Foot orthoses and asymptomatic pediatric flatfoot

ots for kids

geckos...

 

Totally confused on the "geckos" comment but wanted to add...

I think we all to often get caught up in our little "subtalar joint position" world and forget the body that is connected to this little joint and what potential impact that it's position has.

I agree fully that a mildy pronated asymptomatic foot should be left alone. Moderate to severly pronated asymptomatic? I guess we need to continue to look at what is asymptomatic. Do we just consider pain or do we continue to look at how the 4 year old navigates stairs, how is their jumping or hopping, how long can they hold a single leg stance, do they have high guard arm posture when going around corners or running? When a foot isn't functioning as a stable platform, how does a child learn these vital gross motor skills well.

I would love to see some research done on this...or if anyone can point me to some that would be great. Anecdotally though, there is nothing more satisifying as a practitioner, to see a 5 year old that can't balance or hop, within 1-2 months with no excersices etc but some form for orthoic/triplanar wedge therapy only come in and be able to hop down the hall and stand with their eyes closed. Works for me....

 

Isn't the point also the potential effects on the other structures of the lower limb over time?

 

But do we know without a doubt, the potiental effects that have been proven, to be related to the foot posture alone?

I think it is something we have to continue to ask ourselves in the absence of evidence.

 

I struggle with this issue also. During the 90's the University of Western Sydney Campbelltown advised no intervention to asymptomatic flat feet, but recently at the state conference in Sydney Dr Josh Burns presented a paper on his research with the conclusion that we should treat asymptomatic flat feet. I agree it is one of those issues that will never be understood. Perhaps if an ethics committee approves to treat one identical twin, & not the other? Now we only need to find a parent who would allow this! Often I give parents both views & allow them to decide.

 

One can find many literature refferences to flatfoot and its eitology.
A symptomatic flatfoot foot should be clinically evaluated and diagnosed [sometimes the diagnosis might be difficult to pinpoint initally] but eventually the diagnosis should be attained. With the correct diagnosis one would prescribe the treatment most appropriate. The diagnosis would result in therapy specific to the diagnosis , either mechanical/surgical/medical/physiotherapuetical.
Individuals with a Painful foot or feet should be examined without any preconcieved bias/ clinical diagnosis should be consistent with the chief complaint , examination and observation and the treatment should be based opon clinical dignosis with either further testing or consultation.
Just because a patient is sent to my clinic for treatment dosnot mean that the patient has an INTRINSIC FOOT PROBLEM.

Sincerely;
Steve Levitz
NYCPM 1979