It can also occur in adults with congenital pes planus, especially those who participate in repetitive high impact sports such as basketball, running, or soccer. Posterior tibial tendon dysfunction is most common in females over the age of 40 with comorbidities, including diabetes and obesity. Acquired pes planus is most commonly occurs secondary to posterior tibial tendon dysfunction. The function of the posterior tibial tendon is to support the arch as well as inversion and plantarflexion of the foot. Obesity in children is significantly correlated with the tendency of the longitudinal arch to collapse in early childhood. There is a small percentage of children who fail to develop a normal arch by adulthood. Flexible pes planus describes a normal arch without bearing weight, which disappears with weight-bearing. Most cases of pes planus in children are flexible. Most children develop normal arches by age 5 or 6. Infants have a fat pad under the medial longitudinal arch, which serves to protect the arch during early childhood. Infants and young children are prone to absent arches secondary to ligamentous laxity and lack of neuromuscular control. Pes planus can either be congenital or acquired.
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