Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

BAN Pes Planus

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Robertisaacs, Jul 6, 2011.


  1. Members do not see these Ads. Sign Up.
    Ok. I'm feeling pugnacious. Gonna play a little devils advocate.

    I move that we remove the term "pes planus" from our lexicon and consign it to the same dustbin as overpronation.

    Who's with me?:rolleyes:
  2. Going ban Pes cavus as well ?

    ps I think the terms Pes Planus and Pes Cavus are ok and should not be banned - while not a Diagnosis - as has been used it is a clearly recognized foot type.

    Same as a patient saying Ive got flat feet - Yep now now lets discuss the reason you have pain and we move on.
  3. Good man. Knew I could count on you :drinks

    Exactly the same. Only in Latin (or greek?)

    Here's the thing. I believe that for terminology to be useful, it has to give me specific information. Flat feet does not.

    If I write "pes planus" in my notes, and you come to read them, it could mean any one of the following:-

    Foot is unremarkable NWB but becomes flat on weight bearing.

    Foot is flat on WB but arch reforms in gait due to windlass

    Foot is flat on WB and remains so through gait.

    Forefoot is fixed inverted to the point that the foot is flat on or off WB

    Forefoot is "normal" nwb but forefoot inverts on wb to make the foot flat.

    Forefoot is stable in frontal plane but dorsiflexes on WB to make the foot flat in WB

    STJ and MTJ position are unremarkable but the arch is full of pudge (as in paeds)

    Stj and MTJ position are unremarkable but the arch is full of bone (as in Charcot)

    I've probably missed a few.

    Any one of these will show a foot which is flat on WB and I've seen all of them described as "pes planus" by colleagues in the past. Each of these will require different management. Each, potentially, have different causes and treatments.

    How can a term be useful to us if it could mean such a wide variety of things?

    Pes Cavus? Somewhat different kettle of fish. I can only thing of a very few "flavours" of Pes Cavus. If you tell me a patient has Pes cavus I have a pretty good idea what is in your mind. But hey, if you're hot to ban that one, I'll come along with you ;).

    Is "flat feet" (in whatever language) really that informative?
  4. No but it does start to build the picture.

    if we look at another a type of thing

    if I said I live under a roof - you may then start to ask questions ie house or flat - but you get the picture that I´m not homeless if you get what am I saying

    Fairly useless but not worth banning
  5. What better reason for banning something than it be useless?

    Indeed. and thats sort of my point. We're the experts right? If I paid £300 for a surveyor to assess my house I would not expect that report to start with "it has a roof". I'd expect them to tell me in detail what kind of roof it was.
  6. RobinP

    RobinP Well-Known Member

    Additionally, I would imagine that surveyors don't talk about just roofs. In order to communicate to another surveyor the structure of the roof, they will have certain terminology to distinguish between roofs.

    When speaking to the lay public, flat feet might be OK(although I try to explain it in any way but that). Doesn't mean that it is necessarily descriptive enough for us to use when communicating to each other.

    That being said, I can't think of a good alternative

    PS - can you really get a survey done for just £300?!
    Last edited: Jul 6, 2011
  7. No, only the basic.:eek: But they do tell you about your single truss red tile in mostly good condition with felt in need of renewal. ;)

    I tend to avoid the term with patients because of the undeservedly traumatic connotations in Paediatrics. I had a patient once ask me to put "flat feet" in a report she wanted me to write to get disability living allowance:bang:. Kid had no pain. With Pods for the reasons I outlined.

    For an alternative I suggest that if its a hypermobile foot which is structurally sound and corrects well with windlass but which is flat in static weight bearing we call it a hypermobile foot which is structurally sound and corrects well with windlass but which is flat in static weight bearing.
    A foot which is structurally flat due to a fixed structural invertus could be called A foot which is structurally flat due to a fixed structural invertus. Etc. That way when you read my notes or I describe a patient to you, you'll know more or less exactly what I mean.
  8. Robert:

    Can you, in two words or less, give us a set of words that better describes a foot with a low medial arch height than the terms "pes planus" or "flat foot"?
  9. Please define the term "hypermobile foot".
  10. Ian Linane

    Ian Linane Well-Known Member

    Was waiting for Kevin to pick that one up :)
  11. David Smith

    David Smith Well-Known Member


    Overall I have to agree with you, I for one never use the term 'pes planus' on it's own to describe any foot, its just a rubbish term. In my notes I always describe the foot type/action/ mechanical properties in some way that accurately and precisely describes what I observe.
    "Hello goodly podiatrist I think I have flat feet", "Oh sir you have Pes Planus and we have just the arch support to fix that for you, see it says pes planus on the box, I've got a degree you know so I understand such things".:D (Another thing I dislike is using people names to describe some diagnostic tests. Thompson's test, McMurray's test etc, but that's another gripe.)

    Now having said that I've just bought a Talar Made QuadraStep System with 6 different pre formed orthotic types that match a particular foot type. (OOHH! I can hear you groan from here :eek:) No wait! They have typical prescription values in their design, e.g. medial skives, lateral forefoot posting, 1st mpj c/o with 2-5 ext etc.

    While I think the foot typing protocol for treatment of pathological conditions with a mechanical aetiology is flawed, the reality is that many people will be suitable for a pre made orthotic with a prescription that is close enough to be effective and at a lower cost and faster turn round time. Plus the material they are made is pleasing and the high tec professional marketing presentation will, I think, make them very acceptable to the customer.

    Perhaps in the same way the loose terms like Pes planus and Pes cavus are useful in that they have a general meaning that can be expanded upon by the professional when greater understanding is required.

    Regards Dave
  12. Griff

    Griff Moderator

    I'm torn on this one. Whilst I share Rob's fondness of fighting the plight for the removal of anachronistic terminology, I'm not entirely convinced we can treat 'pes planus' in the manner with which we do terms such as 'overpronation'.

    Yes, it is not a diagnosis and should not be reported as such.

    Yes, it is just a description of an observation.

    No, its not terminology I'd necessarily use when talking to peers, or even patients.

    But, in a world (of biomechanics at least) in which we dissect everything we know (or think we know) to the smallest minutiae, there is a part of me that craves simplicity from time to time. And if someone says "pes planus" to me, I immediately picture a foot in my head; and I'll bet 9 times out of 10 it's pretty close to the foot they are describing. That is likely to be the same for all of us - whether we'd like to admit it or not. So as loose a term as it first appears to be, you can't deny it serves a purpose. [Sometimes we'll be really spoilt and they'll add the prefix 'flexible' or 'rigid' to further help us understand the morphology of the foot they are describing to us and how it may function dynamically].

    In summary, I personally don't have a problem with it.
  13. timharmey

    timharmey Active Member

    It is more specific than Mortons Neuroma. In terms of referrals received - those for a Pes Planus have actually got a Pes Planus of sorts, while those refered for Mortons Neuroma hardly ever do. It seems to be a GP term for any foot pain that does not involve the heel.
  14. Nope. Why am I limited to two words though? Brevity in terminology should not excuse lack of specificity. If there is ANYTHING I've learned from you, its that.

    Personally? A foot which scores 7< on the LLAS. But granted that terminology is also pretty poor. Gives you more information than pes planus though. Pes planus could be anything from absurdly floppy to completely fused.

    Why is pes planus acceptable and hypermobile not? Pes planus is an observation of gross morphology with no reference to the way in which that morphology is set, nor its correctability. Hypermobile as a description lacks specificity in terms of which joints, and agreed thresholds in terms of what constitutes normal range or quality of movement, but it gives an idea of the nature of the foot rather than simply the shape.
  15. efuller

    efuller MVP

    Pes planus, most would agree applies to arch height. As you mention hypermobile does not describe a specific joint. It may not even describe the foot. Sometimes hypermobile is used instead of flat, but it could be rigid in that flat shape. I would say that hypermobile is misused more than pes planus.

    Besides, I like using the greek because it makes me feel smarter than my patients.;)
  16. I find the term "pes planus" acceptable for a basic term describing the static medial longitudinal arch geometry of the foot. I find "pes cavus" also an acceptable term simply because it very nicely describes a medial longitudinal arch height which is static. Of course, using pes planus as a diagnosis is innapropriate and only describing medial longitudinal arch height, without also describing other important biomechanical factors of the foot in question would also not be appropriate.

    On the other hand, I find the term "hypermobility" or "hypermobile" to be unacceptable terms. Since "hypermobility" is a word meaning "excess motion" but is used to clinically describe the load vs deformation characteristics of a joint/joints within the body, the word has no meaning for the biomechanical characteristics it is being used to describe. Would you say that a bicycle frame, a golf club shaft or an automobile shock absorber is "hypermobile" when you are attempting to describe the ability of the bicycle frame, golf club or shock absorber to resist deformation upon externally applied loading forces?! I hope not. But, for some reasons, podiatrists are still using "hypermobility" or "hypermobile" to describe how easily a joint rotates under load, when in fact, the term they are using has no provision for the magnitude of applied load and only has a provision of "excess motion".

    Stiffness or compliance are the proper terms that should be used to describe the load-deformation characteristics of any joint of the foot and lower extrmity since they are more definable, precise, quantifiable and unambiguous terms that are standardly used within the international biomechanics community. "Hypermobility" has none of these qualities. "Hypermobility" and "hypermobile" does not have a good definition, is not mathematically quantifiable, is ambiguous and if any word needs to be banned within podiatry, "hypermobile" or "hypermobility" should be the first ones to go since their continued use by biomechanics professors and teachers is holding back the profession from truly understanding the biomechanics of the foot and lower extremity.
  17. CraigT

    CraigT Well-Known Member

    Is 'pes coitus' more acceptable a description of gross pes planus with recalcitrant related symptoms?
  18. F
    Ok. Is there an agreed definition? For eg, you said static, did you mean wb or non wb? And when you say lowered do you mean completely flat or lower. And if the latter, how low. If you tell me someone has pes planus, what can I deduce?
  19. David Smith

    David Smith Well-Known Member

    First it needs to be established that when we say pes planus we mean exactly that and there is no significant f/f abduction or compensated rearfoot varus (whatever that term is supposed to mean). Then we need a reference i.e. planus compared to what? The open chain non weight bearing compared to the weight bearing closed chain perhaps. So the pronating rearfoot is described as compensated i.e. due to w/b it becomes pronated (we assume a pronation compensation for some reason :eek: ) and so we could perhaps say compensated pes planus. Or we could say something like flexible pes cavus n/wb and pes planus w/b. At least these give some idea of the nature of change.

    Regards Dave Smith
  20. davidh

    davidh Podiatry Arena Veteran

    They have flat feet. Dependant of course on GRF;). They may not demonstrate Pes Planus if they stand on an uneven or soft surface.
    I quite like the term Pes Planus. I can write about it in reports, and in letters to Orthopods, and GPs and other health professionals, and I can be pretty confident everyone knows what it means. If I need to elaborate I can.

    Pes Pancakeus I'm not so sure about...........:eek:.
  21. David Smith

    David Smith Well-Known Member

    doubled up post cancelled
  22. Most clnicians would not assess the height of the medial longitudinal arch (MLA) of the foot while the foot is non-weightbearing so I believe, that for the majority of circumstances, when clinicians say that a "pes planus" is present, they mean that the MLA height is lower than normal during static weighbearing assessment of the foot.

    As you stated, the problem with the term "pes planus" is that it does not actually describe the absolute measured height of the MLA but rather describes a range of MLA heights from absolutely no MLA height to a threshold MLA height which is low enough for the clinician to determine that the foot has reached the MLA height that makes it a "pes planus".

    Of course, "pes planus" is not a precise term but is simply a general clinical term that describes a subset of MLA heights which will be present during static weightbearing clinical examination of the foot. That being said, the term "pes planus" is no less precise than saying that a patient has "genu valgum" , "genu recurvatum", "equinus", "hallux valgus", "hammertoe", or any of the other clinically descriptive terms that are meant to convey a general description of abnormalities of the lower extremity, and not a complete description of the mechanics of the foot. All of these terms will have a different threshold value for each clinician depending on their training, experience and what purpose they are using that term for.

    Therefore, should we ban the term "pes planus"? No. However, we should realize that, when used by itself to describe the biomechanics, function and overall three dimensional structure of the foot, it is too vague of a term to be used by itself to describe these complex mechanical processes.

    Now, Robert, your turn. Please define the terms "hypermobile", "fixed structural invertus", "flat" and "structurally flat" which you used within your proposed definition for pes planus deformity.

  23. efuller

    efuller MVP

    The observer thinks that there is a below average arch height in static stance. Now the observer might not know what the average is... However, that is pretty much what everyone else is saying when we admit it is a vague term.

  24. Since you made some interesting and strong points on this, perhaps it deserves its own thread?
    :edit: done it

    the full description I gave was
    thus, a forefoot which is inverted relative to the rearfoot to the point that a straight line can be drawn from the medial planter heel, under the nav and to the forefoot and cannot be everted. With a reasonable amount of effort. As Simon explained in portugal, almost any structure can acquire almost any range if you don't mind breaking a few bones.


    Flat. Having a horizontal surface without a slope, tilt, or curvature. Obviously within the bounds of soft tissue lumps and bumps when Non weight bearing.

    As above when no external forces (besides gravity) are acting on it. As opposed to compliant, becoming flat when placed on a flat surface.

    Wasn't really offering a proposed definition for pes planus. More descriptions of presentations which fit the general pes planus description.

    You know more clinicians than me so I'll take your word for for most of them think. But to me, a term describing the shape of the foot would make more sense non weight bearing. The shape of the foot on the ground is a position into which force can push the foot. But can we describe the shape or form of a flexible structure by the shape it adopts under certain specific forces? If my knee is capable of flexing you would not describe it as a flexed knee. If my spine is capable of bending you would not describe it as a curved spine. So why If my foot is capable of being flat, would it be described as a flat foot.

    And there's the rub. The threshold will vary depending on who's saying it. What is "average"? What is the threshold? Is this not a little like the "grades of hallux rigidus" debate? Can a foot which is not flat (has a "below average" arch on WB) be accurately described as flat?

    I am, as I said at the top, slightly playing devils advocate here. But I does strike me that if pes planus could mean anything from a foot which is rock solid fused flat on or off WB to a foot which returns to an "average" shape non weight bearing but conforms to whatever shape is placed on it (including flat clinic flooring), it is an exceedingly broad term indeed.

    A good point. How much of someone's daily life is spent standing still on a hard flat surface?
    I don't know, I'm rather taken with "pes Coitus"!
    Last edited: Jul 7, 2011
  25. Further to last.

    You said, of hypermobility that a term should be:- definable, precise, quantifiable and unambiguous. Can that standard be applied to pes planus?

    Pes planus has no globally agreed definition (unless someone knows better?).

    Its definitely not precise, if it could mean anything from rigid to... very low stiffness and from some arch to no arch and tells nothing about what movements at what joints are making the foot flat.

    I guess you could quantify it by arch height. I'll give it that.

    And I'd suggest for all the reasons above that it IS ambiguous.

    Can it be made to satisfy more than 1 of the 4?

Share This Page