PES PLANUS (Flat foot)
This can be congenital (had the problem since childhood) or acquired, as well as being flexible or rigid. Patients do not have a normal foot arch; however, this is not always symptomatic. But it can cause other problems if it progresses, such as the toes of the foot turning in, middle of the foot slanting out, heel turning out and a
Flexible, symptomatic, types are associated with dysfunction of the posterior tibialis tendon – this goes through several stages depending on severity and treatment changes accordingly.
A rigid flat foot deformity in the adolescence and young adult population is suggestive of a pathological condition, such as a coalition (bones at the back of the foot joined together abnormally).
Investigations include plain radiographs as well as magnetic resonance imaging (MRI) scans to assess for coalitions, integrity
of the posterior tibialis tendon and assessment of joint surfaces.
In the early stages of acquired flat feet, symptoms can be managed with activity modification and shoe orthotics/insoles to protect the medial foot arch and posterior tibialis tendon.
As the condition progresses and if symptoms do not resolve with insoles/orthotics surgical intervention maybe required. If the posterior tibialis tendon remains intact but is inflamed, the tendon can be debrided (cleaned) to help settle symptoms. If the deformity remains flexible, a tendon transfer may be performed in combination with a calcaneal osteotomy (break in the heel bone and move it inwards).
In more severe cases, when the deformity is not flexible and there
is evidence of joint cartilage damage, a fusion type procedure
If the posterior tibialis tendon is simply debrided, your foot will be
in heavy bandaging and a walking boot will be applied before you go home. You will be provided with crutches for support, and you will be permitted to weight-bear in the boot. Elevation, as much as possible, is important in the first few weeks. This boot will be removed in 2 weeks’ time for a wound check and physiotherapy will be started.
In cases of tendon transfer and calcaneal osteotomy or fusion procedures, your leg will be placed in a below-knee cast for 2
weeks, at which stage a wound check will be performed and a complete below-knee cast applied for a further 4 weeks. For this initial 6 weeks no weight-bearing will be allowed, and crutches will
be supplied for support. Elevation, above the heart level, as much as possible, is important. After 6 weeks, a walking boot will be applied, and weight-bearing will be permitted in the boot for 6 weeks and physiotherapy instigated.
As with any surgery there are potential risks. This will be
discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection,
non-union, and prothesis loosening.