Article written by Dr. George Ionuț Maftei , Pediatric Orthopedic Specialist
One of the most common reasons why parents go to the pediatric orthopedist is to find out why the child has a vicious, unsightly gait, „stepping inward” and, on top of that, stumbling. Flat-toe valgus or flat-toe valgus (PPV) is often the cause of this series of symptoms.
Present in all children up to the age of 3, under the name of „fat foot” or „fat foot”, the appearance of a flat foot is given by the fat cushion present in the sole, which masks the plantar arch. This is not a true flat foot or at least we can’t diagnose it at this age as a flat foot. For the 2-3 year age segment, only a routine consultation with a pediatric orthopedist is recommended, the first orthopedic reassessment after birth which includes hip ultrasound .
Most preschoolers, especially girls, have an appearance of PPV caused by hyperlaxity, ie increased elasticity that is characteristic of age. In other words, most 4-7 year olds have a „normal” PPV. However, a visit to the pediatric orthopedist is recommended in order to have a starting point in following the evolution or to detect possible asymmetries. Asymmetry is the key word because an asymmetry between the lower limbs makes us suspect the presence of a condition.
When is flat-valgus foot treatment needed?
Schoolchildren and adolescents (8-14 years old) with this condition need orthopedic treatment.
About 25% or 1 in 4 of the PPV cases require orthopedic treatment and about 75% or 3 in 4 require it. PPV at this age is visible, including when the patient is wearing shoes, and sometimes even more visible, especially when the shoes are less new and have had time to erode, characteristically, on the inner edge.
If the patient came to the recommended regular consultations, respectively hip ultrasound, to the consultation from 2-3 years and to the one of 4-7 years, we will have access to very important information regarding the way and the rhythm in which the PPV evolved. That is, if it has improved, if it has been maintained, or if it has worsened with the development of the musculoskeletal system.
Treatment is recommended when:
- pain occurs, either due to the vicious position of the ankle or by the bruises that appear;
- difficult walking or difficult running leads to many falls;
- asymmetrical support leads to uneven weight loading;
- there is difficulty in wearing a certain type of footwear;
- last but not least, there is an aesthetic deficit or social stigma.
Arthroereisis surgery, a minimally invasive treatment method
Unfortunately, there are no studies that demonstrate the effectiveness of conservative treatment, through massage, gymnastics, certain exercises, etc.
Orthosis treatment, or the application of plantar supports or heels, can help in some cases. What we need to understand, however, is that we will have a partial, temporary correction, only when the patient is wearing shoes.
Surgical treatment is the only one that completely and permanently corrects, ensures the improvement of the patient’s quality of life, avoids joint degradation and the appearance of possible evolutionary sequelae.
Arthroereisis surgery is the most elegant and effective method of treatment. The intervention is minimally invasive . An incision of 1-2 cm is made and the screw that ensures the correction is inserted under radioscopic control. The screw is extra-articular and extra bony, so it does not block growth, joints, does not damage the bone and does not give pain, and the risk of bleeding is minimal. The entire surgical procedure takes an average of 30 minutes, and the risks are much lower.
Recovery is immediate . Most interventions do not require cast immobilization after and the gait can be resumed gradually, almost immediately. The scar is practically invisible at about 6-12 months.
In Arcadia, in regional exclusivity, arthroereisis surgery is performed, a method of minimally invasive treatment of the flat-valgus foot.