07/10/2013    Robert D. Phillips, DPM

Surgical Intervention in a 12 Year Old with Flat Foot

This is a good example of why a biomechanical
examination is so important in trying to make
surgical decisions.

Some of the important information needed includes:
1. The angular range of motion of the subtalar
joint on the frontal plane.

2. The heel to leg angular relationship when the
subtalar joint is in neutral position.

3. The linear relationship, how many mm medial or
lateral the center of the bottom of the heel is
to the to the center of the leg when the STJ is
neutral and also maximally pronated.

4. The ratio of transverse plane motion to
frontal plane plane motion in the STJ.

5. The presence of any genu varum or tibial varum
or valgum.

6. The plot of the STJ axis to the bottom of the
foot when the STJ is in neutral and also when the
STJ is pronated enough to bring the FF flat on
the ground.

7. The forefoot to rearfoot relationship with the
MTJ is fully pronated, and when subtalar joint is
in neutral, and again when the STJ is fully
pronated.

8. The frontal plane range of motion of the MTJ.
Also the range of motion of the first ray and the
other rays.

9. The range of motion of motion of the MTJ in
the sagittal and transverse planes.

10. The ankle joint dorsiflexion, active and
passive, with the knee joint fully extended and
again when flexed.

11. Posterior tibial strength

12. The presence of contracture of the hamstring
muscles or the ilio-psoas muscle.

13. Any other signs of muscle weaknesses of the
lower limb.

14. Signs of excess internal or external femoral
or tibial torsion.

Once we have this information, then deciding
which procedure(s) are in the patient’s best
interests will be much easier. Of course most
practitioners would not advocate using surgery in
lieu of orthotic therapy, but as an addition.
Best wishes to the physician managing this case.

I recommend that the submitter of this case
review my lecture at www.podiatry.com on
Indications for Flatfoot Surgery.

Robert D. Phillips, DPM, Orlando, FL,
Robert.Phillips9@va.gov

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