Major causes of clinic visits for pediatric foot problems

• Absence  of the medial longitudinal arch of the baby foot especially while standing.
• Most of the time these flat feet are physiological and do not need any treatment, that is because fat pad is present underneath the medial longitudinal arch of child foot gives appearance of absence of medial arch, this fat bad resolves between the ages of 2 and 5 years.
• Flat foot can be flexible(correctable when asking the child to stand on his toes)or rigid (can’t be corrected while standing on toes).
• Usually there is no pain or complain from the child, just the parents notice the flat foot, but sometimes after walking  a long distance or playing there is pain on medial side of the foot or pain at the leg.
• Asymptomatic flatfeet patients may progress to symptomatic disease as ongoing degenerative processes turn flexible deformities into rigid ones.

Physiotherapy to strengthen leg and foot muscles and stretching calf muscle , anti-inflammatory medicine, insole and shoe modifications(medial arc..)and immobilizing in a cast for sever pain are the main treatment.

If the conservative treatment failed we go to some surgical solutions that will help the child with flat foot .

We have many surgical techniques starting with

1. Achilles tendon lengthening,
2. Calcaneal lengthening osteotomy(Evans)
3. Calcaneal sliding osteotomy
4. Medial cuneiform osteotomy(cotton osteotomy)
5. Stabilizing the subtalar joint with a new implants ,and finally triple arthrodesis of the hind foot joints