What is it?

The flat foot (pronator syndrome) is a recurrent pathology in children and, if not corrected, may over time affect the posture and gait. The plateau is a clinical situation in which the foot tends to pronate, that is to fall inside, with the hindfoot that, on the contrary, is valgized bringing itself outside. Even the knee conditioned by the abnormal position of the feet is evaluated by varying the correct anatomical axis. Flat feet can be physiological in children and undergo spontaneous correction as they grow. When this is not the case, the abnormal structure gives rise to painful symptoms and, if not amenable to conservative therapy, surgical correction is necessary.

Which are the symptoms?

The patient with pronator syndrome has what is commonly referred to as "flat foot", characterized by hindfoot valgus and pronation of the foot, and absence of the plantar arch. Often this picture is accompanied by pain and functional limitation, and walking with extra-rotated feet. Axial deviations of the knees (valgus) and the big toe should also be investigated.
The pronated foot valgus can be flexible, when the flatness is correctable with exercises of activation of the muscles (walking on tiptoes or heels), or rigid, when the plantar arch is not highlighted with these maneuvers.

  • Foot pronation
  • Hindfoot valgus
  • Absence of plantar arch
  • Painfulness
  • Functional limitation
  • Increased incidence of knee valgus
  • Increased incidence of hallux valgus
  • Extraruotal gait

How is it diagnosed?

The patient is often sent to the orthopedist by the attending pediatrician who observes flawed attitude of the young patient's feet persisting beyond 5-6 years of age. Fundamental is the clinical examination, both with patient standing and in supine position, which allows to distinguish the flexible flat foot from the rigid flat foot. The instrumental examination of choice is the radiography of the feet in load in 2 projections, with which it is possible to assess the relationships between the bones of the foot and any alterations (calcaneal scaphoid synostosis).

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How is it treated?

In the first years of life, in the presence of flat feet, it is recommended to stimulate exercises to activate the muscles that support the arch of the foot and avoid flat-soled shoes, preferring anti-pronatory shoes (such a shoes for running). Towards the end of growth, the patient should be re-evaluated to observe the evolution and the eventual need for corrective intervention. This, in fact, is indicated in the terminal phase of growth, especially if the flat foot is associated with pain and stiffness. In most patients who undergo surgery, the technique of choice is sinus arthrorisis (endorthesis).

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