MANAGMENT OF RIGID FLAT FOOT IN CHILDREN An

Abstract

The human foot is a highly complex structure .It has two major functions to support the body in standing and progression to lever it forwards in walking, running and jumping. The human foot is normally arched, its medial border arches up between the heel and the ball of big toe forming a visible and obvious medial longitudinal arch. The bones that form the Medial longitudinal arch consist of calcaneus, talus, navicular the three cuneiform and their three metatarsal bones. The pillars of arch are the tuberosity of calcaneus posteriorly and the heads of the medial three metatarsal bone anteriorly. Bony factor do not play a significant role in maintaining the stability of this arch. Ligaments are important, but are unable to maintain the arch on their own. The most important structure is the flexor hallucis longus muscle. Plantar aponeurosis, Deltoid, plantar and talocalcaneal interosseous ligament together with the capsule of the talonavicular and naviculocuneiform joints play important role in maintaining the medial longitudinal arch. The posterior tibial muscle, flexor digitorum longus, and intrinsic muscles of the foot also help in supporting the arch. Loss of the medial longitudinal arch of foot results in pes planvoalgus. The term is used to describe a mixture of anatomical variations and pathological conditions. In children and adolescents the most common disorder seen in rigid flat foot include congenital vertical talus, tarsal coalition, accessory navicular bone, peroneal spastic flat foot without coalition and iatrogenic or posttraumatic flat foot. Congenital vertical talus is a severe type of pediatric rigid pes planovalgus, may occur as isolated defect but occur more commonly in association with other congenital anomalies. Vertical talus a condition that produces a rocker –bottom deformity of the foot. The term vertical talus should be reserved for feet with fixed equinus of the calcaneus and dorsal dislocation of the navicular on the talus. It has also been called congenital convex pes valgus. The diagnosis must be established as soon after birth as possible. Surgical treatment is often required, however casting before surgery may stretch the soft tissues and make skin closure easier. Some authors have recommended a two stage procedure but a single stage procedure is the most commonly utilized method.