Search Results
The Flat-Footed Child—To Treat or Not to Treat
What Is the Clinician to Do?
Background: This article addresses the treatment of pediatric flatfoot with foot orthoses and explores the existing knowledge from an evidence-based perspective.
Methods: Studies investigating the use of foot orthoses for pediatric flatfoot were reviewed and ranked on the evidence hierarchy model according to research designs. Clinical guidelines and efficacy rating methods were also reviewed.
Results: Three randomized controlled trials exist, and a systematic review and possible meta-analysis of these studies is in progress. The results of these studies, although not definitive for the use of orthoses for pediatric flatfoot, provide useful direction. Clinical guidelines for the management of flatfoot are a useful supplement for clinical decision making and have been enhanced.
Conclusion: This article presents a pragmatic and evidence-based clinical care pathway for clinicians to use for pediatric flatfoot. It uses a simple “traffic light” framework to identify three subtypes of pediatric flatfoot. The clinician is advised to 1) treat symptomatic pediatric flatfoot, 2) monitor (or with discretion simply treat) asymptomatic nondevelopmental pediatric flatfoot, and 3) identify and advise asymptomatic developmental pediatric flatfoot. (Children with juvenile arthritis should receive customized foot orthoses.) This approach will dispel much of the contention surrounding the use of foot orthoses in children. (J Am Podiatr Med Assoc 98(5): 386–393, 2008)
Background
Clinicians routinely assess foot posture as part of their assessment and management of foot pathologies. Flat or high-arched foot postures have been linked to kinematic deviations and increased risk of foot injuries. The Foot Posture Index (FPI) is a valid clinical tool used to classify feet into high-arched, normal-arched, and flat foot groups and predicts foot function during walking well. Walking and running are distinct locomotion styles, and studies have not been performed to correlate FPI to foot function during running. This study aims to investigate the association of FPI scores to foot kinematics during running. The results will further inform clinicians who perform static assessment of feet of individuals who are runners.
Methods
Sixty-nine participants had their feet assessed using the FPI scoring system. Based on these scores, the feet were categorized as flat foot, normal-arched, and high-arched. Rearfoot eversion and forefoot dorsiflexion (arch flattening) of the foot were analysed during slow running between 1.4 and 2.2 m/sec. The Pearson correlation was used to analyse the FPI scores on an interval scale, with Cohen's d used to report effect size. One-way analysis of variance and a Bonferroni post hoc test was used to analyze data by category. Level of significance was set at P < .05.
Results
Thirty-four flat feet, 26 normal-arched feet, and nine high-arched feet were analyzed. The FPI scores correlated significantly with rearfoot eversion (moderate effect size) and forefoot dorsiflexion (low effect size). Rearfoot eversion was greatest in the flat foot, followed by the normal-arched foot and the high-arched foot. Forefoot dorsiflexion was significantly higher in the flat foot compared with the high-arched group.
Conclusions
Foot Posture Index scores are positively correlated with rearfoot eversion and forefoot dorsiflexion during running. Clinicians can use this information to aid their foot assessment and management of individuals who are runners.
Abstract
Background: In patients with rheumatoid arthritis (RA), the pathological progression of lower limb biomechanics is established. Although specific aspects of RA gait patterns have been studied and described, we are aware of no studies of gait pattern compensations over the entire disease course. This study aimed to describe a model that could predict the evolution of lower limb pathomechanics in patients with RA.
Methods: A literature review was conducted of electronic databases (MEDLINE, PEDro, Trip Database, DOAJ, BioMed Central, PLOS clinical trial, ScienceDirect, and CRD York University, AHRQ, NICE, Cochrane Library) to October 3, 2023.
Results: A theory was developed that all people with RA induce or augment gait evolution syndromes following the same biomechanical course. Specifically, we postulate the “rheumatoid equinus syndrome,” the “rheumatoid abnormal pronation syndrome” and the “rheumatoid shuffle syndrome,” which have never been described before.
Conclusions: A new model of the evolution of gait compensation in RA is proposed. An important challenge of RA is that it increases the risk of ulcerative lesions, falls, pain, fractures, and healthcare costs. The proposed model can be used to reduce morbidity in this patient group by helping to explain and reduce the pain, deformity, and ankylosis of foot RA.
A case of a child with Becker's muscular dystrophy is presented. Because of the genetic and clinical similarity with the more common Duchenne muscular dystrophy, these two diseases are compared. Since muscular dystrophy often initially presents with toe walking, flat-foot, and waddling gait, podiatrists may be the first physicians to see the child and provide early diagnosis.
Abstract
Background: The human foot has three arches. The medial longitudinal arch is the longest, the highest, and the most important. The development of a normal foot arch is greatly affected by genetic inheritance, differences in the environment, socioeconomic development, body weight, sex, ethnicity, and culture. The purpose of this study was to compare the arch type between shoe-wearing and barefooted individuals.
Methods: A cross-sectional study was conducted. The data obtained were checked for clarity and consistency before analysis. The analysis was done using descriptive statistics and chi-square. p-values less than 0.05 were considered to be statistically significant.
Result: From a total of 446 subjects, 217 (48.7%) were males, 131 (29.6%) were urban residents and 226 (50.6 %) were shoe wearers. From the total sample, 46.2%, 42.8%, and 11% are high, normal, and flat-arched individuals, respectively. Of the shoe wearers, 6.7% have a flat arch while 4.3% of the barefooted subjects are flat-arched. Of the total flat-arched subjects, 8.3% are males and 2.7% are females. Of the urban residents, 17.5% have a flat foot and 8.3% of rural residents were flat arched. Among the shoe wearers, 8.8% use closed-toe shoes, and 4.4% that wear sandals are flat-arched.
Conclusion: The result indicates sex, type of shoes, wearing shoes, and being barefooted affected the development of the foot arch.
The pediatric 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, an article in this journal provoked active debate about the pediatric flatfoot as part of development, and proposed a considered titration of presenting cases in an effort to justify treatment and appreciated the range and expected change in normal foot posture with growth. A decade later, the availability of normative pediatric foot posture data, and the prospective findings to confirm lessening flat feet with age, encourage a structured and considered approach to this frequent primary care presentation. The pragmatic concept of the “boomerang” is built on the research identifying pediatric flat feet 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 pediatric flatfoot concerns. Furthermore, the three boomerang flat feet factors delineating symptomatic from asymptomatic flat feet, and applicable cutoff levels, are availed for practical reference and use. Given the recognized state of overdiagnosis and resulting unnecessary treatment that pervades the 21st century, it is timely for clear 20/20 vision for the presentation of pediatric flatfoot.
