Flexible Pes Planovalgus. Early Physiotherapy

Introduction

Pes planovalgus (flat feet) is a common condition, in which the longitudinal arch of the foot is low or absent. The heels
are in valgus position (leaning outward). The ankle-bones are leaning inward and the front part of the foot is in
abduction. In children until 2 years old flat feet are normal. After that age, the arch develops gradually. When the
children stands on its toes and an arch is appeared, then the flat foot is called flexible, if not, its called rigid or painful.
The rigid cases need advanced orthopaedic care, while the flexible are expected to get improved until 6-7 years old.
But, we could never say which of these cases will remain the same or will worsen. The aim of this presentation is to
study the size of the problem among children between 3-6 y.o., the practice of the early physiotherapy on flexible pes
planovalgus and its effectiveness during 1 year follow up.

Methods

We did measurements in 93 children and found 45 with flat feet (48.3%). From 39 children aged 3-4 y.o., we found 27
cases with flat feet (69.2%) and from 54 aged 5-6 y.o., found 18 cases (33.3%). We divided all patients in 2 groups (A
& B), each with almost equal number, from 3-4 and 5-6 y.o. patients. Group A used as a standard group. We followed
up group B during 1 year, by practicing physiotherapy, strengthening muscles that preserve the foot arch (tibialis
posterior and anterior, fibularis longus and brevis, flexor hallucis longus and brevis, flexor digitorum longus and brevis,
and triceps surae). Stretching of the extensors and pronators muscles of the foot. The exercises took also the form of
game with the collaboration of the parents. It was recommended patients to be barefooted on the sand, grass and rough
ground. Special care was given on diet. We practiced also massage, hot baths and paraffin baths. In some excessive
cases foot orthotics and other shoe inserts were used, for small periods of time each day.

Results
The table below includes the results of both groups A and B.
Table. Study on patients from 3-6 years old with flexible flat feet during 1 year, separated in two groups. Group A (without any
physiotherapy) and group B (with physiotherapeutic intervention).
Discussion/ Conclusions
As shown, there is an expected improvement due to children growth in both groups. However, it’s clear that early
physiotherapy (on patients after 3 years old, right after the diagnosis "flexible flat feet" is given), helps to decrease
almost by half, these incidents, prevents further collapse and improves feet arches by strengthening the responsible
muscles.

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