Buckle foot

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A buckled foot (pes valgus) is a foot malposition in which the heel is slightly bent inwards. Most of the time, the entire longitudinal arch of the foot descends. Doctors then speak of a flat arched foot or a flat arched foot, depending on the severity. This misalignment is very common in children and is mostly congenital. It is to be differentiated from the acquired buckle foot in adults.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M21Q66

Brief overview

• What is a buckle foot? Foot malalignment, congenital or acquired later, usually as a combined malalignment with the flat arched foot (Pes planovalgus); The foot is lowered in the longitudinal axis towards the inside. In combination with the arched foot, the arch of the foot is flattened or completely absent.
• How do we treat a buckle foot? No treatment of the flexible arched arch arch in children, therapy in adults only in the case of existing complaints, exercises to strengthen the foot muscles, walking barefoot, physiotherapy, orthopedic splints (orthosis), insoles, in severe cases, surgery
• Symptoms: Usually no complaints, in adolescents and adults load-dependent pain in the metatarsus or in the arch of the foot, possibly in the lower leg
• Causes: In children mostly innate and part of physical development. In adults, the long-term effects of a malalignment from childhood or damage to the tendon on the inside of the foot
• Diagnostics: A tilted heel is easy to recognize. Gait analysis, footprint measurement and imaging procedures
• Prevention: Possible for the acquired shape by strengthening the foot muscles and good shoes

What is a buckle foot?

Buckle foot (pes valgus) is a foot deformity that occurs very often, especially in children. The heel is clearly bent inwards, which doctors call the valgus position. This pushes the inner edge of the foot down and lifts the outer edge slightly. In most cases, the longitudinal arch of the foot also sinks. Then one speaks of a flat arched foot / flat arched foot or a flat flat foot (Pes planovalgus) - depending on how pronounced these changes are.

Buckle foot in children

A flat foot or flat arch can be observed temporarily in almost all small children. So in this age group it is the normal state. If the child continues to grow and the muscles develop stronger and stronger, the heel will usually straighten up and straighten out again. Most of the time, the foot is easy to move to flexible. In a small proportion of children, however, the misalignment persists or progresses. Mobility is limited in some cases. Then there is a so-called rigid buckle foot.

Seldom is a congenital arched flat foot or arched flat foot so pronounced that doctors assume from the outset that it will not resolve on its own. This severe form is often inherited.

Most often, the knee foot is congenital in children. However, it is rarely the result of another disease. Doctors then speak of a secondary articulated foot.

Buckle foot in adults

Knuckle feet, flat arch feet or flat feet also occur in adults. This is either a buckled heel that has existed since childhood or it was acquired over a lifetime. Such a misalignment often causes discomfort in old age.

Symptoms of Bucklefoot in Childhood

In young children, the predominant symptom of buckled foot is appearance. Parents can clearly see the inwardly bent heel. This is especially true when the children are running. The misalignment of the feet sometimes forces the legs to tilt, which leads to so-called knock knees. Pain is possible in older children with buckles, but it rarely occurs.

Symptoms of buckfoot in adults

In adults, bent feet or flat arched feet are often noticeable due to their significantly more severe symptoms. There is often swelling, which occurs mainly on the inner ankle, but also on the outer ankle. Sometimes it looks like the inner ankle is literally protruding. These signs are mostly associated with pain. They pull from the inside of the foot to the lower leg. They are usually strongest just below the medial malleolus.

The flat arched feet are also associated with similar visual symptoms in adults as in children. The heel in particular is clearly visibly inclined inwards. A pronounced inclination means that the outer toes stick out outwards. The misalignment of the feet can also be seen in the shoes. The soles are more worn on the inner edge. For many adults, improper posture triggers other symptoms in other parts of the body, such as pain in the knees or back.

How is a flat arch foot treated?

A flat or flat arch does not have to be dealt with automatically. Above all, the common form in early childhood usually grows without therapy. Treatment is necessary for a congenital arched foot if doctors anticipate long-term consequences or if they are already emerging. In adults, the malalignment of the foot is treated when symptoms occur. There are several options.

Support healthy growth

Over 90 percent of all babies and toddlers have bent feet, flat feet or flat feet. Very few of them need to be treated. Parents have an opportunity to promote healthy growth by making sure that their children exercise a lot and walk barefoot as often as possible. Shoes should be comfortable and have enough space for your feet.

Playful exercises help to strengthen the muscles. It is recommended, for example, that children regularly stand on tiptoe. On the other hand, orthopedic surgeons advise against using supporting shoes or insoles, as they tend to prevent healthy development. They relieve the muscles of work instead of demanding it.

Sensorimotor insoles and night splints

Insoles are recommended if children have pain because of the flat arched feet or if the foot is injured in the root area, i.e. between the metatarsus and the lower leg. Depending on the exact diagnosis, the doctor will prescribe special insoles or higher orthoses to protect and support the ankle.

In both cases sensorimotor elements are included. This means that the insoles or orthotics are equipped with elastic chambers that stimulate the sensory cells of the feet when they move. They promote healthy foot development. Purely mechanical insoles made of a hard material are not recommended for children. If the calf muscles are shortened, it makes sense to use splints to get the feet into the correct position at night.

Adults with congenital or acquired malleolus feet also benefit in many cases from sensorimotor insoles.

Relieving insoles and good shoes

For adults, in addition to the sensorimotor insoles, there is the option of using insoles that relieve certain parts of the feet. So-called bedding inserts, for example, help normalize movement sequences and alleviate discomfort. They are raised on the inside edge to push the heel into a normal position. However, this only works if the insoles are worn in sturdy shoes.

physical therapy

Well-developed muscles compensate for foot misalignments to a certain extent. Physiotherapy is therefore often helpful in children in whom the buckle foot does not resolve itself sufficiently. The following reasons speak in favor of physiotherapy for school children and adolescents:

• The arch of the foot has not yet fully straightened itself.
• The ankles and ankles are not as flexible as they should be.
• The leg axes are not straight.
• The doctor has determined that there is an imbalance in the muscles or ligaments.
• The child has pain in the foot when exerted.

For adults, physiotherapy is the most important pillar of treatment alongside the supply of insoles. Articulated foot exercises are mainly used to strengthen the muscles of the feet, the calves and the deeper muscles in the shin area.

Lose excess weight

Regardless of the age of the person affected, being overweight puts a lot of strain on the feet and sometimes worsens malpositions such as a flat foot, flat foot or flat foot. Treatment should therefore include shedding additional kilos if possible in order to relieve the musculoskeletal system.

Articulated foot surgery in children

It is only very rarely necessary to operate on a flat foot, flat foot or flat foot in children. This is particularly the case if the orthopedic surgeon assumes that the misalignment will not recede on its own. Or he may find that the functionality of the foot is deteriorating and symptoms such as pain are getting worse.

Various techniques are available for angled foot surgery. You will be selected according to which malformations (deformities) cause the problems in detail. If necessary, different methods are combined. These are the most important interventions:

The calf muscles and Achilles tendon are lengthened if there is also a tendency towards equinus foot, i.e. the toes are tilted downwards.

The insertion of the anterior tibial muscle is offset so that its pull helps the foot straighten up.

The so-called subtalar arthrorise is the most common knee surgery in children. The mobility of the ankle is restricted by an obstacle so that it no longer bends inward. As a result, the longitudinal arch of the foot usually develops normally. The arthrorisis is performed in a minimally invasive manner, i.e. only with a small incision. The surgeon inserts a screw or bone chip as an obstacle between the talus and heel bone.

In the so-called Evans operation, also called calcaneus lengthening, the heel bone is first cut through and then lengthened. To do this, the doctors insert a bone graft, which they take from the pelvis, for example.

It is also possible to offset the relevant area of ​​the calcaneus a little.

Surgeons also have the option of attaching temporary screws to the lower end of the tibia in order to guide the growth there and thus correct the arched arches. This procedure is only possible as long as the bones have not yet finished growing.

Articulated foot surgery in adults

In adults, too, knee surgery can usually be avoided with insoles and physiotherapy. Doctors recommend them if those affected suffer from symptoms despite these conservative measures. Which procedure promises the greatest success depends on which areas of the foot are affected by the deformity and to what extent. In the case of adults, doctors also include secondary diseases such as joint wear and tear (osteoarthritis) in the assessment. These surgical methods are particularly important for a flat foot or flat arch:

With an acquired buckle foot, inflammation of the tendon on the inside of the foot that is too stressed (tibialis posterior tendon) usually occurs. Often times it helps to remove the inflamed areas or even to replace the tendon with a graft. If the inflammation has lengthened this tendon, the surgeon will surgically shorten it a little. Interventions on this tendon are particularly promising if the joint has not yet worn out due to the articulated foot or arched flat foot.

Changing the position of the calcaneus may help not only children, but adults too. To do this, the doctor inserts a bone wedge in the outer area of ​​the calcaneus, which he takes from the iliac crest, for example. If necessary, the heel bone is also shifted through an articulated foot surgery to correct the malalignment.

Another surgical procedure is to artificially lengthen the bone on the outer edge of the foot. For this purpose, doctors mostly use bone parts from the iliac crest or the fibula.

If the arched foot has already led to very painful osteoarthritis, the surgeon stiffens various areas of the ankle, thus restricting mobility. This so-called arthrodesis enables many sufferers to walk again symptom-free.

How is a flat foot or a flat flat foot created?

When it comes to the causes of buckled foot, it is important to distinguish between congenital and acquired forms. The most common flat feet, flat feet or flat feet in babies and children is a normal stage of development in growth. The heel leans inward because the muscles and ligaments are not yet able to hold them in the correct position. As soon as these structures become stronger, the deformity usually recedes. However, if the disease is inherited, it usually needs treatment.

Secondary arch foot or arch arch in children

The malalignment of the foot is rarely the result of another disease. Doctors then speak of a secondary articulated foot. Mostly these are diseases that result in decreased muscle tension. Examples are the genetic malformation trisomy 21, also known as Down syndrome, the neurological development disorder Rett syndrome or brain damage in early childhood (cerebral palsy). The spine malformation of the open back (spina bifida) as well as diseases of the nerves often affect the position of the feet.

Acquired buckle foot in adults

A clear risk factor for symptoms in adulthood is a child's flat foot or flat arch that has not fully straightened up. In the course of life it leads to discomfort. The likelihood of this increases if the person concerned is very overweight.

The second major cause of buckled foot in adults is an imbalance in the structures in the foot. Because different tendons and muscles are responsible for keeping the foot in the correct position. If they no longer fulfill this task, misalignments occur. Most often, a weakening of the tibialis posterior tendon is the cause of an arched foot in adults. It runs on the inside of the foot. There are various reasons why it is impaired in its function, for example through injuries or accidents, rheumatic diseases or tendinitis.

Risk factors include a sugar metabolism disorder (diabetes mellitus) and years of taking the anti-inflammatory drug cortisone. Women are three times as likely to be affected by a flat arch foot as men. The reason for this is not known. Incorrect footwear promotes misalignment of the feet. For example, those who frequently wear high heels promote an imbalance in the muscles. This increases the pressure on the forefoot, so that even a flat arched foot becomes more likely, in which the individual bones of the forefoot are also too far apart.

How is a buckled foot determined?

Orthopedic surgeons usually diagnose a flat foot, flat foot or flat foot in both children and adults through simple physical examinations. The misalignment is clearly recognizable from the rear thanks to the inwardly bent heel. In adults, the outer toes often stick out. A gait analysis via video or a load measurement of the footprint (pedobarography) support the diagnosis.

Further examinations are necessary to determine the extent of the foot deformity and to analyze which areas are affected in detail. In adults, the doctors also check whether there have already been any sequelae such as joint wear and tear. Imaging methods such as x-ray examinations, ultrasound (sonography), magnetic resonance tomography (MRT) and computed tomography (CT) are used.

Prevent

It is possible to prevent an acquired buckling foot to a certain extent. For this it is important to maintain the function of the structures. Regular exercise, especially barefoot walking and foot exercises, help to strengthen muscles and prevent damage to the ligamentous apparatus. Comfortable shoes are also an important factor in avoiding misalignments such as a buckled foot.

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