Pes Planovalgus (flat feet)

Definition / Symptoms

Pes planus is the loss of the medial longitudinal arch of the foot. Infants typically have a minimal arch, however by the age of 10, children should have developed an anatomical arch structure. Abnormal development may be symptomatic of a medical condition – such as Cerebral Palsy – or simply an inherited condition.

Excessive foot pronation, which usually occurs with flat feet, can have a knock-on effect, contributing to foot pain and foot problems such as tibialis posterior dysfunction, hallux valgus (bunion), metatarsalgia (pain in the ball of your foot) and plantar fasciitis (policeman’s heel). It can also contribute to developing tightness in the calf muscles which can lead to gait deviations and medical conditions, such as Sever's disease.

Orthotic Treatments

We will assess your child's complete lower limb alignment and general posture.

If appropriate, bespoke foot orthotics may be prescribed to ease pain and to ensure that other symptoms do not develop because of your child's flat feet. We will design the orthotics and provide advice with the objective of helping your child to grow in correct alignment, therefore reducing future orthopaedic problems.

OSKAR Clinic

In recognition of this, we have set up a specialist clinic within LOC called OSKAR. This stands for the Optimal Kinematic Alignment approach to Rehabilitation and is an orthotic method of treating children with lower limb neurological conditions. It was originally developed by Elaine Owen MBE MSc SRP MCSP, a world-renowned physiotherapist.

In the OSKAR clinic, we dedicate even more time to the initial consultation and utilise our video vector Gait Lab facility. This gives us highly accurate information about the forces that are exerted on a body during the gait cycle. It allows us to prescribe and fit more accurate and objectively measured orthotics.

FAQs:

An AFO is an Ankle Foot Orthosis which as the name would suggest encompasses the ankle and foot. The objective is to control the position and movement of the ankle. AFOs are used to support weak limbs; they can also be used to immobilise the ankle and lower leg to correct foot drop. When set up correctly they can also have a great influence on the knee and hip joints. They are the most commonly used Orthoses.

The length of time that one needs to wear an AFO very much depends on the condition being treated. If it is a long-term condition like cerebral palsy or post-polio syndrome it is likely to be years as the condition cannot be cured. Your orthotist will advise you.

A patient’s comfort in their AFO is vital for compliance with the prescribed wearing regime.

So there are a number of steps the orthotist should take to ensure a comfortable fit: the patient’s heel should fit fully into the heel cup without excess space, the contours of the plantar surface of the AFO should match the patient’s foot, for children there needs to be up to half an inch growth room in the toe shelf length. At LOC we use our Gait Laboratories at our Kingston and Manchester clinics to fine-tune our bespoke orthotics.

A GRAFO is used to control instabilities in the lower limb by maintaining proper alignment of limbs and controlling their motion. It reaches around to the front of the knee extending down to the ankle. It works by altering a patient’s limb presentation to displace load and impact as well as offering further control to the knee.

The cost of an AFO is dependent on the type of AFO that has been prescribed and the material that it has been made with. Carbon fibre will be more expensive than metal or plastic for example. LOC’s bespoke AFOs cost can be found on our Orthotic Prices page.

The ability to drive while wearing an AFO is dependent on the condition being treated and the orthosis that has been prescribed. If wearing a hinged AFO, for example, you will be able to drive, but if wearing a knee brace, you won’t. Your orthotist will advise you.

The most flexible type of AFO is a Dynamic Ankle Foot Orthosis (DAFO).  It is thin and provides flexible support to the foot and ankle.

Both normal AFOs and DAFOs improve static balance (eg: while standing). Research among MS sufferers suggests that DAFOs aided balance while walking more than AFOs.

The simple answer is: yes they can. However one has to be sensible and look for wide-fitting trousers/jeans preferably of light and thin material.

Typically an AFO is stiff and rigid whereas a DAFO is thin, flexible and wraps around the patient’s entire foot. A DAFO provides support but also allows some range of normal movement.

A Supra Malleolar Orthosis SMO gets its name from the part of the body it encompasses. Thus an SMO supports the leg just above the ankle bone or malleoli. It allows dorsiflexion and plantar flexion(toes up and toes down) but eliminates mediolateral movement.

It typically takes a few weeks but is slightly dependent on the chosen materials and current availability.

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