The Thanks Classification for Paediatric Flexible Flatfoot

NewsBot · May 16, 2023

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The Thanks Classification, A New Method For
Observing Paediatric Flexible Flatfoot
Junlang Zhu and Jiewei Xie
Research Square

Background: Flatfoot shows the collapse or flattening of the medial longitudinal arch. 90% of emergency
visits for foot pain in children are attributed to flatfoot. The diagnosis and classification of flexible flat
feet in children is currently usually based on imaging or clinical measurements. Most of the existing
classification methods of flexible flat feet in children are limited to single plane classification, without
considering the influence of rotation and vision deformity. The aim of this research was to to summarize
the classification of paediatric flexible flat foot and provide ideas for the treatment strategy of flat feet in
children.
Method foot appearance photos and footscan insole system test data of 126 children with flexible flat
feet (252 feet) from May 2022 to October 2022 were collected. foot-scan insole system test were used to
detect flatfoot and posterior foot heel valgus angle. Based on foot appearance photographs and footscan insole system tests. According to whether the foot arch is flat, whether the forefoot with abduction,
whether the posterior foot is eversion, and other factors, the “Thanks” the classification of children's flat
foot is described. Type A: footscan insole system test results showed flat foot, posterior foot heel valgus
angle less than 5°, and without abduction of the forefoot; Type B: footscan insole system test results
showed flat foot, combined with abduction of the forefoot, posterior foot heel valgus angle less than 5°;
Type C: footscan insole system tests results showed flat foot, posterior foot heel valgus angle more than
5°, and without abduction of forefoot; Type D: footscan insole system tests results showed flat foot,
posterior foot heel valgus angle than 5°, and combine with abduction of forefoot. Three experienced foot
and ankle surgeons and three rehabilitation doctors independently observed the appearance photos and
footscan insole systemtests data of 126 patients with flexible flat feet, determined the flat foot type
according to the “Thanks” classification, and randomly reclassified after 4 weeks interval. Finally, 45
cases were randomly selected for internal validation (2 junior orthopedic surgeons), and the intraclass
correlation efficient value was used to assess the reliability.
Result:The paediatric flexible flat feet were divided into 4 types according to the “Thanks” classification.
The intraobserver and interobserver consistency of the Thanks classification was good (ICC 0.895 for
foot and ankle surgeons, 0.918 for rehabilitation physicians; The first ICC of foot and ankle surgeons and
rehabilitation doctors was 0.903, and the second ICC was 0.856. ICC of internal inspection is 0.873).
Conclsion:The “Thanks” the classification of paediatric flexible flat foot is easily learned and accepted by
both surgical and non-surgical physicians. It has a good significance for evaluating the functionality of
the paediatric flexible flat foot and guiding the selection of the treatment.
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