Are flexible flat feet associated with proximal joint problems in children?

NewsBot · Feb 11, 2016

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Are flexible flat feet associated with proximal joint problems in children?
A. Kothari, P.C. Dixon, J. Stebbins, A.B. Zavatsky, T. Theologis
Gait and Posture; Article in Press

Highlights
?The relationship between flat feet and proximal joint problems was investigated.
?Children with flat feet are more likely to have knee or hip/back symptoms.
?Flat feet are associated with a reduction in vertical ground reaction force.
?There were some kinematic and kinetic parameters associated with low arch height.
?The mechanism by which flat feet cause proximal joint symptoms is not clear.
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The role of flexible flat feet (FF) in the development of musculoskeletal symptoms at joints proximal to the ankle is unclear. We undertook an observational study to investigate the relationship between foot posture and the proximal joints in children. It was hypothesised that reduced arch height would be associated with proximal joint symptoms and altered gait kinematics and kinetics particularly in the transverse plane at the hip and knee. Ninety-five children between the ages of 8-15 were recruited into this ethically approved study. Foot posture was classified using the arch height index (AHI). The frequency of knee and hip/back pain was documented, and each child underwent three dimensional gait analysis. Reduced arch height was associated with increased odds of knee symptoms (p < 0.01) and hip/back symptoms (p = 0.01). A flat foot posture was also significantly associated with a reduction in the second peak of the vertical ground reaction force (p = 0.03), which concomitantly affected late stance hip and knee moments. A reduced AHI was also associated with increased pelvic retraction and increased knee valgus in midstance. No kinematic and kinetic parameter associated with a flat foot posture related to increased proximal joint symptoms in the FF group. Children with a flatter foot posture are more likely to have pain or discomfort at the knee, hip and back; however, the mechanisms by which this occurs remain unclear. Treating FF without explicit understanding of how it relates to symptoms is difficult, and further work in this area is required.
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Admin2 · Feb 11, 2016

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NewsBot · Aug 22, 2017

Gait Analysis of Symptomatic Flatfoot in Children: An Observational Study
Ha Yong Kim, MD, Hyuck Soo Shin, MD, Jun Hyuck Ko, MD, Yong Han Cha, MD, Jae Hoon Ahn, MD and Jae Yeon Hwang, MD
Clin Orthop Surg. 2017 Sep;9(3):363-373

Background
Flatfoot deformity is a lever arm disease that incurs kinetic inefficiency during gait. The purpose of this study was to measure the degree of kinetic inefficiency by comparing the gait analysis data of a flatfoot group with a normal control group.

Methods
The patient group consisted of 26 children (21 males and 5 females) with symptomatic flatfoot. They were examined with gait analysis between May 2005 and February 2014. Exclusion criteria were patients with secondary flatfoot caused by neuromuscular disorders, tarsal coalition, vertical talus, or others. Patients' mean age was 9.5 years (range, 7 to 13 years). The gait analysis data of the study group and the normal control group were compared.

Results
The mean vertical ground reaction force (GRF) in the push-off phase was 0.99 for the patient group and 1.15 for the control group (p < 0.05). The mean ankle moment in the sagittal plane during the push-off phase was 0.89 for the patient group and 1.27 for the control group (p < 0.05). The mean ankle power in the sagittal plane during the push-off phase was 1.38 for the patient group and 2.52 for the control group (p < 0.05). The aforementioned results show that patients with pes planovalgus had a reduction of moment, power, and GRF in the push-off phase during gait.

Conclusions
Symptomatic flatfeet had a moment inefficiency of 30% and power inefficiency of 45% during gait compared to feet with preserved medial longitudinal arches.
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NewsBot · Aug 29, 2020

Flat Foot and Postural Harmony in 6-Year-Old Caucasians: What is Their Relationship?
Teresa Paolucci et al
Annals of Rehabilitation Medicine 2020;44(4):320-326.

Objective
To determine whether asymptomatic flexible flat feet show specific postural assessment with respect to neutral feet in 6-year-old children.
Methods
In this cross-sectional observational study, 164 subjects were observed and divided into two groups: 57 with flexible flat feet and 107 with neutral feet. A non-quantitative inspection by podoscopy and baropodometry were performed to evaluate plantar support, and a clinical examination to assess postural setting.
Results
The prevalence of flexible flat feet was 34.8%. The differenceinthe mean centre of pressure (CoP) between the two groups was significant (p=0.028), regarding the antero-posterior direction of CoP only. There was no significant differencein the presence of postural growth disharmony between the neutral and flat-feet groups.
Conclusion
The flattening of the plantar archseems to be linked to a displacement of CoP Y, more posterior in flat feet than in neutral feet; on the other hand, postural harmony in 6-year-old children during growth is not influenced by flat feet.
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NewsBot · Oct 31, 2021

Foot morphology and correlation with lower extremity pain in Japanese children: A cross-sectional study of the foot posture Index-6
ManatoHorii et al
Journal of Orthopaedic Science; 27 October 2021

Background
Abnormal foot morphology in children and adolescents is a possible risk factor for lower extremity pain. Foot posture index–6 (FPI-6) is a valid and reliable tool to assess foot morphology. However, the normative data on the age distribution for FPI-6 in Asian children and adolescents are still minimal. Further, the correlation of FPI-6 with lower extremity pain is poorly understood. We aimed to investigate the normative distribution for FPI-6 and the relationship between FPI-6 scores and knee and heel pain in Japanese children.

Methods
We included 2569 Japanese children, aged 9–15 years, at a single school from 2016 to 2018. We summarized the age distribution of children and their mean bilateral FPI-6 scores. Additionally, we assessed the tenderness at the apophysis or tendon insertions at the knee and heel. We performed a cross-sectional analysis to investigate the correlations between FPI-6 scores and sex, age, and knee and heel pain for the data obtained each year.

Results
The mean FPI-6 score was 3.1 ± 2.4, 3.4 ± 2.0, and 3.2 ± 1.9 for the left foot and 3.0 ± 2.4, 3.2 ± 1.9, and 3.1 ± 1.9 for the right foot in 2016, 2017, and 2018, respectively. Boys tended to have higher scores than girls, and the FPI-6 score of the left foot was significantly higher than that of the right foot (p < 0.05). There was no correlation between FPI-6 scores and knee and heel pain.

Conclusion
Children and adolescents between 9 and 15 years of age have neutral to slightly pronated foot morphology and an average FPI-6 score of 3.0–3.4. In addition, there was no relationship between foot morphology and knee and heel pain. This normative distribution for FPI-6 in Japanese children could serve as a reference value for future research and clinical evaluation.
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NewsBot · Feb 12, 2022

Flexible Flat Foot, Short Tendo-Achilles, and Altered Gait.
Malige A, Chang H, Mellor X, et al. (February 07, 2022)
Cureus 14(2): e21983. doi:10.7759/cureus.21983

Background
Pediatric patients often present with vague complaints involving the anterolateral foot and ankle, the medial knee, the lower back, and the hip. In our experience, closer examination of these patients reveals a constellation of symptoms that involve pathology in the ankle, knee, back, and hip. This study aimed to detail the identification and treatment of patients with the triad of flexible flat feet, tight Achilles complex, and altered gait, and their clinical course over time.

Methods
All patients of age 18 years or younger who presented to our urban academic center outpatient clinic with foot, ankle, patellar, low back, or hip pain or pathology were included. Patients with identified tarsal coalitions, accessory naviculars, malalignment syndrome, bone cysts or tumors, soft tissue tumors, arthropathy, neuropathy, infection, limb length inequality, patellar subluxation or dislocation, or spinal pathology were excluded. For each patient, demographic information, symptom description, treatment, and clinical course, including the Foot and Ankle Outcome Score (FAOS) was recorded.

Results
A total of 62 patients were included in our study. Patients mostly presented with low back pain (n=24, 38.7%), medial patellar pain (n=36, 58.1%), anterolateral ankle pain (n=35, 56.5%), and vague foot pain (n=13, 21.0%). Overall, 53.8% of patients with back pain at the initial visit, 35.0% of patients with knee pain, 44.4% of patients with ankle pain and 80.0% of patients with foot pain improved at final follow up. While patient-reported sports and recreation subscale scores demonstrated a significant improvement at the final follow-up compared to baseline scores (p=0.02), all other scores did not significantly differ compared to baseline scores. At final follow-up, 12 of 26 (46.2%) patients reported being able to return to play in their desired sport.

Conclusion
Complaints of back, hip, knee, ankle, or foot pain in the pediatric population can be early markers for a constellation of conditions that include low back pain, flexible flat feet, Achilles contracture, and altered gait due to increased lateral subluxation of the patella and hip flexion.
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NewsBot · Feb 15, 2022

EFFECT OF PAEDIATRIC FLAT FOOT ON THE SAGITTAL
ALIGNMENT OF THE PELVIS AND SPINE
Elena Adelina PANAET et al
Physical Education, Sport and Kinetotherapy Journal, Volume 60, Issue 4, 475-484

Human body segments interact harmoniously and efficiently so that homeostasis is maintained in
any circumstances. Even the slightest modification of the support surface can have repercussions on postural
control strategies and consequently can lead to a change in the alignment of the whole body. Flat foot is the
most common condition of the lower limb. It is clinically manifested on multiple anatomical planes: flattening of
the medial longitudinal arch (sagittal plane), valgus of the calcaneus (frontal plane) and abduction of the
anterior foot (transverse plane). In any case, the influence of structural modifications of the flat foot on one’s
posture, especially in children, still remains an insufficiently researched topic. The purpose of this study was to
assess the effects that structural modifications of a flat foot have on the pelvis and spine in the sagittal plane, in
children aged 7-9. Thus, the following hypothesis was formulated: the structural modifications of flat feet can
modify the sagittal alignment of the pelvis and spine in children aged 7-9. The flat feet were assessed using the
Foot Posture Index-6 (FPT-6) while the sagittal alignment of the pelvis and spine was measured using the GPS400 computerised postural analysis system. Statistical analysis of the data did not indicate any significant
correlations between the FPI-6 score and pelvic tilt angle or between the FPI-6 score and differences between
the sensors and the lumbar and dorsal spinous processes.
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