Diagnosis of flexible flatfoot in children: a systematic clinical approach

NewsBot · Feb 19, 2011

Members do not see these Ads. Sign Up.
Diagnosis of flexible flatfoot in children: a systematic clinical approach.
Benedetti MG, Ceccarelli F, Berti L, Luciani D, Catani F, Boschi M, Giannini S.
Orthopedics. 2011 Jan 1;34(2). doi: 10.3928/01477447-20101221-04.

The goal of this study was to provide measures of symptoms and signs in a consecutive case series of children with flexible flatfoot based on a systematic clinical approach. Fifty-three children (age range, 10-14 years) previously diagnosed with flexible flatfoot were evaluated by a structured interview and clinical assessment. Most patients had foot symptoms (65.3% of feet) and functional limitation (68.3%). Symptoms included a sensation of discomfort (11.3%), such as early tiredness or difficulties during prolonged standing or walking, and pain (54%), mostly located in the plantar aspect of the foot (28.7%) and the medial hindfoot (18.8%). Body mass index was positively correlated to the presence of symptoms and their severity.Even if an enlarged footprint was present in 93.1% of feet, objective assessment evidenced the presence of heel valgus only in 83% of feet. Forefoot adduction was present in 22% of feet. Jack's test provided varus correction in only 54% of feet. Internal knee rotation was the most common associated disalignment, present in 43.6% of limbs. Symptoms were significantly correlated to knee alignment, and functional limitation was correlated to heel valgus. Standing balance on 1 leg was significantly correlated to footprint grading severity.A systematic clinical approach to assess children with flexible flatfoot should always be recommended for the correct diagnosis and the associated treatment management based on symptoms, functional limitation, and foot dysfunction. Functional assessment by specific tests should be included in the examination, as evidence exists that morphology and function are not necessarily related.
Click to expand...

NewsBot · Dec 25, 2012

Flatfoot in children and adolescents. Analysis of imaging findings and therapeutic implications.
Bourdet C, Seringe R, Adamsbaum C, Glorion C, Wicart P.
Orthop Traumatol Surg Res. 2012 Dec 20.

INTRODUCTION:
Pes planovalgus (PPV) is a complex three-dimensional deformity of which routine radiographs provide only a two-dimensional analysis.

HYPOTHESIS:
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.

MATERIALS AND 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.

CONCLUSION:
This original classification system provides therapeutic guidance by helping to match the surgical procedure to the nature and location of the deformities.
Click to expand...

NewsBot · Feb 21, 2013

Pediatric Flexible Flatfoot; Clinical Aspects and Algorithmic Approach
Halabchi, Farzin; Mazaheri, Reza; Mirshahi, Maryam; Abbasian, Ladan
Iran J Pediatr xxx 2013; Vol 23 (No x), Pp: xxx

Flatfoot constitutes the major cause of clinic visits for pediatric foot problems. The reported prevalence of
flatfoot varies widely due to numerous factors. It can be divided into flexible and rigid flatfoot. Diagnosis and
management of pediatric flatfoot has long been the matter of controversy. Common assessment tools include
visual inspection, anthropometric values, footprint parameters and radiographic evaluation. Most flexible
flatfeet are physiologic, asymptomatic, and require no treatment. Otherwise, the physician should treat
symptomatic flexible flatfeet. Initial treatment options include activity modification, proper shoe and
orthoses, exercises and medication. Furthermore, comorbidities such as obesity and ligamenous laxity should
be identified and managed, if applicable. When all nonsurgical treatment options faile, surgery can be
considered. Our purpose in this article is to present a clinical algorithmic approach to pediatric flatfoot.
Click to expand...

Admin2 · Feb 21, 2013

Related Threads:
Other threads tagged with pediatric flatfoot
Non-surgical interventions for paediatric pes planus
Prevalence of flat foot in preschool-aged children
How young do you treat biomechanical issues?
Flexible flatfoot: differences in the relative alignment of each segment of the foot between symptomatic and asymptomatic patients.
No evidence for foot orthoses in children
Exercise more effective than foot orthoses in pediatric flat foot
Foot orthoses and asymptomatic pediatric flatfoot
The Flat-Footed Child—To Treat or Not to Treat; What Is the Clinician to Do?

NewsBot · Feb 21, 2013

Flatfoot in children: anatomy of decision making.
Nurzynska D, Di Meglio F, Castaldo C, Latino F, Romano V, Miraglia R, Guerra G, Brunese L, Montagnani S.
Ital J Anat Embryol. 2012;117(2):98-106.

Concern about a child's foot posture is a common reason for frequent consultations for an array of health care professionals; sports medicine specialists are often the first to recognize and advise on foot pathology. In the decision making process, it is essential to distinguish between the different types of flatfoot deformity: paediatric or adult, congenital or acquired, flexible or rigid. Although flatfoot in children is a common finding, evidence for the techniques of the reliable and reproducible assessment of the foot posture is scant. This general review presents the factors involved in the forming and supporting of the foot arches, discusses the protocols useful in the evaluation of the foot posture, and indicates how to differentiate between flatfoot cases needing treatment and cases that need only reassurance.
Click to expand...

NewsBot · May 1, 2013

Flatfoot in Indian population.
Pandey S, Pal CP, Kumar D, Singh P.
J Orthop Surg (Hong Kong). 2013 Apr;21(1):32-6.

PURPOSE. To compare outcomes of different conservative treatments for flatfoot using the foot print index and valgus index.

METHODS. 150 symptomatic flatfoot patients and 50 controls (without any flatfoot or lower limb deformity) aged older than 8 years were evaluated. The diagnosis was based on pain during walking a distance, the great toe extension test, the valgus index, the foot print index (FPI), as well as eversion/ inversion and dorsiflexion at the ankle. The patients were unequally randomised into 4 treatment groups: (1) foot exercises (n=60), (2) use of the Thomas crooked and elongated heel with or without arch support (n=45), (3) use of the Rose Schwartz insoles (n=18), and (4) foot exercises combined with both footwear modifications (n=27).

RESULTS. Of the 150 symptomatic flatfoot patients, 96 had severe flatfoot (FPI, >75) and 54 had incipient flatfoot (FPI, 45-74). The great toe extension test was positive in all 50 controls and 144 patients, and negative in 6 patients (p=0.1734, one-tailed test), which yielded a sensitivity of 96% and a positive predictive value of 74%. Symptoms correlated with the FPI (Chi squared=9.7, p=0.0213). Combining foot exercises and foot wear modifications achieved best outcome in terms of pain relief, gait improvement, and decrease in the FPI and valgus index.

CONCLUSION. The great toe extension test was the best screening tool. The FPI was a good tool for diagnosing and grading of flatfoot and evaluating treatment progress. Combining foot exercises and foot wear modifications achieved the best outcome.
Click to expand...

NewsBot · Jul 10, 2013

Flat foot and associated factors among primary school children: A cross-sectional study
C.I. Ezema, U.O. Abaraogu, G.O. Okafor
Hong Kong Physiotherapy Journal ; Available online 5 July 2013

Prevalence of flat foot and its associated personal characteristics among public primary school students was investigated. This cross-sectional study involved 474 public primary school students (253 females and 221 males) between the ages of 6 and 10 years. Flat foot diagnosis was made using Staheli plantar index (PI), where values >1.15 were indicative of flat foot. The number of children diagnosed with flat foot was 106, yielding a prevalence rate of 22.4%. Flexible flat foot accounted for 93 (87.7%) of the positive diagnoses, whereas bilateral flat foot was present in 97 (91.5%) of the cases. There was a significant relationship between higher prevalence of pes planus and older age, with the 6-year-old group showing the highest prevalence. Boys were twice as likely to be diagnosed with flat foot as girls, and obese participants were three and a half times more likely to have flat foot compared with those of a normal weight. In summary, about one in every five public primary school children aged 6–10 years would be diagnosed with flat foot anomaly, and obesity further increased the risk. Preregistration flat foot screening, and periodic observation for onset of symptoms of progression, should be made available for primary school children.
Click to expand...

NewsBot · Feb 3, 2022

Does the way of weight-bearing matter? Single-leg and both-leg standing radiographic and pedobarographic differences in pediatric flatfoot
MatthiasPallamar et al
Gait & Posture; Available online 14 January 2022

Highlights
•Single-leg or both-leg standing alters radiographic and pedobarographic values
•A more pronounced flatfoot deformity is depicted by single-leg standing radiographs
•Medial foot pressure increased more in a both-leg standing position
•A both leg standing examination is preferred in children with flexible flatfeet
Click to expand...

Background
An exact definition is lacking for the term “weight-bearing” or different standing modalities when implementing foot radiographs for children and adults; moreover, only few studies have investigated the relationship between radiographic and pedobarographic measurements.

Research question
We hypothesised that the method of weight-bearing in single-leg and both-leg standing positions could influence the measurement results in radiographs and the distribution of foot pressure.

Methods
This prospective study evaluated 33 children (66 feet) with flexible flatfoot deformities scheduled for subtalar screw arthroereisis surgery. Radiographs in the lateral and anteroposterior (AP) views were assessed independently in the single-leg and both-leg standing positions. Static pedobarography was performed as that for measuring weight-bearing. Standardised radiographic angles and pedobarographic data were analysed and correlated.

Results
There were differences in radiographic measurements between the single-leg and both-leg standing positions, including the AP talocalcaneal angle (p=0.032), AP talus-first metatarsal base angle (p=0.003), AP talus-first metatarsal angle (p=0.003), lateral calcaneal pitch angle (p=0.001), talus-first metatarsal index (p=0.004), and talocalcaneal index (p=0.029). Moreover, differences between these two standing modalities were found in most of the static pedobarographic data, including the contact area (p=0001), maximal force (p=0.001), and peak pressure (p=0.007). Overall, medial foot pressure increased more in both-leg standing than in the single-leg standing position, whereas radiographic measurements showed a more pronounced flatfoot deformity in the single-leg standing position. The AP talus-first metatarsal angle was the only angle or index with a significant association to some pedobarographic measurements in both standing modalities.

Significance
As there are significant differences between single-leg standing and both-leg standing radiographic and static pedobarographic values, observers have to be precise in the definition of “weight-bearing” to gain reproducible and comparable study values in children and adults. We recommend acquiring both-leg standing foot radiographs because children with flexible flatfeet can stand more steadily in this position than in the single-leg standing position.
Click to expand...

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Diagnosis of Exercise Induced Leg Pain

Assessment of Visual Diagnosis by Podiatrists for HPV and Onychomycosis:

Need Diagnosis

Diagnosis and Management of Diabetic Foot Complications ADA

Diagnosis of Medial Tibial Stress Syndrome

Hallux Limitus Diagnosis

Genetic Disorder But No Diagnosis.

Share This Page