the patients, in a quite overwhelming percent, benefitted from a non-surgical treatment. The feet (with evolutionary potential) labelled at a certain point by the supporters of the non-treatment of such deformities as asymptomatic and free of risk where identified, after remote assessments, as non-diagnosed and/or neglected rigid flat feet.

Results: The periodic assessment allowed me to note that a series of feet have an evolutionary nature and only a very small number are free of such potential and did not present any symptomatology r other inconveniences even after the age of 60. A part of the rigid or rigid flat- valgus feet encountered in cerebral paralysis or arthrogryposis could not be corrected through the current surgical methods and we applied to the reconstruction of the plantar arch on splint calcaneus- metatarsal 1, initially at interventions and then per-primam.

Conclusions: The flat and flat-valgus foot is a complex deformity, the subject of long discussions, controversial and debatable. The evolutionary potential cannot be currently established based on standardised criteria.

The flat foot is a different entity from the flat valgus foot. The classification is based on clinical and evolutionary criteria.

The occurrence of the plantar disease is systematically assessed at children with flat and flat valgus foot, especially during the age of 1 to 10 years.

The neurosurgical treatment must be eclectic, simultaneous and long-term. The surgical treatment is recommended for symptomatic and rigid forms. It consists in the application of interventions according to the methods Mosca, Dwyer, Maxwell- Brancheau, Grice sau Gianini. The calcaneus metatarsian splint 1 provides security in the rigid cases, especially in cerebral paralysis and arthrogryposis.

Article Details

How to Cite
BURNEI, Gheorghe et al. Flat and flat-valgus deformed foot. Medical Research Archives, [S.l.], v. 8, n. 6, june 2020. ISSN 2375-1924. Available at: <https://journals.ke-i.org/mra/article/view/2162>. Date accessed: 15 july 2020. doi: https://doi.org/10.18103/mra.v8i6.2162.
Research Articles


1. Bonnel M, Bonnin F, Canovas M, Chamoun M, Bouysset. Anatomy of the foot and ankle. Bone and Joint Disorders of the Foot and Ankle. 1998; 1-14
2. Riga I Th. Practical Anatomy Vol. 1 Part 1. Live Anatomy: Skeleton; 1971: 529-82
3. Lowe W, Chaitow L. Orthopedic Massage (Second Edition), 2009; 6: 77-115
4. Carr JB, Yang S and Lather LA. Pediatric Pes Planus: A State-of-the-Art Review. Pediatrics. 2016; 137 (3): e20151230;
5. Mosca VS. Flexible flatfoot in children and adolescents. J Child Orthop. 2010;4(2):107– 21
6. Harris EJ, Vanore JV, Thomas JL, et al. Diagnosis and treatment of pediatric flatfoot. J Foot Ankle Surg. 2004;43(6):341–73
7. Stavlas P, Grivas TB, Michas C, Vasiliadis E and Polyzois V. The Evolution of Foot Morphology in Children Between 6 and 17 Years of Age: A Cross-Sectional Study Based on Footprints in a Mediterranean Population. The Journal of Foot and Ankle Surgery 2005 ; 44 (6) : 424-8
8. Pita-Fernández S, Cristina González-MartínC et al. Validity of Footprint Analysis to Determine Flatfoot Using Clinical Diagnosis as the Gold Standard in a Random Sample Aged 40 Years and Older. Journal of Epidemiology 2015; 25 (2) 148-54
9. Parvizi J, Gregory K. Kim GK and Associate Editor. High Yield Orthopaedics. Saunders/ Elsevier 2010; 88: 183-4
10. Morley AJ. Knock-knee in children. BMJ. 1957;2(5051):976–9
11. Staheli LT, Chew DE, Corbet M. The longitudinal arch. A survey of eight hundred and eighty-two feet in normal children and adults. J Bone Joint Surg Am. 1987;69(3):426–9
12. Edinger J, Fisher M. Atlas of Orthoses and Assistive Devices (Fifth Edition). Elsevier 2019; 30: 303-12
13. Agarwal A, Lalchandani R. Osteochondritis of Intermediate Cuneiform with Delayed Appearance Ossification Centre of Navicular Bone-A Rarity Article. The Journal of Foot and Ankle Surgery (Asia Pacific) 2018 ; 5(2):77-9
14. García-Mata S. Avascular necrosis of the intermediate cuneiform bone in a child: a very rare cause of limp in a child. A variant of the normality? Journal of Pediatric Orthopaedics B 2013 ; 22 : 255-8
15. Kose O, Demiralp B, Oto M, Sehirlioglu A. An unusual cause of foot pain in a child:osteochondrosis of the intermediate cuneiform. J Foot Ankle Surg 2009;48: 474-6.
16. Dowling AM, Steele JR, Baur LA (2001) Does obesity influence foot structure and plantar pressure paterns in prepubescent children? Int J Obes Relat Metab Disord. 2001; 25: 845– 52.
17. Mickle KJ, Steele JR, Munro BJ. The Feet of Overweight and Obese Young Children: Are They Flat or Fat?. Obesity 2012 ; 14 (11) : htps://doi.org/10.1038/ oby.2006.227
18. Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons. J Bone Joint Surg Br. 1995;77:254–7.
19. Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br. 1992;74:525–7
20. Gould N, Moreland M, Alvarez R, Trevino S, Fenwick J. Development of the child‟s arch. Foot Ankle. 1989;9:241–5
21. Wenger DR, Mauldin D, Speck G, Morgan D, Lieber RL. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am. 1989;71: 800–10
22. Jones BH,Thacker SB,Gilchrist J, Kimsey Jr. CD, Sosin D. Prevention of Lower Extremity Stress Fractures in Athletes and Soldiers: A Systematic Review. Epidemiologic Reviews. 2002 ; 24 (2): 228–47
23. Harris EJ. The Natural History and Pathophysiology of Flexible Flatfoot. Clinics in Podiatric Medicine and Surgery. 27 (1): 1–23
24. Harris EJ. The Natural History and Pathophysiology of Flexible Flatfoot. Clinics in Podiatric Medicine and Surgery. 27 (1): 1–23
25. Tudor A, Ruzic L,Sestan B, Sirola L, Prpić T. "Flat-Footedness Is Not a Disadvantage for Athletic Performance in Children Aged 11 to 15 Years" lPediatrics 2009 ; 123 (3): e386–e92
26. Hintermann B, Nigg BM. "Pronation in Runners: Implications for Injuries". Sports Medicine. 1998 ; 26 (3): 169–76.
27. Kraft D, Zippin J. Baxter's the Foot and Ankle in Sport (Second Edition), 2008; 23: 535- 46
28. Bleck EE, Berzins UJ. Conservative management of pes valgus with plantar flexed talus, flexible. Clin Orthop Relat Res. 1977;122:85–94
29. Bordelon RL. Correction of hypermobile flatfoot in children by molded insert. Foot Ankle. 1980;1(3):143-50
30. Bok SK, Kim BO, Lim JH, Ahn SY. Effects of custom-made rigid foot orthosis on pes planus in children over 6 years old. Ann Rehabil Med. 2014;38(3):369–75
31. Kosashvili Y, Fridman T, Backstein D, Safir O, Bar Ziv Y. The correlation between pes planus and anterior knee or intermitent low back pain. Foot Ankle Int. 2008 ; 29 (9) : 910–13 32.
32. Ruello O. “Walking and Running Shoe”. EC Orthopaedics 2016 ; 2 (6) : 206-17. Atik A and Ozyurek S. Flexible flatfoot. North Clin Istanb. 2014; 1(1): 57–64
33. Evans A. The Pocket Podiatry Guide: Pediatrics. Churchill Livingstone 2010; 6: 107-37
34. Pita-Fernández S, Gonzalesz-Martin C, Alonei-Tajes F, Seoane-Pillado T, Perthes-Diaz S, Perez-Garsia S, Seijo-Bestilleiro R and Balboua-Barreiro V. Flat Foot in a Random Population and its Impact on Quality of Life and Functionality. J Clin Diagn Res. 2017 ; 11(4): 22–7.
35. Brosky Jr. JA, Balazsy JE.Orthopaedic Physical Therapy Secrets (Third Edition), 2017; 75: 581-6
36. Shuyuan L, Mark S M. Excizion of a Middle Facet Tarsal Coalition. Jbjs Essential Surgical Techniques. 2020 ; 10 (1) : e0114
37. Li S, Myerson MS. Excision of a Middle Facet Tarsal Coalition. JBJS Essential Surgical Techniques. 2020 ; 10 (1) : e 01114
38. K.C. Chen, C.J. Yeh, Li-Chen Tung, J.F. Yang, S.F. Yang, C.H. Wang – Relevant factors influencing flatfoot in preschool-aged children. Eur J Pediatr 2011;170(7):931-6.
39. Cass AD, C.A. Camasta CA. Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning. 2010 J Foot Ankle Surg 2010;49(3):274-93

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