Pes Planus Flat Foot

Imaging - Please include an up to date X ray with weight bearing views report within or attached to the referral.  This includes for soft tissue injuries to exclude underlying pathology.  .

Referrals without up to date reports included and Xrays that are not weight bearing will be returned, unless there are mitigating circumstances why this is not possible

Loss of medial longitudinal arch of the foot. Can be flexible or fixed. Developmental, congenital or acquired.

Pes planus can be part of normal development. Most children spontaneously develop a strong normal arch by about 10 years.

Abnormal development/reduction in arch strength of the foot may be due to:

·         Neurological problems eg cerebral palsy

·         Bone abnormalities eg accessory navicular bone, tarsal coalition

·         Ligamentous laxity eg. Familial, Down’s and Ehlers-Danlos syndrome

·         Dysfunction of the tibialis posterior tendon- age related degeneration

·         Neuropathic foot eg. Diabetes

·         Age related degenerative changes or foot and ankle joints eg. RA and OA.

·         Obesity and Pregnancy causing increased load

·         Inappropriate footwear

 

Acquired Adult Flatfoot deformity (AFFD)

Symptoms: Increasing medial ankle and arch pain on activity. In severe deformity lateral pain due to fibular impingement can be seen. Change in foot shape.

Assessment: Establish whether foot is flexible by asking the patient to stand on tiptoe. Weight bearing radiographs of the foot and ankle are useful.

Prognosis: As condition progresses painful arthritis may develop with increasing stiffness and rest and night pain. Mobility becomes significantly affected and the foot shape is not correctable.

Conservative Management:

·         Activity modification

·         Orthotics and footwear adjustments (Referral to Podiatry)

·         Bracing/splints

·         Physiotherapy

·         Appropriate analgesia.

·         Image guided/targeted injections may be used

·         Weight loss

REFERRAL:

Red Flags:

·         History of diabetes or trauma, red hot or swollen foot – acute review to exclude Charcot foot. See Diabetic foot check & referral pathway

·         A new onset of flatfoot deformity following recent trauma requires urgent review in fracture clinic

Urgent Referral:

·         Deteriorating foot shape

Routine Referral:

·         MARKEDLY symptomatic or RIGID flat foot

·         Significant rest or night pain  

·         Significant functional impairment *

·         MINIMALLY symptomatic and FLEXIBLE flat foot not responding to conservative treatment >6 months.

 

(If the patient can go up onto tip toe unaided and the foot is flexible when assessed on the couch, most patients will get significant relief from referral to MSK podiatry and orthotic management.)

*Significant functional impairment is defined as a restriction or interference with an individual’s capacity to meet personal, social or occupational demands.  Please state the impairment of the individual is experiencing

 

REFERENCES:

BOFAS Evidence Based Commissioning guidelines: https://www.boa.ac.uk/wp-content/uploads/2016/11/flatfoot-pathway-2-2.pdf

 

 

Date reviewed                     25/06/2019

Next review due                  25/06/2020

Sifter name                          Dr Rebecca Hopkins

 

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