Flatfoot, or pes planus, occurs when the arch on the inside of the foot is reduced or absent, causing the entire sole to contact the ground. While many children appear to have flat feet as their arches develop, congenital pes planus is a less common type present from birth, involving structural differences.
Understanding Congenital Pes Planus
Congenital pes planus involves a flattened arch present from birth in one or both feet. Unlike flexible flatfoot, which often resolves, congenital pes planus is rigid; the arch remains flat even when not bearing weight. This rigidity differentiates it from flexible flatfoot. The foot may also have a “rocker-bottom” appearance, where the middle bulges downward and the heel and toes curve upward.
Developmental Origins and Causes
Congenital pes planus results from developmental anomalies affecting foot bones and soft tissues, preventing proper arch formation during fetal development. One common cause is congenital vertical talus, where the talus bone is abnormally positioned, pointing downward and preventing normal alignment of other foot bones.
Another cause is tarsal coalition, where two or more bones in the midfoot or hindfoot fail to separate during development and remain fused. While often asymptomatic in early childhood, symptoms may appear later when these connections ossify and stiffen the foot. Genetic factors can also play a role, with some cases being familial or associated with broader genetic syndromes affecting muscle and nerve development.
Recognizing the Condition
Signs of congenital pes planus include a flat foot with little to no arch, even when the child is not standing. The foot may also have a “rocker-bottom” appearance, where the sole is convex. Children might experience issues with balance and coordination, or fatigue and pain in their feet, ankles, or legs after activity.
Healthcare professionals diagnose the condition through a physical examination, observing the foot’s shape, mobility, and movement during standing and walking. They assess the range of motion to differentiate between flexible and rigid flatfoot. Imaging tests, such as X-rays, are often used to identify underlying bone abnormalities like vertical talus or tarsal coalition.
Treatment and Management Strategies
Managing congenital pes planus depends on the condition’s severity and underlying cause. Initial approaches often involve non-surgical methods aimed at improving foot alignment and flexibility.
Serial casting, where casts are periodically changed, can gradually stretch tight tissues and realign the foot. This process, sometimes called “reverse Ponseti” casting, aims to improve forefoot-hindfoot alignment. Physical therapy is also a common component, incorporating exercises to strengthen foot muscles and improve flexibility. Orthotic devices, such as custom-made shoe inserts or ankle-foot orthoses, can provide support and help maintain proper foot position.
For more severe cases, or when conservative treatments do not achieve sufficient correction, surgical intervention may be considered. Surgery aims to restore normal anatomical relationships within the foot, particularly between the talus, navicular, and calcaneus bones. Procedures can include releasing tight tendons, such as the Achilles tendon, or surgically correcting bone abnormalities like a vertical talus or tarsal coalition. The goal of treatment is to create a functional, stable, and pain-free foot, improving gait and preventing long-term complications.
Differentiating Congenital from Flexible Flatfoot
Distinguishing congenital pes planus from flexible flatfoot is important because they differ in nature and management. Flexible flatfoot is common in infants and toddlers; an arch is visible when the foot is not bearing weight but flattens when standing. This type is usually asymptomatic and often resolves naturally as the child grows, typically by age 10.
In contrast, congenital pes planus is characterized by a rigid flatfoot, meaning the arch is absent regardless of whether the foot is bearing weight or at rest. This rigidity often indicates a structural abnormality, such as a vertical talus or tarsal coalition. Unlike flexible flatfoot, congenital pes planus usually requires medical intervention due to its fixed nature and potential for pain or functional limitations.