Extensor deficiency as a cause of pediatric flatfoot

NewsBot · Feb 20, 2009

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Extensor deficiency: first cause of childhood flexible flat foot.
Vittore D, Patella V, Petrera M, Caizzi G, Ranieri M, Putignano P, Spinarelli A.
Orthopedics. 2009 Jan;32(1).

Childhood flexible flat foot is the most common paramorphism of the lower limb. The cause is not a bony malformation of the foot but a functional deficiency of the anatomic structures supporting the plantar arch. These structures, working as active tie rods (the tibialis anterior and posterior muscles) or passive factors of support (flexor hallucis longus and flexor digitorum longus muscles) act together to maintain the plantar arch. Their deficiency is responsible for childhood flexible flat foot, characterized by a flattening of the plantar arch and calcaneus pronation (heel valgus) and manifested in the characteristic "duck walking" in children. Hypothesizing poor extensor activity of the tibialis anterior, extensor digitorum longus, and extensor hallucis longus muscles during the heel contact phase of the gait cycle, we began a preliminary study to evaluate, through superficial electromyography (sEMG), the activation of muscle groups involved in the pathogenesis of childhood flexible flat foot, in particular the tibialis anterior and extensor hallucis longus muscles, to plan a rehabilitative program addressing the strengthening of insufficient muscles. The therapeutic program should also include the use of a medial elastic push orthosis. Data obtained by sEMG highlight a reduced activation of muscles related to the grade of flat foot, emphasizing the concept that a reduced activation of extensor muscles may be involved in determining flexible flat foot.
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NewsBot · Jan 18, 2022

Effect of Foot Orthoses in Children With Symptomatic Flexible Flatfoot Based on Ultrasonography of the Ankle Invertor and Evertor Muscles
Dong Joon Cho et al
Ann Rehabil Med. 2021 Dec;45(6):459-470.

Objective: To examine the changes in the cross-sectional area (CSA) ratio of the ankle invertors and evertors following rigid foot orthosis (RFO) application in children with symptomatic flexible flatfoot and to determine the correlation between the degree of change in CSA ratio and pain-severity after RFO application.

Methods: We included 24 children with symptomatic flexible flatfoot without comorbidities and measured the CSAs of tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) using ultrasonography, resting calcaneal stance position (RCSP) angle, calcaneal pitch (CP), Meary's angle, talonavicular coverage angle, and talocalcaneal angle using radiography, and foot function index (FFI) at baseline and 12 months after RFO application. We analyzed 48 data by measuring both feet of 24 children. The CSA ratios, the ratio of CSA of each muscle to the sum of CSA of TA, TP, and PL, were also compared. Correlations between the degree of change in FFI, each muscle's CSA ratio, RCSP angle, and radiographic measurements were investigated.

Results: Following RFO application, significant increase in the PL ratio and CP and significant decrease in the RCSP angle, FFI total, pain, and disability scores were observed. The degree of change in the total score, pain, and disability score of FFI were significantly correlated with the degree of change in the PL ratio and RCSP angle.

Conclusion: RFOs applied to children with symptomatic flexible flatfoot might reduce the compensatory activities of the ankle invertors, thereby increasing the PL ratio, and pain decreases as the PL ratio increases.
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