Background: Pediatric flatfoot is a common deformity. Unfortunately, the common opinion has been that most children with this faulty foot structure will simply out-grow it, despite no radiographic evidence to support this claim. Every step on a deformed foot leads to excessive tissue strain and further joint damage. Many forms of conservative and surgical treatments have been offered. This study was aimed at investigating the effectiveness of non-surgical and surgical treatment options.
Main Text: faulty-foot structure is the leading cause of many secondary orthopedic deformities. A wide range of treatments for pediatric flatfeet have been recommended from the “do-nothing” approach, observation, to irreversible reconstructive surgery. Most forms of conservative care lack evidence of osseous realignment and stability. A conservative surgical option of extra-osseous talotarsal joint stabilization provides patients an effective form of treatment without the complications associated with other irreversible surgical procedures.
Conclusion: Pediatric flatfeet should not be ignored or downplayed. The sooner effective treatment is prescribed, the less damage will occur to other parts of the body. When possible, a more conservative corrective procedure should be performed prior to irreversible, joint destructive options.
Pediatric flatfeet are a very common concern for parents and one of the most frequent presenting complaints to a pediatric practice (1). Unfortunately, parents are told that it isn't necessary to treat and to simply ignore this foot deformity. One author even concluded “the best treatment is simply taking enough time to convince the family that no treatment is necessary” (2). Other authors suggest that surgical intervention is rarely necessary, that there is very little evidence for the efficacy of non-surgical care but that non-surgical care should still be considered (2–4). While a child's foot shape and size change over the first several years of life, there is a recognizable difference between normal development and pathology at any age. Foot and ankle specialists know that sooner or later, flat and misaligned feet will slowly lead to other pathologies within the foot and ankle and proximal structures (5).
Walking is one of the most common unconscious functions of our body. We are told to take 10,000 steps a day, to keep healthy (6). The stability and alignment of the foot is very important because the foot is the foundation to the upright body. Failure to identify and treat foot and ankle instability and misalignment will lead to long-term tissue pathology. Foot misalignment has been shown to reduce propulsive phase push off muscle power by 35%, which seems to be an obvious gait inefficiency (7). Tissue strain leads to pain, increased deformity, and eventually decreased activity level. The body's metabolic rate decreases as a result which leads to other health risks such as obesity, diabetes, hypertension, and heart disease (8, 9).
The goal in treating any disease is early identification and intervention with a method proven to achieve the desired outcome that is measurable and makes sense. There is a long evolution in the internal correction of this faulty-foot alignment disease. The use of extra-articular realignment and stabilization techniques have stood the test of time. The medical necessity and evidence basis of extra-osseous talotarsal stabilization has been established (10). The time has come to embrace this minimally invasive, reversible solution as an early intervention to pediatric flatfeet.
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