Pes Planus: Difference between revisions
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The medial longitudinal arch of the foot normally develops by the age of 5 or 6 as the fat pad in babies is gradually absorbed and balance improves as skilled movements are acquired. In some children however, the arch fails to develop which may be a result of tightness in the calf muscles, laxity in the Achilles tendon or poor core stability in other areas such as around the hips. <ref name="6">1. K.C. Chen, C.J. Yeh, Li-Chen Tung, J.F. Yang, S.F. Yang, C.H. Wang – Relevant factors influencing flatfoot in preschool-aged children - Springer – 2010 A2</ref>, <ref name="7">7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010 A1</ref> Over time it may lead to an altered walking pattern, clumsiness, limping after long walks, and pain in the foot, knees or hips. Beside the aforementioned causes for pes valgus, tarsal coalitions, peroneal spasm and vertical talus are common aetiologies during the childhood. It is therefore important that appropriate treatment starts at an early age. <ref name="8">3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010 A1</ref><br> | The medial longitudinal arch of the foot normally develops by the age of 5 or 6 as the fat pad in babies is gradually absorbed and balance improves as skilled movements are acquired. In some children however, the arch fails to develop which may be a result of tightness in the calf muscles, laxity in the Achilles tendon or poor core stability in other areas such as around the hips. <ref name="6">1. K.C. Chen, C.J. Yeh, Li-Chen Tung, J.F. Yang, S.F. Yang, C.H. Wang – Relevant factors influencing flatfoot in preschool-aged children - Springer – 2010 A2</ref>, <ref name="7">7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010 A1</ref> Over time it may lead to an altered walking pattern, clumsiness, limping after long walks, and pain in the foot, knees or hips. Beside the aforementioned causes for pes valgus, tarsal coalitions, peroneal spasm and vertical talus are common aetiologies during the childhood. It is therefore important that appropriate treatment starts at an early age. <ref name="8">3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010 A1</ref><br> | ||
== | == Classification == | ||
The classification of the pes valgus is based on three aspects. <br>• Arch height<ref>1. K.C. Chen, C.J. Yeh, Li-Chen Tung, J.F. Yang, S.F. Yang, C.H. Wang – Relevant factors influencing flatfoot in preschool-aged children - Springer – 2010 A2</ref>, <ref>5. H. Wetzenstein – The significance of congenital pes calcaneo-valgus in the origin of pes planovolgus in childhood – Orthopaedic department in Jönköping B</ref><br>The best parameter to characterize medial longitudinal arch structure was found to be a ratio of navicular height to foot length. It is accepted that the flatness of normal children’s feet and their age are inversely proportioned. <br>• Heel eversion angle <ref>3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010 A1</ref>, <ref>8. G.K. Rose, E.A. Welton, T. Marshall – The diagnosis of flat foot in the child – Britih Editorial Society of Bone and Joint Surgery – 1985 A2</ref><br>Heel eversion or hindfoot valgus is generally accepted as a normal finding in young, newly walking children and is expected to reduce with age. The eversion of the heel has been repeatedly used for determining the posture of the child’s foot. <br>Resting calcaneal stance position is a more recent method. It has guided clinicians in assessment of the child’s foot posture and calcaneal eversion has been suggested to reduce by a degree every 12 months to a vertical position by age 7 years. A vertical heel is optimal for foot function. The average rear foot angle for children from 6 to16 years is 4° (raging from 0 to 9° valgus).<br>• Whether the flat foot structure is rigid or flexible (cf. Jack’s test <ref>7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010 A1</ref>)<br>Rigid pes valgus, also called congenital pes planovalgus (convex) <ref>4. H. Wetzenstein – Pes plano-valgus in childhood – Orthopaedic department in Jönköping B</ref>, is often a result of tarsal coalition, which is typically characterized as a painful unilateral or bilateral deformity.<br>In flexible pas valgus, also called congenital pes cancaneovalgus <ref>5. H. Wetzenstein – The significance of congenital pes calcaneo-valgus in the origin of pes planovolgus in childhood – Orthopaedic department in Jönköping B</ref>, the foot lies against the lower leg, or can be extended without resistance until it impinges against the leg. In contrast to the congenital pes planovalgus, the foot can be restored to a normal position without great resistance. Plantar flexion is occasionally is reduced.<br><br><br> | |||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
Revision as of 22:21, 4 March 2012
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Search Strategy[edit | edit source]
1. SEARCH STRATEGY ARTICLES
Keywords:
- Pes valgus physiotherapy (10 results and 3 free full texts): Most successful search
- Pes valgus (75 results and 4 free full texts) (Elsevier Sciencedirect)
- Pes planovalgus (23 results and 2 free full texts) (ADB Vubis)
- Flatfeet children (2 results and 1 free full text) (Elsevier Sciencedirect)
Search engines : Pubmed / Web of knowledge
2. SEARCH STRATEGY BOOKS
Keywords:
• Examination peadiatric foot posture
Via Google Books: Clinical Pediatric Orthopedics
Introduction[edit | edit source]
This text describes pes valgus in children. It is a problem commonly encountered in pediatric orthopedics and is generally considered as caused by the collapse of the medial longitudinal arch in the foot. It was found that 42% of children between 3 and 6 years witch normal weight develop pes valgus. Age, gender, obesity, cerebral palsy, syndrome of Down, … are known risk factors for the development of growth and musculoskeletal changes. Almost 20% of the adult population has pes valgus.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Cause[edit | edit source]
The medial longitudinal arch of the foot normally develops by the age of 5 or 6 as the fat pad in babies is gradually absorbed and balance improves as skilled movements are acquired. In some children however, the arch fails to develop which may be a result of tightness in the calf muscles, laxity in the Achilles tendon or poor core stability in other areas such as around the hips. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Over time it may lead to an altered walking pattern, clumsiness, limping after long walks, and pain in the foot, knees or hips. Beside the aforementioned causes for pes valgus, tarsal coalitions, peroneal spasm and vertical talus are common aetiologies during the childhood. It is therefore important that appropriate treatment starts at an early age. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Classification [edit | edit source]
The classification of the pes valgus is based on three aspects.
• Arch height[1], [2]
The best parameter to characterize medial longitudinal arch structure was found to be a ratio of navicular height to foot length. It is accepted that the flatness of normal children’s feet and their age are inversely proportioned.
• Heel eversion angle [3], [4]
Heel eversion or hindfoot valgus is generally accepted as a normal finding in young, newly walking children and is expected to reduce with age. The eversion of the heel has been repeatedly used for determining the posture of the child’s foot.
Resting calcaneal stance position is a more recent method. It has guided clinicians in assessment of the child’s foot posture and calcaneal eversion has been suggested to reduce by a degree every 12 months to a vertical position by age 7 years. A vertical heel is optimal for foot function. The average rear foot angle for children from 6 to16 years is 4° (raging from 0 to 9° valgus).
• Whether the flat foot structure is rigid or flexible (cf. Jack’s test [5])
Rigid pes valgus, also called congenital pes planovalgus (convex) [6], is often a result of tarsal coalition, which is typically characterized as a painful unilateral or bilateral deformity.
In flexible pas valgus, also called congenital pes cancaneovalgus [7], the foot lies against the lower leg, or can be extended without resistance until it impinges against the leg. In contrast to the congenital pes planovalgus, the foot can be restored to a normal position without great resistance. Plantar flexion is occasionally is reduced.
Characteristics/Clinical Presentation[edit | edit source]
1. GENERAL SYMPTOMS
General symptoms that appear are (level of evidence D)iv,vii,viii :
• Pain that increases in severity when sitting or getting up from a chair
• Provoked pain over the tailbone
• Bruising or swelling in the tailbone area
• Bowel movements and straining are often painful
• There are no neurological signs
An important number of people suffer from long lasting pains over the coccyx following trauma (with or without fracture of the coccyx), better known as cocydynia.(level of evidence D)
2. CLINICAL PRESENTATION IN PATIENTS WITH SPINAL CORD INJURY
Patients with SCI, suffering from painful symptoms in the low back, gluteal, hip and thigh region, have coccyx fracture with a frequency of 34,6%. Patients who had coccyx fracture have higher pain scores when compared with those who don’t have any fracture, however the difference is only statistical significant regarding Sensory Pain Index (SPI) and total McGill scores.( level of evidence C)
Differential Diagnosis[edit | edit source]
Diagnostic Procedures[edit | edit source]
1. MEDICAL DIAGNOSIS
A plain radiography or MRI is necessary to confirm the diagnose of a coccyx fracture. (level of evidence D)
2. CLINICAL DIAGNOSIS
The diagnose is made after rectal examination. (level of evidence D)iv By passing the finger up the rectum and then pressing the bone backwards and forward, the unnatural degree of motion will then be felt. Related to the age and sex of the patient must be remembered that in the female this bone naturally possesses more motion than in the male, and that in youth a degree of motion, that does not exist at a later period of life, is present, allowing the ossification being less complete. However the free motion of the bone is taken as a symptom. (level of evidence D)
Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
[edit | edit source]
1. COCCYGEOPLASTY
By applying the novel techniques that are used in vertebroplasty and sacroplasty, coccygeoplasty is introduced as a new percutaneous treatment modality for fractures of the coccyx. This procedure can be helpful for patients with refractory pain resulting from a fracture of the coccyx and can be performed quickly and safely with high-resolution c-arm fluoroscopy. The coccygeal fracture treated with an injection of polymethylmethacrylate cement can provide early symptom relief. Although the promising results, an experience with a larger patient population is warranted. ( level of evidence C)
2. COCCYGECTOMY
Literature reports suggest that coccygectomy, partial or total removal of the coccyx, has been beneficial with success rates as high as 60-91%. However, coccygectomy is a more invasive procedure, with a common complication rate as high as 22%, and is usually associated with perineal contamination of the wound. Other complications could include persistent bleeding from the hemorrhoidal venous complex of the rectum. (level of evidence C)ix
Physical Therapy Management
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1. K.C. Chen, C.J. Yeh, Li-Chen Tung, J.F. Yang, S.F. Yang, C.H. Wang – Relevant factors influencing flatfoot in preschool-aged children - Springer – 2010 A2
- ↑ 5. H. Wetzenstein – The significance of congenital pes calcaneo-valgus in the origin of pes planovolgus in childhood – Orthopaedic department in Jönköping B
- ↑ 3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010 A1
- ↑ 8. G.K. Rose, E.A. Welton, T. Marshall – The diagnosis of flat foot in the child – Britih Editorial Society of Bone and Joint Surgery – 1985 A2
- ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010 A1
- ↑ 4. H. Wetzenstein – Pes plano-valgus in childhood – Orthopaedic department in Jönköping B
- ↑ 5. H. Wetzenstein – The significance of congenital pes calcaneo-valgus in the origin of pes planovolgus in childhood – Orthopaedic department in Jönköping B
MOORE K.L., DALLEY A.F., AGUR A.M.R., Clinically oriented anatomy: chapter 3: Pelvis and perineum, Wolters Kluwer health, sixth edition, 2010, pag. 451-452, level of evidence D
YU-TSAI T., LI-WEN T., CHENG-HSIU L., SHIH-WEI C., The influence of human coccyx in body weight shifting, medicine and science in sport and exercise, 2011, Volume 43, Number 5, pag. 494-496, level of evidence B
MOORE K.L., DALLEY A.F., AGUR A.M.R., Clinically oriented anatomy: chapter 3: Pelvis and perineum, Wolters Kluwer health, sixth edition, 2010, pag. 332, level of evidence D
HAARMAN H.J.Th.M., Klinische traumatologie, Elsevier gezondheidszorg, 2006, pag. 117, level of evidence D
MOORE K.L., DALLEY A.F., AGUR A.M.R., Clinically oriented anatomy: chapter 3: Pelvis and perineum, Wolters Kluwer health, sixth edition, 2010, pag. 461, level of evidence D
TEKIN L. et al., Coccyx fracture in patients with spinal cord injury, European journal of physical and rehabilitation medicine, March 2010, Volume 46, Number 1, pag. 43-46, level of evidence C
RAISSAKI M.T.,Fracture dislocation of the sacro-coccygeal joint: MRI evaluation, Pediatric radiology, March 1999, pag. 642-643, level of evidence D
LONSDALE E.F., A practical treatise on fractures, Walton and Mitchell printers, 1838, pag. 269-270, level of evidence D
MIYAMOTO K. et al., Exposure to pulsed low intensity ultrasound stimulates extracellular matrix metabolism of bovine intervertebral dosc cells cultured in alginate beads, Spine, November 2005, level of evidence B
EBNEZAR J., Essentials of orthopaedics for physiotherapist, Jaypee, 2003, pag. 174, level of evidence D
DEAN L.M. et al., Coccygeoplasty : treatment for fractures of the coccyx, J. Vasc. Interv. Radiol, 2006, pag. 909-912, level of evidence C
COOPER G., HERRERA J.E., Manual of musculoskeletal medicine, Wolters kluwer, Lippincott Williams & Wilkins, 2008, pag. 144, level of evidence D
