Abstract
Background Context: All the flat and flat valgus feet with evolutional potential or rigid, excepting the ones without evolutional potential entail static and predominantly dynamic discomfort in idle and locomotive state. A part of these children and teenagers have a hard time in dealing with the discomfort and many of them interrupt their training in athletic carriers due to the enhancement of the symptomatology as they grow older.
Purpose: In order to limit this impact encountered in many children in the ambient environment or in the children who intend to become athletes, the investigation and conceptualisation of the flat and flat valgus foot notions provide the chance of an accurate professional orientation and of a suitable diagnostic and treatment. A special group includes the children with severe forms of rigid flat and flat valgus from cerebral paralysis and arthrogryposis where the management has to ensure the possibility of walking stability and current independence.
Study design: Synthesis of a retrospective observational survey carried out during 45 years of activity.
Outcome measures: The long-term assessment of hundreds of patients with flat and flat valgus foot with evolutionist potential, the comparisons of the pre-operatory and post-operatory state of patients recommended for surgery and the evolution of these patients, professional orientation and their degree of satisfaction.
Methods: All the patients included in the assessment benefitted from differential treatment based on their symptomatology, the type of deformation and the character thereof, i.e. either flexible or rigid. We took into account the etiopathology, the age, the degree of development of the medial arch and the classification referred to in the text.
The majority of the patients, in a quite overwhelming percent, benefitted from a non-surgical treatment. The feet (with evolutionary potential) labelled at a certain point by the supporters of the non-treatment of such deformities as asymptomatic and free of risk where identified, after remote assessments, as non-diagnosed and/or neglected rigid flat feet.
Results: The periodic assessment allowed me to note that a series of feet have an evolutionary nature and only a very small number are free of such potential and did not present any symptomatology r other inconveniences even after the age of 60. A part of the rigid or rigid flat- valgus feet encountered in cerebral paralysis or arthrogryposis could not be corrected through the current surgical methods and we applied to the reconstruction of the plantar arch on splint calcaneus- metatarsal 1, initially at interventions and then per-primam.
Conclusions: The flat and flat-valgus foot is a complex deformity, the subject of long discussions, controversial and debatable. The evolutionary potential cannot be currently established based on standardised criteria.
The flat foot is a different entity from the flat valgus foot. The classification is based on clinical and evolutionary criteria.
The occurrence of the plantar disease is systematically assessed at children with flat and flat valgus foot, especially during the age of 1 to 10 years.
The neurosurgical treatment must be eclectic, simultaneous and long-term. The surgical treatment is recommended for symptomatic and rigid forms. It consists in the application of interventions according to the methods Mosca, Dwyer, Maxwell- Brancheau, Grice sau Gianini. The calcaneus metatarsian splint 1 provides security in the rigid cases, especially in cerebral paralysis and arthrogryposis.