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No subject in orthopxdic surgery is more muddling than flatfoot. It is a common
experience for an orthopedic surgeon to see in his out-patient department hordes of
children sent up from school clinics with a diagnosis of pes planus, children who have
perfectly normal feet except that their longitudinal arches are low. One is reluctant
to send these children away without treatment, because the mothers have been led to
believe that treatment is necessary
An equinus, when present, is compensated for, when the person stands, by
dorsifiexion at the subtaloid-midtarsal joint, but dorsiflexion at this composite joint
is accompanied by eversion. Although the foot becomes plantargrade by this means,
it does so at the expense of a malalignment of the body-weight, which no longer-
passes through the centre of the subtaloid-midtarsal joint.
Varus deformity of the forefoot is compensated for by eversion at the subtaloid-
midtarsal joint (fig. 7) and again the foot is rendered plantargrade at the expense
of malalignment of the body-weight.
Equinus has long been recognized as a cause of flatfoot but until recently varus.
deformity of the forefoot has been overlooked as a causative factor. Both deformities
are common. Their origins are obscure. They might result either from a fault ii
the growth of the tarsal bones, or more likely from the growth of the muscles failing- to keep pace with the growth of the skeleton.
In the case of an equinus the calf muscles do not lengthen as quickly as the tibia,
and in the case of a varus forefoot the increase in length of the tibialis anticus does
not keep pace with the growth of the tibia and tarsus.
For pes planus due to varus forefoot.-We are here dealing with an architectural
defect of the longitudinal arch. The arch, when the foot is correctly aligned so that
the body-weight passes through the centre of the subtaloid-midtarsal joint, has only
two of its three bearing points on the ground; and the problem is to get all three on
the ground. This can be done by a forcible manipulation under anesthesia, at which
the medial border of the front part of the foot is thrust downwards. It is interesting
to note that some bone-setters empirically use this manceuvre in treating flat feet.
In resistant cases the aid of two Thomas's wrenches is invoked; one of which grips
the os calcis horizontally to hold the heel inverted, while the other grips the forefoot
vertically and rotates it into valgus (fig. 15). As a rule it is necessary to immobilize
the longitudinal arch in the corrected position for some weeks. Accordingly after
the manipulation the foot is put into plaster, with the heel inverted as much as
possible, the forefoot everted as much as possible and the whole foot at right-angles