Flexible Flatfoot

GENESIS

Flexible flatfoot is common in children and influenced by age, weight, and gender. This deformity usually becomes evident with weight bearing and is often caused by ligamentous laxity; hence it is strongly associated with genetic connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome. When flexible flatfeet are part of such a broader pattern of connective tissue dysplasia, there is usually hyperextension of fingers, elbows, and knees with a positive family history because such disorders are often genetic. The prevalence of flexible flatfeet in 3-year-old children is 54%, whereas in 6-year-old children it is 24% and 15% in 10-year-olds. Overall in the 3–6-year age group, the prevalence is 44% (52% in boys and 36% in girls), with pathologic flatfoot present in less than 1%. Overweight boys have a 55.6% prevalence of flatfeet. Children with flexible flatfeet are generally asymptomatic as adults, and the development of the arch occurs with growth and is not related to the use of external supports or shoes. There is a higher prevalence of flatfeet in children who wear shoes versus those who wear no shoes at all, and closed-toe shoes inhibit development of the arch more than do slippers and sandals. The support of the longitudinal arch is primarily ligamentous, with muscle supporting and stabilizing the arch during heavy loading.