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Does Your Child Suffer from Flatfoot (Pes Planovalgus)?
Visit Dr Qureshi, pediatric Orthopedic Specialist, for treatments of pes planovalgus, commonly known as flatfoot, in chiildhood. Our expert care seeks to enhance the alignment of your child’s feet and ankles for increased comfort and mobility. Dr Assad carefully selects non operative treatment strategies as a first line before considering flatfoot surgery. Book an appointment now to give your child the best possible pediatric orthopedic care. At every stage of the treatment process, we put your child’s health and well-being first.
Flat feet are very common in the general population and usually cause no problems. They are seen in most infants and young children where it is very unusual to have any complaints other than their appearance. The arch usually develops during childhood so many parents just require re-assurance. According to Dr. Qureshi, Pediatric Orthopedic Surgeon UAE, there is no scientific evidence to support insole use to encourage the arch to develop faster or to a greater degree in healthy young infants.
Flat feet may become symptomatic in the teenage years as the calf muscles become tight during growth spurts and the child gets heavier. In most instances, a good insole/orthotic helps to augment the arch of the foot and make the heel straight making the foot more comfortable when walking long distances. Physiotherapy can also be of benefit to stretch out the calf muscles and make the foot more flexible and pain-free.
Surgery for symptomatic flat feet is best reserved for cases where non-operative treatment measures such as physiotherapy and orthotics have been exhausted despite an adequate course of treatment over extended follow-up.
There are many different surgical options available to correct symptomatic flat feet. Joint fusion surgery to eliminate movement in certain joints and keep the foot straight is usually reserved for severe cases with an underlying neurological cause. Subtalar implants involve a small operation to insert an implant that pushes apart the bones in the hindfoot to make the heel straight. They are a non-biological reconstruction and many questions remain unanswered as to who is the ideal patient for this procedure, when to remove the implant, and what happens to the foot after the implant is removed.
Dr. Qureshi prefers a personalized biological flat foot reconstruction technique, employing osteotomies and soft tissue rebalancing. Tailored to the patient’s unique deformity, the operation typically involves a thoughtfully chosen combination of the following surgical techniques:
- Calcaneal lengthening osteotomy: A procedure lengthening the heel bone, straightening the outer border of the foot. The bone division is carefully opened, achieving the desired correction, and supported with a bone graft typically sourced from the pelvis. The patient’s own bone is usually the best choice although commercially available bone grafts can be used.
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Case A: 15 year old with right flat foot showing calcaneal lengthening osteotomy
- Heel shift osteotomy: In severe cases where the heel points outwards, a calcaneal lengthening osteotomy alone may be insufficient so a separate osteotomy to realign the heel beneath the leg may be required.
- Medial cuneiform osteotomy: This osteotomy is used to augment the arch on the inner border of the foot
- Tibialis posterior advancement: The tibialis posterior tendon is responsible for pulling up the arch of the foot so this procedure tackles any slack by re-tensioning the tendon.
- Calf muscle complex lengthening: If there is significant tightness, lengthening of the involved muscles or the combined Achilles tendon may be included in the surgical plan.
Case A continued : 15 year old with right flat foot before and after surgery
Following surgery, the foot is placed into a cast for 6 weeks with partial weight bearing while the bones and soft tissues heal. At 6 weeks the patient is transitioned to a custom-made splint as weight bearing is introduced to help maintain the correction for a further 6 weeks.
Dr. Qureshi generally recommends considering flat foot reconstruction when the foot has completed the majority of its growth, typically during the teenage years. The concern with earlier surgery lies in potential changes in foot shape with growth. Dr. Qureshi often suggests operating on one foot at a time, allowing patients to assess outcomes before proceeding with surgery on the other foot, ensuring reasonable mobility throughout the treatment.
Certain conditions such as cerebral palsy and spina bifida among others may give rise to flat feet that demonstrate more severe deformity and stiffness early on in life and the treatment of these flatfeet depends on the underlying cause.
