What's New in Pediatric Flatfoot?

NewsBot · Aug 23, 2015

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What's New in Pediatric Flatfoot?
Bauer K, Mosca VS, Zionts LE.
J Pediatr Orthop. 2015 Aug 20

BACKGROUND:
Children with flatfeet are frequently referred to pediatric orthopaedic clinics. Most of these patients are asymptomatic and require no treatment. Care must be taken to differentiate patients with flexible flatfeet from those with rigid deformity that may have underlying pathology and have need of treatment. Rigid flatfeet in infants may be attributable to a congenital vertical talus (CVT); whereas those in older children and adolescents may be due to an underlying tarsal coalition. We performed a review of the recent literature regarding evaluation and management of pediatric flatfeet to discuss new findings and suggest areas where further research is needed.
METHODS:
We searched the PubMed database for all papers related to the treatment of pediatric flatfoot, tarsal coalition, and CVT published from January 1, 2011 to December 31, 2014, yielding 85 English language papers.
RESULTS:
A total of 18 papers contributed new or interesting findings.
CONCLUSIONS:
The pediatric flexible flatfoot (FFF) remains poorly defined, making the understanding, study, and treatment of the condition extremely difficult.Pediatric FFF is often unnecessarily treated. There is very little evidence for the efficacy of nonsurgical intervention to affect the shape of the foot or to influence potential long-term disability for children with FFF. The treatment of tarsal coalition remains challenging, but short-term and intermediate-term outcome studies are satisfactory, whereas long-term outcome studies are lacking. Management of the associated flatfoot deformity may be as important as management of the coalition itself. The management of CVT is still evolving; however, early results of less invasive treatment methods seem promising.
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NewsBot · Apr 10, 2018

S2-Guideline: Pediatric Flat Foot
Hell AK et al
Z Orthop Unfall. 2018 Apr 9. doi: 10.1055/s-0044-101066

In pediatric flat foot a differentiation has to be made between the flexible and the rigid form. The diagnosis is based on the history, clinical examination as well as pedobarography, gait analysis and imaging techniques. It is important to rule out neuropediatric conditions such as muscular dystrophies, Ehlers-Danlos- or Marfan syndrome. In children six years of age and younger a flexible flat foot is nearly always physiological (97% of all 19 months old children). Up to the age of ten years the medial column of the foot is developing. Only a minority of children (4% in ten year olds) has a persistent or progressive deformity. Beyond to age of ten there is a danger of deformity decompensation as well as an increased rigidity. Only a minority of children develops some pain (< 2%). A clear risk factor for persistent pediatric flat foot is obesity (62% of six year old children with flat foot are obese). Pathogenetic factors include muscular, bony or soft tissue conditions. However, there specific rule is still unclear. Prevention consists in a thorough parent information about the normal development as well as encouragement of regular sportive activities. Soft and large enough shoes should be carried as a protection. Barfoot walking has to be encouraged on uneven grounds. If physiotherapy is needed different methods can be applied. Orthosis treatment should include a proprioceptive approach. Surgical interventions in children are rare. If surgical treatment is planned a detailed algorhythm should be used before utilizing one of the many different surgical methods.
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NewsBot · Jun 9, 2021

Paediatric Flatfeet - a 2020 guide for clinicians to identify the 'Boomerangs'
Angela M Evans
J Am Podiatr Med Assoc. 2021 May 5;20-103

The paediatric flatfoot has long occupied a place in the medical literature, with concerns about the significance of its appearance. At the end of the first decade of the 21st century, a paper in this journal provoked active debate about the paediatric flatfoot as part of development, and proposed a considered titration of presenting cases in effort to justify treatment and appreciated the range and expected change in normal foot posture with growth. A decade later, the availability of normative paediatric foot posture data, and the prospective findings to confirm lessening flatfeet with age, encourage a structured and considered approach to this frequent primary care presentation. The pragmatic concept of the boomerang is built upon the research identifying the paediatric flatfeet likely to be symptomatic, thus requiring intervention, and filtering from those likely to remain asymptomatic. Differential diagnoses are advisedly considered, and gait remains the hallmark outcome. In this contemporary guide, an eight step strategy has been developed to improve the approach to community paediatric flatfeet concerns. Further, the three 'boomerang' flatfeet factors delineating symptomatic from asymptomatic flatfeet, and applicable cut-off levels, are availed for practical reference and use. Given the recognised state of overdiagnoses and resulting unnecessary treatment that pervades the 21st century, it is timely for clear '20:20' vision for the presentation of the paediatric flatfoot.
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NewsBot · Jun 10, 2021

Results of the Italian Pediatric Orthopedics Society juvenile flexible flatfoot survey: diagnosis and treatment options
Vito Pavone et al
J Pediatr Orthop B. 2021 Jun 7

Objectives: To collect and analyze current diagnosis and treatment options of symptomatic flexible flatfoot (FFF), as well as to identify treatment expectations, among the members of the Italian Pediatric Orthopedics Society (SITOP).

Methods: Diagnosis and treatment preferences were recorded according to a web-based survey. The survey was divided into six main sections: (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; (6) treatment options.

Results: One hundred and ten out of 248 SITOP members answered to the questionnaire. Age (85.5%), pain at the level of the plantar arch or fascia (61.8%), fatigue (59.1%) were the clinical parameters of crucial importance. Heel valgus (85.4%), flexibility (61.8%) and forefoot supination (47.3%) were identified as the most important foot aspects. Ninety-two responders (83.6%) identified the 'improved ability to walk longer without symptoms or discomfort' as the principal treatment expectation. Pain evaluated through the visual analog scale (VAS) was considered crucial in 31.8% of cases. All respondents confirmed they also treat patients with FFF surgically; in particular, 97.3% of SITOP affiliates declare to perform arthroereisis followed by lateral column lengthening (29.1%) and medializing calcaneal osteotomy (9.1%).

Conclusions: Although in this survey heterogeneous findings for diagnosis and treatment of patients with symptomatic FFF within SITOP members were found, a large preference for age, heel valgus, flexibility as clinical aspects and parameters, as well as nonoperative treatment and arthroereisis, was reported.
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NewsBot · Feb 4, 2022

No, children don’t magically ‘grow out’ of flat feet. Treatment is key to avoid long-term pain

NewsBot · Feb 8, 2022

NewsBot said: ↑

No, children don’t magically ‘grow out’ of flat feet. Treatment is key to avoid long-term pain
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Do all paediatric flatfeet need management? My thoughts on the self professed controversial article

NewsBot · May 17, 2022

Overview and Treatment for A Flatfoot in Children
Nguyen Ngoc Hung et al
Int. J. of Orth. 2022 May 6; 9(2): 1614-1631

Although the exact incidence of flatfoot in children is unknown, it
is a common finding. All children have only minimal arch at birth,
and more than 30% of infants have calcaneovalgus deformities in
both feet. The condition is painless and usually clears up on its own
without treatment; It is very rarely necessary to cast correction. Most
children who visit an orthopedist for an evaluation for flatfoot will
have flexible flatfoot without treatment. However, the examining
physician must rule out other conditions that require treatment, such
as congenital longitudinal defects, dorsal alignment, and misaligned
feet. Left untreated, congenital vertical nails can lead to an awkward
gait; Manipulation and casting have been tried, but most authors
now agree that surgical treatment is necessary. Although dorsal
alignment may be asymptomatic in adulthood, the anatomy will
of talocalcaneal union treatment is less predictable. Skewfoot
should be treated with manipulation and serial casting as soon as
discovered. In older children, it may be necessary to stabilize the
hindfoot and realign the midfoot. Surgical management is rarely
indicated for true soft flat feet. Many tendon transfer methods and
reconstructive procedures have been advocated, but none have been
shown to be equally successful. Nor is there any kind of support
that has been shown to alter arch architecture. Although parents are
often concerned about flat feet in their children, children often have
no symptoms and no indication for treatment. In most cases, the best
treatment is simply taking enough time to convince the family that no
treatment is needed.
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NewsBot · Aug 9, 2023

Pediatric Flatfoot: Is There a Need for Surgical Referral?
Manuel Vergillos Luna et al
J Clin Med. 2023 Jun 1;12(11):3809

Pediatric foot deformities are a common finding, concerning up to 44% of preschool aged children. The absence of accepted international guidelines, as well as heterogeneity in definitions and measurements, makes management of pediatric flatfoot a challenge, and decisions surrounding specialized care referral confusing and biased. The objective of this narrative review is to provide guidance to primary care physicians treating these patients. A non-systematic review of the literature regarding the development, etiology, and clinical and radiographic assessment of flatfeet using the PubMed and Cochrane Library databases was performed. The exclusion criteria for the review were adult populations, papers detailing the outcome of a specific surgical procedure, and publications prior to 2001. The included articles showed great heterogeneity in definition and proposed management, which makes the study of pediatric flatfoot challenging. Flatfoot is a common finding in children under 10 years old, and should not be considered pathological unless stiffness or functional limitation are present. Surgical referral should be reserved to children with stiff or painful flatfoot, while simple observation is indicated for flexible, asymptomatic flatfeet.
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