title: Flatfoot in children and adolescents. Analysis of imaging findings and therapeutic implications.
abstract: BACKGROUND
  Pes planovalgus (PPV) is a complex three-dimensional deformity of which routine radiographs provide only a two-dimensional analysis.
  
  
  OBJECTIVE
  Angles and other radiographic parameters of the foot in children and adolescents, when studied on both the dorsoplantar and the lateral view, can be used to establish a radiographic classification system for PPV that provides useful therapeutic guidance in clinical practice.
  
  
  METHODS
  A retrospective single-centre study was conducted on 65 feet in 35 patients aged 7 to 18 years and having adequate ossification. All patients had a clinical diagnosis of idiopathic or neurologic PPV and available weight-bearing dorsoplantar and strict lateral radiographs. We excluded pes planus due to tarsal coalition, congenital bone deformities, or overcorrection of talipes equinovarus (n=25). All possible axes were drawn and angles measured after an evaluation of interindividual agreement.
  
  
  RESULTS
  We identified four patterns of PPV: subtalar pes planus (n=16) with marked subtalar valgus and longitudinal sag predominating at the talonavicular joint, midtarsal pes planus (n=12) without subtalar valgus but with marked midtarsal abduction and sag predominating at the cuneonavicular joint, mixed pes planus (n=28) with subtalar valgus, midtarsal abduction, and sag at both the talonavicular and cuneonavicular joints, and pes planocavus (n=9) with sag of the medial arch and cavus deformity of the lateral arch.
  
  
  CONCLUSIONS
  This original classification system provides therapeutic guidance by helping to match the surgical procedure to the nature and location of the deformities.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of pediatric radiology, Paris Descartes University, Cochin - Saint-Vincent-de-Paul Hospital, AP-HP, 27, rue du Faubourg-Saint-Jacques, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Bourdet
authors.forename: R
authors.initials: R
authors.lastname: Seringe
authors.forename: C
authors.initials: C
authors.lastname: Adamsbaum
authors.forename: C
authors.initials: C
authors.lastname: Glorion
authors.forename: P
authors.initials: P
authors.lastname: Wicart
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005413:Flatfoot / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult