From the Guidelines
Pes planus (flat feet) with subtalar joint eversion in a 9-year-old typically requires conservative management rather than immediate intervention. I recommend starting with supportive footwear featuring a firm heel counter and good arch support, combined with custom or over-the-counter orthotic inserts to help correct the foot alignment, as suggested by 1 and 1. Physical therapy focusing on strengthening the tibialis posterior, intrinsic foot muscles, and ankle stabilizers should be implemented 2-3 times weekly for 6-8 weeks. Daily home exercises including toe curls, heel raises, and arch doming exercises performed 10-15 repetitions, 2-3 sets daily will help improve foot mechanics. Some key points to consider in management include:
- Most pediatric flat feet are flexible and asymptomatic, representing a normal developmental variant that often improves with age as the medial longitudinal arch develops 1.
- Persistent pain, activity limitations, or abnormal wear patterns on shoes warrant further evaluation.
- Severe cases unresponsive to conservative measures after 6-12 months may require referral to a pediatric orthopedist, as outlined in 1.
- Weight management is also important if the child is overweight, as excess weight increases stress on the feet.
- Regular monitoring every 6 months is recommended to assess progression and response to treatment until skeletal maturity.
From the Research
Pes Planus in Children
- Pes planus, also known as flatfoot, is a common condition in children, affecting up to 14% of children 2.
- It is characterized by a reduction or absence of the medial longitudinal arch (MLA) of the foot, with or without additional deformities of the foot and ankle 2.
Subtalar Joint Eversion
- Subtalar joint eversion is a component of pes planus, and can be classified into different subtypes based on the morphology of the os calcis subtalar joint (OCST) 3.
- A study using weightbearing computed tomography (WBCT) and distance mapping (DM) found that the OCST morphology can be classified into four subtypes: type A, type B, type C, and type D, with types B and D being more prevalent in children with symptomatic pes planus 3.
Assessment and Management
- The assessment and management of symptomatic pes planus in children can vary between healthcare professionals, with different techniques and treatment options being used 4.
- A study found that orthoses were commonly used as a treatment option, but there were inconsistencies in how healthcare professionals assessed and managed children with foot symptoms 4.
- Another study outlined a method for pediatric pes planus assessment and management, involving a multidisciplinary approach with GPs, rehabilitation physicians, orthopaedic surgeons, physiotherapists, orthotists, and podiatrists 2.