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Flatfoot deformity pathogenesis. A trilogy
1Indian Valley Podiatry Associates, Souderton, Pennsylvania, USA.
Insights
Most developmental flatfeet originate at birth due to intrauterine positioning, leading to abnormal bone alignment and muscle imbalances. Orthotics aim to correct these issues, improving foot function and gait mechanics.
Area of Science:
- Orthopedics
- Biomechanical Engineering
- Pediatric Podiatry
Background:
- Developmental flatfeet are often congenital, stemming from intrauterine forces and fetal foot positioning.
- Abnormal bony relationships in anatomically normal bones precede the onset of walking.
- Existing theories often focus on passive bone alignment, overlooking active muscular influences.
Purpose of the Study:
- To investigate the etiology of developmental flatfeet, emphasizing the role of intrauterine factors and muscular imbalances.
- To elucidate the biomechanical changes in the foot and ankle during the gait cycle in individuals with flatfeet.
- To clarify the mechanism by which orthotic devices function to correct flatfoot deformities.
Main Methods:
- Analysis of bony relationships and muscular force balance in the development of flatfeet.
- Examination of the gait cycle, specifically at heel contact, to understand biomechanical alterations.
- Review of the proposed mechanisms of action for orthotic interventions in managing flatfeet.
Main Results:
- Developmental flatfeet are primarily present at birth, caused by intrauterine forces and fetal positioning.
- Abnormal bone alignment leads to a muscular force imbalance, with one muscle group gaining a mechanical advantage.
- This imbalance actively perpetuates and worsens the deformity, influencing gait mechanics from heel strike onwards.
Conclusions:
- The study highlights that active muscular forces, not just passive bone alignment, are crucial in creating and maintaining flatfoot deformities.
- Orthotic devices are designed to provide disadvantaged muscles with adequate time during the gait cycle to restore normal bone relationships.
- Effective orthotic use can re-establish a stable foot foundation, enhancing lever arm function for efficient forward propulsion during gait.
Abstract:
The significant conclusion from this trilogy is that most developmental flatfeet are present at birth. It is likely that intrauterine forces and fetal foot position initially create the abnormal bony relationships between anatomically normal bones. This bony relationship is present before the child takes his first step. Second, as the result of this abnormal relationship between normal bones, the active muscular force balance between opposing muscle groups is distorted. This allows one muscle to have a mechanical advantage over its antagonist. This actively maintains and progressively worsens the abnormal bony relationship. Third, this abnormal bony relationship and disturbed muscular mechanical advantage exert their influence immediately at the point of heel contact in the gait cycle. At this point, the foot and posterior talocalcaneal joint are dorsiflexed relative to the supporting surface so that the majority of motion occurs in the transverse body plane. Finally, the goal of an orthotic device is to simply give the disadvantaged (muscularly challenged) muscle groups more time in the gait cycle to re-establish the normal bony relationships. The orthotic will restore the foot to a stable sturdy foundation acting as an effective lever mechanism that can propel the body forward efficiently in gait. Much of the author's previous discussion is a natural progression of ideas that originated during training with the late James V. Ganley, DPM. He was a proponent of the philosophy that the talus was blamed for causing a flatfoot deformity. Ganley felt that the talus was relatively innocent in the cause of this condition and the remainder of the bones of the foot were the true villains in the pathogenesis of the valgus foot. However, Ganley regarded the abnormal bone relationships of the deformity as if they are passive in nature. This article places emphasis on how the active muscular forces create the abnormal bony relationships.