Classification of Johnson and Strom for Acquired Flatfoot Deformity (Pes Planus)

Johnson and Strom reported a classification for acquired flatfoot deformity.

Flatfoot deformity:

(1) collapse of the medial longitudinal arch

(2) failure of the supporting posterior medial soft tissue strictures of the ankle and hindfoot

Possible causes:

(1) posterior tibial tendon dysfunction

(2) trauma

(3) arthritis

(4) developmental neuromuscular disease

Parameters for the classification:

(1) medial pain

(2) tenderness of the posterior tibial tendon

(3) deformity

Medial Pain	Tenderness of the Posterior Tibial Tendon	Deformity	Stage
mild	mild with swelling	absent	I
moderate	moderate with swelling	flexible	II
severe	marked without swelling	fixed	III

Other findings:

(1) "too many toes" sign

(2) tears in the posterior tibial tendon

(3) heel-rise test

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