pathology: flatfoot

yogabook / pathologie / flatfoot

flatfoot / kinked flatfoot / kinked flatfoot (pes planus/planovalgus)

Definition

The non-native form is caused by failure of the short foot muscles and subsequent overloading of the ligaments, which results in a sunken medial arch of the foot with valgus hindfoot and pronated(endorotated plantar flexed) talus, which can slip medially-ventrally over the calcaneus, extending to contact with the ground with pressure absorption even when loaded with body weight without kinetics (reduction of the longitudinal arch of the foot when walking). Some intrinsic foot muscles form the active part of the foot’s traction belt, which together with the passive muscles( plantar long ligament and plantar fascia) pull the unloaded foot back into the flexed form with longitudinal arch after loading, which was reduced under load. If these muscles become insufficient, the active part of the traction belt fails and strains the passive part beyond its capacity, which also causes it to fail and leads to flat feet and later flat feet.

A certain degree of flat-footedness as a result of the child’s knock-knees, which cause a bowed flat foot, is normal during childhood development, but must grow out; the longitudinal arch should develop between the 6th and 10th year of life. Flat feet usually occur together with bowed feet and also frequently lead to splayfoot. The acquired form is usually the result of a tibialis posterior dysfunction (PTTD).

A further distinction must be made between reducible and contractural forms. The contracture is no longer treatable conservatively. Muscle-induced kinked foot in children should not be taken lightly. The assumption that it „grows out“, especially if the children do enough sport, is incorrect and only applies up to the age of 6 years. On the contrary, a lot of sport can aggravate the disorder. The load on the foot during sport is often underestimated; a track and field athlete jumping 6 m puts a ton of weight on his foot when he lands. If this is done incorrectly, the disorder will continue to develop. In sport, the term hyperpronation is often used to trivialize the condition instead of kinked foot or kinked flat foot, which purports to describe a movement characteristic rather than a disorder. It is often associated with other deviations from the norm such as pronated midfoot, shortened Achilles tendon, abduction of the midfoot and forefoot. Flat feet are distinguished from fallen arches by the fact that in the former the longitudinal arch of the foot does not yet reach the ground.

The peak incidence of flat feet is between 40 and 50 in women. Differences:

  1. Congenital flat foot(pes planus congenitus): convex sole, concave dorsum, abducted forefoot, endorotated hindfoot, steep position of the talus (too low at the front, too high at the back), forefoot in dorsiflexion. Congenital flat feet occur rarely, but are usually rigid. A vertical talus is usually the cause.
  2. Acquired flat foot: muscular (especially the weakness of the posterior tibialis muscle, the tibialis posterior dysfunction syndrome, PTTP) and ligament insufficiency cause the longitudinal arch of the foot to sink in, the talus remains in a normal position, the heel in valgus position, talus normal; this changes the direction of pull of the Achilles tendon and promotes the progression of the flat foot. Obesity is a risk factor. A distinction is made between childhood, adolescent and adult flat feet. Distinguish between soft/reducible and contractured (often inflammatory) flat feet: continuous strain causes cartilage degeneration and arthritic irritation, the ligaments shorten and later the bones also deform. Obesity is a risk factor. In the case of contractured (inflammatory) flatfoot, the cartilage degeneration and arthritic irritation caused by constant stress shortens the ligaments and later also deforms the bones.
  3. Post-traumatic flat foot: e.g. after calcaneus fracture

The extent to which a non-contractual flatfoot has disease value and requires treatment and which therapy is helpful is still the subject of debate, as it usually does not cause any symptoms. It is also unclear whether a non-contractual childhood or adolescent flatfoot will cause symptoms in adulthood or under what circumstances. There should at least be agreement that a non-contractured, symptom-free childhood flatfoot should not be treated surgically. Surgical interventions are available for fixed juvenile flat feet that become symptomatic. However, if the flatfoot is contracted and painful, it must be treated surgically – usually with a triple arthrodesis.

Terminologically, a distinction is often made in the English-language literature between the infantile (non-contracted) pes calcaneovalgus and the later (non-contracted) pes planovalgus.

ICD M21.4 / Q66.8

Cause

– general

  1. congenital
  2. inflammable
  3. traumatic
  4. Calcaneus fracture

– Musculoskeletal system

  1. idiopathic weakness of the connective tract
  2. Dysfunction and weakness of various lower leg muscles, in particular: tibialis posterior dysfunction syndrome (PTTD)
  3. Presence of an Os tibiale externum

– Dispositional diseases

  1. Poliomyelitis epidemica (polio)
  2. rheumatic diseases
  3. Rickets
  4. neurological diseases

– Other factors

  1. inadequate footwear

Predisposing

  1. X-legs, O-legs
  2. Trisomy 21 (Down syndrome)
  3. Overweight
  4. familial disposition
  5. Lack of length of the Achilles tendon or contracture of the triceps surae
  6. Instability of the tarsometatarsal joint I

Symptoms

  1. from initially asymptomatic in the development of flat feet to severe pain in the foot and lower leg in the development of flat feet
  2. Hyperpronation
  3. Pressure sores, possibly pressure ulcers
  4. Painfulness on exertion, reduced walking distance
  5. restricted ROM in the OSG

Complications

  1. Hyperpronation-disposed disorders
  2. Various arthroses, e.g. in the hUSG or in proximal joints
  3. Consecutive pain and damage: in the knee or hip, back pain, calf pain

Therapy

  1. If necessary, insoles, barefoot walking, strengthening training of the foot and lower leg muscles, KG
  2. Avoid inappropriate footwear, especially shoes that are too small or have heels
  3. NO cortisone infiltrations on the tibialis posterior tendon
  4. Rare surgery, especially for severe disorders of the posterior tibialis (e.g. tendon rupture), correction of the calcaneus if necessary

Asana practice

Conservative treatment of flatfoot is only possible in non-contracted cases; congenital and acquired flatfoot that has become contracted must be treated surgically. If a tibialis posterior dysfunction is assumed to be the cause, the aim must be to intervene as early and successfully as possible before the attachment tendon elongates and makes it impossible for the muscle-tendon system to function adequately. To this end, training of the medial, supinating aspect of the rein system of the ankle is particularly important. In order to avoid creating a muscular imbalance, which is obvious because the range of motion in the supination direction is much greater than that in the pronation direction and an imbalance could not only strain the lateral knee joint but also increase the likelihood of supination trauma, the entire ligament system would generally be trained.

Another approach is to train the active part of the traction girdle of the longitudinal arch of the foot, i.e. the intrinsic toe flexors. To do this, contrary to the usual interpretations of the postures and the resulting instructions, the toes can be pressed to the floor in most standing postures. Firm pressure on the essentially stretched toes is sufficient; they do not have to bend visibly, as this would more easily lead to a cramp in these muscles anyway.

In addition to many types of foot gymnastics such as gripping movements with the toes, which of course also include flexion, and regularly worn insoles, training the plantar flexors (foot extensors) and dorsiflexors (dorsiflexors) is also a good idea, as improving this system can relieve the strain on the traction belt or an insufficiency can damage the traction belt. Furthermore, a shortened triceps surae or a shortened executing tendon, the Achilles tendon, can contribute to overloading the traction belt of the foot due to the plantar flexor moment exerted on the calcaneus. This must also be counteracted with stretching. Prolonged pointed foot postures should be avoided, such as those that easily occur with stomach sleepers or with back sleepers when they sleep under a heavy comforter. The same applies to sitting postures, where prolonged pointed-foot postures should also be avoided. People with meniscus problems in particular may tend to extend rather than flex their knee joints when sitting, and therefore tend to drop their foot into a marked plantar flexion due to muscle tension and gravity. For the same reason – and of course many others – wearing high heels is also contraindicated.

Asanas

Slightly less frequently/intensively too: