PHYSIOTHERAPY AND ORTHOTIC TREATMENT OF FLAT FOOT (PES PLANUS) IN CHILDREN

Abstract

From a kinesiological point of view, there are three main arches differentiated in the foot - two longitudinal (medial and lateral) and one transverse. They are the basis of the ability of the foot to absorb significant daily loads and any pathology associated with them has adverse effects on the functions of the ankle-foot complex. The formation of the arches of the foot is a process starting from early childhood (1-2 years) and lasting up to 8-9 years, with the most dynamic development observed between 4-7 years [1,2]. Due to its arched shape, the foot can combine the necessary stability and mobility, which is crucial for its function. In addition, the arches provide a static and dynamic balance in everyday life and in sports. Several factors have been identified as influencing static balance control, including additional stress and muscle fatigue [10]. The deformations of the arches, regardless of whether they are congenital or acquired, have a negative impact on the entire ankle-foot complex, which also affects the biomechanics of gait [4,6,7]. Flatfoot, or more specifically static flatfoot (Pes planus staticus), common in childhood, is one of the main causes of pronator (valgus) curvature of the foot [3,8]. This condition often proves to be an underestimated problem and its neglect can lead to unwanted changes in the musculoskeletal system [5,11]. Despite the significance of the problem and the many possibilities for measurement and classification of flat-valgus foot. There is a little information about the accompanying functional changes [6]. To prevent and correct this condition, measurements are made and kinesitherapy is performed, including orthotic treatment, which is most often expressed in the wearing of individual orthopedic insoles. Measurements establishing the presence of such pathology are performed from a standing or sitting position. In our study, the study of children was performed from a standing position, and for qualitative assessment of the available deformity we used different assessment scales such as Foot Posture Index (FPI-6) [9,10], test for position of Os naviculare (Navicular drop test, MLAA method) and measurement of 3D plantographs.
The combination of a precise kinesitherapy program and proper orthotic treatment is essential for the prevention and correction of deformities of the arches of the foot