Pes Planus

Question 1

What is pes planus?

Answer 1

Flatfoot - lower than normal medial arch

Question 2

How do you classify pes planus?

Answer 2

Classified as either rigid or flexible

Sub divided into congential or acquired

Question 3

What are causes of rigid congential pes planus?

Answer 3

Tarsal coalition - peroneal spastic flatfoot

Congenital convex pes valgus (talus lies between the calcaneus and navicular

Question 4

What are causes of rigid acquired pes planus?

Answer 4

Arthritis 
Trauma
Rocker bottom foot 
Spastic flat foot 
Neurological conditions

Question 5

What are causes of flexible congential pes planus?

*CCCHATTFELLS

Answer 5

Compensated FFVR
Hypermobile flatfoot with short achilles tendon 
Torsional flatfoot 
Adducted flatfoot 
Ligamentous laxity 
Accessory navicular 
Cerebral palsy 
Marfans Syndrome, Downs syndrome, Ehlers Danlos fragile
Flexible FFVL, compensated RFVR 
Short 1st met 
Compensation for transverse plane deformity 
LLD, obestiy, genu VL/VR

Question 6

What are causes of flexible acquired pes planus?

Answer 6

Tendon failure 
Arthritis 
Trauma 
Neuromuscular disease 
Spasticity 
Myelodysplasia

Question 7

What is a tarsal coalition? What are the three types?

Answer 7

Congential union between 2 or more tarsal bones

Fibrous, cartilaginous or osseous

Question 8

What is peroneal spastic flatfoot?

Answer 8

Painful rigid flatfoot due to tonic spasms of peroneals (always in contraction)

Question 9

What is the most common coalition?

Answer 9

Calcaneo-navicular
Talo-calcaneal
Often present in 2nd decade as ossifying

Question 10

How does a talocalcaneal coalition appear on a radiograph? What view should be used?

Answer 10

Lateral view: shows a C shape or halo sign

Harris & Beath projection may be useful

Question 11

What are clinical features of TC in children?

Answer 11

Joint stiffness
Muscle spasm
Altered foot shape
Protective gait

Question 12

What are clinical features of TC in adolescents?

Answer 12

Symptomatic 
Local tenderness
Decreased or absent RF ROM 
Muscle spasm 
Some degree of rigid flatfoot

Question 13

What are treatments for TC?

Answer 13

Footwear modifications 
Orthotic therapy 
NSAIDs
LA injection 
Cast immobilisation 
Surgery:
- resection of the coalition 
Osteotomy
Arthrodesis

Question 14

What is Charcot-neuropathy?

Answer 14

Rocker bottom foot 
Commonly associated with diabetes
Minimal pain 
Rapid progression 
Very destructive

Question 15

What is treatment for Charcot-neuropathy?

Answer 15

Immobilisation: total contact casting
Reconstructive surgery
Accommodate the deformity

Question 16

What are possible causes of peroneal spastic flatfoot?

Answer 16

Tarsal coalition (most common) 
Juvenile chronic arthritis
Osteochondral fractures
Neoplasms 
Idiopathic

Question 17

What are features of peroneal spastic flatfoot?

Answer 17

Peroneal muscle spasm
Decreased STJ and ankle joint ROM
Valgus appearance of the foot
Pain: protective limitation of motion by extrinsic muscles

Question 18

What happens to gait with peroneal spastic flatfoot?

Answer 18

Antalgic
Apropulsive
External rotation of foot/leg

Question 19

What is treatment of peroneal spastic flatfoot?

Answer 19

Treat the cause 
Treat the symptoms:
- modify activity 
- NSAIDs
- Footwear modifications 
- Orthotic therapy
- Immobilisation 
- Common peroneal nerve blocks 
- Surgery

Question 20

What is a skewfoot?

Answer 20

Forefoot adductus and rearfoot valgus
RF: adducted
Midfoot: abducted
FF: adducted

Question 21

What are 4 types of skewfoot?

Answer 21

Congenital idiopathic
Congential associated with syndromes
Neurogenic (cause/arise in nervous system)
Iatrogenic (illness caused by medical examination)