Analysis of ankle alignment abnormalities as a risk factor for pediatric flexible flat foot

Majority of paediatric flat feet are flexible and asymptomatic; less than 0.1% of all flat feet are rigid. If these can be diagnosed and managed early, then various complications can be prevented and they will remain asymptomatic. This study was conducted to analyse the ankle rotational malalignments in the natural course of flexible flat foot in children. Seventy-six patients of flexible flat foot and one hundred controls were included in this study. The height of foot arches was judged clinically by inspecting the height of the medial arch and by measuring the arch index on weight-bearing podograms. Tibial torsion and bimalleolar angle were assessed in all subjects. Tibial torsion was assessed in the first twenty subjects (ten cases and ten controls) both by clinical methods (foot-thigh angle) and CT. As no statistical difference in the two methods was observed, tibial torsion was measured by clinical methods only in the remaining subjects. Bimalleolar angle was measured on weight-bearing podograms in all subjects. For a minimum of two years, cases were followed up regularly with a standard conservative protocol and the height of the arches observed. Majority of cases of flexible flat foot were found to have increased tibial torsion and increased foot-bimalleolar angle (high talar spin). The severity of collapse of the medial arch and the response to conservative treatment was found to correlate with these rotational mal-alignments of the ankle. Ankle rotational mal-alignments were seen to make these flexible flat foot deformities more complex and less responsive to conservative treatment. KEY WORDS: Flat foot; Pediatric flat feet; Flexible flat feet