Orthopedics - Oleksa A.P. 2006

Congenital and Acquired Defects of the Lower Extremity
Orthopedic Deformities of the Foot
Flatfoot

Flatfoot (pes planus) can be congenital or acquired (static, post-rachitic, paralytic, and traumatic).

According to M. Kuslik (1960), congenital flatfoot occurs in 2.8% of newborns and manifests immediately after birth. Mass screening of children in Latvia (Berzdite E.I., 1972) as well as data from Bogdanov F.R. (1964), Godunov S.F. (1968), Tsyrkunova N.A. (1967), and others, reveal varying percentages of flatfoot ranging from 6.9% to 70% of cases.

Flatfoot is especially common in young children, reaching 81.2% of all examined cases (Boyarska V.P., Pavlova G.A., Lepekhina L.P., 1979; Yaralov-Yaralyants V.A., 1971; Smetana V., Vejvoda V., 1973).

Parents frequently consult physicians with toddlers who are just starting to walk, concerned about the presence of flat feet or flatfoot with a valgus deformity.

Today, this FOOT position in young children is explained in various ways, with its cause attributed to the archless Structure OF THE foot and the presence of pronounced fat pads on the soles that obscure the medial longitudinal arch (Aleksandrov N.G., 1953; Nedrigaylova O.V. and Yaremenko O.A., 1969).

Several authors (Bogdanov F.R., 1964; Mirzoyeva N.I., 1972; Niedereker K., 1959; Zsemaviczky J., Barz B., 1975) consider the cause to be weakness of the Muscle-Ligamentous apparatus of the foot, lower leg muscle imbalance, biomechanical features during gait acquisition, and improper footwear Selection. These authors' interpretation of the Etiology of flatfoot is well-founded, given that this type of flatfoot is absent at rest when the child bears no weight on the legs.

Diagnosing flatfoot is straightforward. Physical examination typically reveals pronounced degrees of flatfoot. When the patient stands and bears weight on the foot, the degree of flatfoot changes due to the contraction of Muscles that stabilize the foot.

When a patient is asked to show the soles of their feet, the pattern of weight-bearing can be observed from the thickening of the Skin's epidermis on the soles. More precise data can be obtained using lateral radiographs of the feet (Fig. 203) or plantograms (Fig. 204), which clearly show footprint impressions under weight-bearing conditions. The disadvantage of this method is the staining of the soles with a dye (2% brilliant green solution, Dutch soot, etc.) and less-than-sharp imprints on paper.

In 1926, M.O. Friedland proposed the iodometric method, which involves determining the percentage ratio of the foot arch height to its length. To calculate this, the distance from the arch (projected at the navicular bone) to the floor in millimeters is multiplied by 100 and divided by the foot length in millimeters. Normally, this index is 31–29. An index within 29–27 indicates a lowered arch, 27–25 indicates flatfoot, and below 25 indicates severely pronounced flatfoot.

In Ukraine, draft boards use the generally accepted definition of flatfoot based on lateral radiographs of the feet taken while the conscript alternately stands on one leg (Table 5).

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Fig. 203. Radiograph of flatfoot.

Fig. 204. Plantogram of the foot: a — normal, b — grade I flatfoot, c — grade II flatfoot (Godunov S.F.).

Table 5. Determination of the degree of flatfoot

Note: X-ray beams must be centered on the middle of the navicular bone.

Three lines are drawn on the radiograph: the first from the plantar surface of the first metatarsal HEAD to the plantar surface of the calcaneal tuberosity (line A-B in Fig. 205); the second from the junction of the horizontal line (A-B) with the calcaneal tuberosity to the inferior margin of the cuneonavicular joint (point B); and the third from the inferior margin of the cuneonavicular joint (point B) to the plantar surface of the first metatarsal head (point B). A perpendicular line is drawn from point B to line A-B, which indicates the height of the foot arch.

Acquired flatfoot (both static and rachitic) develops due to weakness of the ligamentous apparatus, the peroneals, and the tibialis posterior muscle, and occurs rarely. Traumatic flatfoot results from injuries to these muscles or their tendons, as well as bone fractures in the midtarsal region. Paralytic flatfoot occurs following poliomyelitis As a result of paralysis of the muscles that maintain the foot arches.