Flatfoot In Children Research Articles

A Combined Reconstructive Procedure with Rerouting of Tibialis Anterior Tendon in Management of Severe Flexible Flatfoot in Children in Damietta

A Combined Reconstructive Procedure with Rerouting of Tibialis Anterior Tendon in Management of Severe Flexible Flatfoot in Children in Damietta

Dynamics of feet dorsiflexion after percutaneous Achilles lengthening for correction of flat feet in children

BACKGROUND: Achilloplasty is one of the most common procedures in the reconstruction of various foot deformities. Achilles tendon lengthening is often used in most reconstructive interventions in patients with flatfeet. Literature data reflecting the dynamics of foot dorsiflexion after percutaneous achilloplasty are limited. AIM: This study aimed to determine the foot dorsiflexion dynamics in children with flatfeet at different time points after foot reconstruction in combination with percutaneous Achilles tendon lengthening. MATERIALS AND METHODS: The study included the observation results of 159 children (260 feet) aged 12 (9–17) years having flatfeet with Achilles tendon shortening after flatfoot reconstruction and percutaneous Achilles tendon lengthening. Dynamic follow-up was performed for 3 years after foot reconstruction. The obtained data were analyzed statistically by nonparametric one-factor analysis of variance, Kruskal–Wallis and post hoc test, pairwise comparisons, and Dwass–Steel–Critchlow–Fligner test. RESULTS: At follow-up after Achilles tendon lengthening, significant differences were obtained in the magnitude of the initial foot dorsiflexion up to 2 years after surgery, and other indicators were not significantly different. Foot dorsiflexion with tarsal joint stabilization was significantly different at all stages of follow-up compared with baseline. Foot dorsiflexion tended to decrease throughout the follow-up period. CONCLUSIONS: After reconstructive interventions on the feet in combination with percutaneous Achilles tendon lengthening, the dorsiflexion of the feet decreased over time. At 2 and 3 years after Achilles surgery, dorsiflexion was not significantly different from baseline. The angle of dorsiflexion of the feet with the tarsal joint stabilization 3 years after Achilles tendon lengthening was significantly different from the initial level, but throughout the follow-up there was also a tendency to its gradual decrease.

PENYULUHAN DAN IMPLEMENTASI PENGGUNAAN RIGID CUSTOM FOOT ORTHOSIS DALAM MENGURANGI DERAJAT FLATFOOT

The aim of this service activity is to increase understanding about the use of rigid custom foot orthoses in reducing the degree of flatfoot in students with flat feet. Method: counseling/education regarding the effect of using rigid custom foot orthoses in reducing the degree of flat foot for teachers. After being given counseling, the teachers were guided and trained to apply the use of rigid custom foot orthoses in order to increase understanding regarding the need to use custom foot orthoses for flat foot sufferers. Then intervention was carried out in the form of providing custom foot orthoses to students who experienced flat feet. Results: more than 80% of participants understood about one of the musculoskeletal disorders of the foot, namely flat foot, more than 75% of participants were able to understand the effect of using a rigid custom foot orthosis in reducing the degree of flat foot, after follow-up for approximately 1 month several children conveyed comfortable and always using the tool, they said that the arches of his legs were starting to appear. Conclusion: outreach activities and implementation of the use of rigid custom foot orthoses in reducing the degree of flat foot can help the community in dealing with flat feet in children.

Dynamic Gait Analysis in Paediatric Flatfeet: Unveiling Biomechanical Insights for Diagnosis and Treatment.

Flatfeet in children are common, causing concern for parents due to potential symptoms. Technological advances, like 3D foot kinematic analysis, have revolutionized assessment. This review examined 3D assessments in paediatric idiopathic flexible flat feet (FFF). Searches focused on paediatric idiopathic FFF in PubMed, Web of Science, and SCOPUS. Inclusion criteria required 3D kinematic and/or kinetic analysis during posture or locomotion, excluding non-idiopathic cases, adult feet, and studies solely on pedobarography or radiographs. Twenty-four studies met the criteria. Kinematic and kinetic differences between FFF and typical feet during gait were outlined, with frontal plane deviations like hindfoot eversion and forefoot supination, alongside decreased second peak vertical GRF. Dynamic foot classification surpassed static assessments, revealing varied movement patterns within FFF. Associations between gait characteristics and clinical measures like pain symptoms and quality of life were explored. Interventions varied, with orthoses reducing ankle eversion and knee and hip abductor moments during gait, while arthroereisis normalized calcaneal alignment and hindfoot eversion. This review synthesises research on 3D kinematics and kinetics in paediatric idiopathic FFF, offering insights for intervention strategies and further research.

Flatfoot in children

The diagnosis of flatfoot in children is made clinically. In most cases it is an age-appropriate benign physiological variant, as long as it can be passively and actively redressed and the child does not show any neurological abnormalities, especially under the age of 6 years. Treatment is only indicated for symptomatic variants. In the case of rigid flatfeet, further diagnostics are necessary to exclude neurological or structural causes. Subtalar arthroereisis has become established and is an effective but slightly invasive procedure. Further options include the lengthening and medial translational osteotomy of the calcaneus or the Cotton operation; however, the indications must always be critically questioned, especially for surgical but also for conservative treatment, even if it is the wish of the family.

Risk factors of flat foot in children

Background: The condition of flat feet in children will affect activity, development, and weight management. Even though there are often no symptoms, if the condition leads to a severe stage, it will interfere with the function of the feet. The impacts that can be caused by flat feet include walking that is not good, being quickly tired, impaired agility, and poor balance, which affects children's activities. Therefore, knowing the factors that can affect flat feet is necessary. This study aimed to determine the risk factors for flat feet in children. Methods: The study used a literature review design using secondary data from published literature. The literature search was conducted online through PubMed, ScienceDirect, and Google Scholar, using the keywords “flat foot”, “plantar index”, and “risk factors”, which were selected based on inclusion and exclusion criteria. Results: Aged 6-12 years are described as having a higher risk of experiencing flat feet. The male sex has a greater risk than women, the use of closed footwear also has a greater risk, and low physical activity is one of the risk factors. Besides that, being overweight and obese can increase the risk of flat feet. Conclusion: The strongest risk factor for flat feet was age, which was also influenced by gender, footwear shape, activity, and nutritional status.

Innovative technology «Plantar Support Load Simulator (Corvit)» in medical rehabilitation of children with flat foot

For the first time, the possibility of using the innovative technology «Plantar Support Load Simulator (Corvit)» in the medical rehabilitation of children with flat feet has been scientifically substantiated. Purpose. Scientific rationale for the use of innovative technology «Plantar Support Load Simulator (Corvit)» for flat feet in children. Materials and Methods. The clinical study included 30 children with flat feet aged 7 to 17 years. The study group consisted of 15 children who were treated with the plantar support load simulator «Corvit»; the comparison group (15 children) had no exposure to the plantar support load simulator «Corvit». The children of groups 1 and 2 received a standard complex of therapeutic exercises for flat feet in children. To determine the effectiveness of using support stimulation with the plantar support load simulator «Corvit», we carried out the assessment of orthopedic status, subjective determination of the severity of pain syndrome according to the VAS, determination of the functional state of the feet in statics and dynamics (DIERS pedoscan of the DIERS formetric 4D system), and the assessment of the state of microcirculation in the foot area using laser Doppler flowmetry. Results and discussion. The conducted prospective open randomized comparative study allowed us to establish relief of pain during physical activity in the area of the legs and feet and the reduction of fatigue in most children under the influence of mechanical stimulation of support zones. According to the assessment of the orthopedic status by the DIERS pedoscan of the DIERS formetric 4D system, an improvement in the support, spring, and balancing functions of the feet was revealed, characterized by an improvement in podometry and stabilometry indicators. An improvement in the state of microcirculation has been proven according to laser Doppler flowmetry in the form of an improvement in perfusion and regulatory mechanisms of the microcirculatory bloodstream. A significantly more pronounced therapeutic effectiveness of medical rehabilitation of children using the plantar support load simulator «Corvit» for flat feet in children (86.7 %), in relation to the comparison group (53.3 %), p < 0.05, was established.

PENINGKATAN PENGETAHUAN TENTANG STUNTING PADA IBU KEK DAN FAKTOR RESIKO TUMBUH KEMBANG FLAT FOOT PADA ANAK

Pregnant women who experience chronic energy deficiency (KEK) can put their baby at risk of stunting. Stunting is a child's developmental disorder caused by a lack of nutritional intake, infection, or inadequate stimulation. Flat feet in children are a consequence of various factors such as obesity or heredity. It can be classified as a physiological or pathological disorder. Foot problems such as flat feet or flat feet are one of the main causes of various other complaints that are often underestimated. The implementation method used in this Community Service activity is presentation, discussion, and mentoring. It was concluded that increasing stunting knowledge for SEZ pregnant women and flatfoot risk factors in children meant that the learning process which lasted for two sessions with 20 participants of pregnant women with SEZs could be carried out smoothly and well.

The Relationship Between Fundamental Movement Skills, Body Composition, and Flat Feet in Children Aged 3-6 Years

Background and Aims Children have a very high ability to learn. With correct planning, we can provide conditions for them to perform various movement patterns to increase their motor skills and thus reduce the risk of skeletal injuries and obesity. This study aims to investigate the relationship between fundamental movement skills, body composition, and flat feet in children. Methods This is a descriptive-correlational study on 50 healthy children (girls and boys) aged 3-6 (mean age: 5.13±0.831 years) who were selected using a convenience sampling method from Novak Kindergarten in Tehran, Iran. To evaluate the fundamental movement skills, Ulrich (2015)’s test of gross motor development was used. The InBody 270 device was used to examine the body composition, and a digital photo scanner was used to evaluate the flat feet deformity. Data analysis was performed by using the Pearson correlation test and multiple regression analysis in SPSS software, version 24. P≤.0.05 was considered statistically significant. Results The results showed a negative and significant relationship of body weight (P=0.001), body mass index (P=0.001), body fat percentage (P=0.001), and flat feet (P=0.009) with fundamental movement skills. Also, the relationship between musculoskeletal mass and fundamental movement skills was positive and significant (P=0.001), but its relationship with flat feet was negative and significant (P=0.004). The body weight had the highest power to predict fundamental movement skills, and musculoskeletal mass had the highest power to predict flat feet (P=0.001) in preschool children. Conclusion It seems that, by improving fundamental movement skills and musculoskeletal mass index, the development of flat feet and overweight in preschool children can be prevented.

The effects of foot orthoses on radiological parameters and pain in children with flexible flat feet: a systematic review and meta-analysis.

This study aimed to investigate the impact of foot orthoses on foot radiological parameters and pain in children diagnosed with flexible flatfoot. A comprehensive search was conducted across several databases, including PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO, covering publications from the inception of each database up to 8 June 2024. The study focused on randomized controlled trials investigating the use of foot orthoses for treating flexible flat feet in children. Four researchers independently reviewed the identified literature, extracted relevant data, assessed the quality of the studies, and performed statistical analyses using RevMan 5.4 software. Six studies involving 297 participants were included. The methodological quality of the included literature ranged from moderate to high. Radiological parameters of the foot improved significantly in older children with flexible flat feet following foot orthotic intervention compared to controls, particularly in the lateral talar-first metatarsal angle [mean difference (MD) = -2.76, 95% confidence interval (95% CI) -4.30 to -1.21, p = 0.0005], lateral talo-heel angle (MD = -5.14, 95% CI -7.76 to -2.52, p = 0.0001) and calcaneal pitch angle (MD = 1.79, 95% CI 0.88-2.69, p = 0.0001). These differences were statistically significant. Additionally, foot orthoses significantly improved the ankle internal rotation angle and reduced foot pain in children with symptomatic flexible flatfoot (MD = -2.51, 95% CI -4.94 to -0.07, p = 0.04). The use of foot orthoses positively impacts the improvement of radiological parameters of the foot and reduces pain in older children with flexible flat feet. However, in younger children with flexible flat feet, the improvement from foot orthoses was not significant, likely due to challenges in radiological measurements caused by the underdevelopment of the ossification centers in the foot. Further studies are needed. Consequently, the results of this meta-analysis support the implementation of an early intervention strategy using foot orthoses for the management of symptomatic flat feet in older children. https://www.crd.york.ac.uk/, PROSPERO [CRD42023441229].

Lečenje bolnog ravnog stopala kod dece korišćenjem minimalno invazivne hirurške procedure nakon neuspelog konzervativnog lečenja

Introduction/Aim: Flexible flatfoot (FFF) is one of the most common skeletal deformities in the pediatric population, especially in preadolescence. This retrospective observational study evaluates results of a calcaneal subtalar extra-articular arthrodesis (subtalar arthroereisis) with one cannulated screw for the treatment of painful flexible flatfoot in children, after previously failed conservative treatment. Material and Methods: Preadolescent and adolescent pediatric patients were observed at the Department of Pediatric Orthopedic Surgery. The study included 28 feet of 15 children (5 girls and 10 boys) during a 6-year period, from 2016 to 2021 (average 36 months). The average age was 11.46 years (range 8-15 years). We performed the same operative technique under fluoroscopy for all patients. Radiographic parameters were taken before, after operative treatment, and after hardware removal. The following radiological parameters were measured: talo-calcanear (TC), talo-navicular (TN), talo-first metatarsal bone (T1MT) and calcanear pitch (CP) angles, in the anteroposterior and/or lateral views. Functional outcomes (extension and eversion of the foot) before surgery and after hardware removal were compared. Results: After operative treatment, the midfoot radiographic parameters were not statistically significantly altered; however, the subtalar joint and forefoot were statistically significantly improved: both radiologically and clinically. The range of extension and eversion of the foot were remarkably reduced without disturbing the morphological and functional aspects of the talocrural and subtalar joints. Conclusion: Extra-articular arthrodesis, using a cannulated screw is a minimally invasive technique, represents an optimal method for the operative treatment of symptomatic flexible flatfoot in children. This technique is simple, efficient and does not disrupt the anatomy of the foot.

Resection of Calcaneonavicular and Talocalcaneal Coalitions With Surgical Correction of the Hindfoot Valgus Deformity in One Step.

Calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions are the most common cause of rigid flatfoot in children. After resection, correction of the most frequent valgus-hindfoot deformity usually requires a second-step surgery. We report results of a retrospective study of patients treated with a one-step correction. Between 2008 and 2019, data were collected on 26 patients (19 male, 7 female) affected by CNC (n = 18) and TCC (n = 13), all with rigid symptomatic flatfeet. Average age at surgery was 12.5 ± 1.1 (SD) years (range, 9.8-15.2). All patients (26/26) underwent resection, 20 of 26 underwent at the same time subtalar extraarticular screw arthroereisis (SESA) for correction of residual hindfoot valgus deformity. Pre- and postoperative talocalcaneal angle according to Costa Bartani and Talar inclination angle in weightbearing were measured. Twenty-five of 26 patients had postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Pre- and postoperative talocalcaneal average angle for CNC was respectively 141.5 ± 7.7 degrees and 130.5 ± 5.2 degrees (P < .0001) and 143.7 ± 7.7 degrees and 129.7 ± 7.0 degrees (P < .0001) for TCC. Talar inclination average angle for CNC was 29.2 ± 5.3 degrees and 19.3 ± 1.6 degrees (P < .0001) and 31.2 ± 6.4 degrees and 21.4 ± 3.4 degrees (P < .0001) for TCC. Average follow-up (FU) was 4.7 ± 3.0 years (range, 6 months-11.9 years, median 4.9 years), with a mean age at FU of 17.2 ± 5.8 (SD) years (min 12.1, max 25.3, median 16.8 years). The mean AOFAS ankle-hindfoot score for CNC and for TCC was 96.6 (range 83-100) for resection and valgus correction as one-step procedure with no statistical difference (P = .5) between CNC and TCC. No patients had additional surgery for complications or recurrence. Symptomatic rigid flatfeet affected by CNC and TCC treated with coalition resection and minimally invasive subtalar arthroereisis (SESA) for residual hindfoot valgus correction in one step in adolescent age achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided. Level IV, retrospective study.

The resting calcaneal stance position (RCSP): an old dog, with new tricks

The objective of this study was to establish the accuracy of the resting calcaneal stance position (RCSP) for the assessment of flat foot (FF) in children, aligned to the validity of the foot posture index (FPI). The RCSP cut-off point was explored, in context of both FF prevalence and the relationship between FF and body weight. A total of 205 healthy children, aged 5 to 10 years, participated in a cross-sectional study. Correlation was performed between RCSP and FPI. ROC curve technique was calculated to assess differentiation between groups. A score equal to or greater than 7 on the FPI was used as the ‘gold standard’ for analysis. The correlation between FPI and RCSP was significant (r = 0.63; p < 0.01). The discrimination score on the ROC curve (6 points/degrees) shows that the model can be used to identify FF through RCSP, with a sensitivity of 67% and specificity of 85% returned. Conclusion: The results of this study indicate the role of RCSP for simple, accessible and quick screening of paediatric FF. This is especially pertinent for non-podiatric healthcare professional without specialised paediatric foot knowledge.What is Known:• Most children develop a normal arch quickly, and flat feet usually resolve on their own between 2 and 6 years of age.• The measurement used to diagnose flat foot in children must be accurate, consistent, and valid to characterize the standard foot position. The Resting Calcaneal Stance Position (RCSP) is another widely used measure to evaluate the position of the flat foot in children.What is New:• The RCSP cut-off point 6 shows a sensitivity of 67% and a specificity of 85% thanks to the FPI as the Gold standard.• The RCSP is useful for health professionals who are not specialised in pediatric foot health. The RCSP is useful to detect flat foot in children.

Arthroereisis with a Talar Screw in Symptomatic Flexible Flatfoot in Children

Background: Pes planovalgus, or flexible flatfoot, deformity is a common problem in pediatric orthopedic patients. There is no consensus on using the technique of arthroereisis in the treatment of symptomatic pes planovalgus. The aim of our study was to prospectively assess the functional outcomes following symptomatic pes planovalgus treatment with the use of the Spherus talar screw. Methods: Twenty-seven patients (11 females, 16 males), at a mean age of 10.5 years (7–14 years) were included in the prospective study. We assessed the level of physical activity (including sports) based on the University of California, Los Angeles (UCLA) activity scale, a 10-point level-of-activity VAS scale, and the Grimby physical activity scale. Pain was assessed based on a VAS pain scale; foot function was assessed with the revised Foot Function Index (FFI-R); and ankle joint mobility was measured. Results: The mean follow-up period was 18 months (14–26 months). There was a significant improvement in VAS-measured physical activity scores from 5.47 to 7 at follow-up, p = 0.048. There was a significant improvement in UCLA activity scale scores from 4.78 to 6.05 at follow-up, p = 0.045. Pain levels decreased from a mean VAS score of 4.73 prior to surgery to a mean score of 2.73 at follow-up, p = 0.047. The functional FFI-R scores showed a significant improvement from 140 points prior to surgery to 97.75 points at follow-up, p = 0.017. Comparison of the preoperative and follow-up values of the range of plantar flexion, adduction, and abduction in the operated limb also showed no significant changes in those individual parameters. The mean values of dorsiflexion, plantar flexion, adduction, and abduction at the ankle joint at follow-up, compared individually between the operated and non-operated foot showed no statistically significant differences. Conclusions: The use of a talar screw in the treatment of symptomatic pes planovalgus helps reduce pain and improve functional outcomes after treatment. Foot function assessments showed diminished pain, improved levels of physical and sport activity, and no effect on the range of motion after surgery in comparison with preoperative data. Arthroereisis with a talar screw is a valid surgical technique for the treatment of symptomatic pes planovalgus.

Comparison of the effectiveness of two kinds of surgeries for treatment of flexible flatfoot combined with painful accessory navicular bone in children

To compare the effectiveness of subtalar arthroereisis (STA) combined with modified Kidner procedure versus STA alone in the treatment of flexible flatfoot combined with painful accessory navicular bone in children. The clinical data of 33 children with flexible flatfoot combined with painful accessory navicular bone who were admitted between August 2018 and August 2021 and met the selection criteria were retrospectively analyzed. They were divided into a combination group (17 cases, treated by STA combined with modified Kidner procedure) and a control group (16 cases, treated by STA alone) according to the surgical methods. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, affected side of the foot, disease duration, and preoperative visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talonavicular coverage angle (TCA), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle), and heel valgus angle (HV). The operation time, incision length, intraoperative blood loss, number of intraoperative fluoroscopies, and perioperative complications were recorded in both groups. The anteroposterior, lateral, and calcaneal axial X-ray films for the affected feet were taken regularly, and T1MT, T2MT, TCA, Meary angle, Pitch angle, and HV were measured. The VAS score, AOFAS ankle-hindfoot score were used to evaluate pain and functional recovery before and after operation. Surgeries in both groups were successfully performed without surgical complication such as vascular, nerve, or tendon injuries. Less operation time, shorter incision length, less intraoperative blood loss, and fewer intraoperative fluoroscopies were found in the control group than in the combination group ( P<0.05). One case in the combination group had partial necrosis of the skin at the edge of the incision, which healed after the dressing change and infrared light therapy, and the rest of the incisions healed by first intention. All children were followed up 12-36 months, with a mean of 19.6 months. At last follow-up, VAS score and AOFAS ankle-hindfoot score significantly improved in both groups when compared with preoperative ones ( P<0.05), and the differences of these scores between before and after operation improved more significantly in the combination group than in the control group ( P<0.05). Imaging results showed that the T1MT, T2MT, TCA, Meary angle, and HV significantly improved in both groups at last follow-up when compared with preoperative ones ( P<0.05), and the Pitch angle had no significant difference when compared with preoperative one ( P>0.05). But there was no significant difference in the difference of these indicators between before and after operation between the two groups ( P>0.05). Both procedures are effective in the treatment of flexible flatfoot children with painful accessory navicular bone. STA has the advantage of minimally invasive, while STA combined with modified Kidner procedure has better effectiveness.

Corrective shoes and inserts as treatment for flexible flatfoot in infants and children

We performedaprospective study to determine whether flexible flatfoot in children can be influenced by treatment. One hundred and twenty-nine children who had been referred by pediatricians, and for whom the radiographic findings met the criteria for flatfoot, were randomly assigned to one of four groups: Group I, controls; Group II, treatment with corrective orthopaedic shoes; Group III, treatment withaHelfet heel-cup; or Group IV, treatment withacustom-molded plastic insert. All of the patients in Groups II, III, and IV hadaminimum of three years of treatment, and ninety-eight patients whose compliance with the protocol was documented completed the study. Analysis of radiographs before treatment and at the most recent follow-up demonstratedasignificant improvement in all groups (p 0.01), including the controls, and no significant difference between the controls and the treated patients (p 0.4).&#x0D; We concluded that wearing corrective shoes or inserts for three years does not influence the course of flexible flatfoot in children.

Tibialis anterior rerouting combined with calcaneal lengthening osteotomy as a single-stage reconstruction of symptomatic flexible flatfoot in children and adolescents

BackgroundSymptomatic flexible flatfoot in children and adolescents should be surgically managed only if conservative measures have failed. The aim of this study was to assess functional and radiological results of tibialis anterior rerouting combined with calcaneal lengthening osteotomy as s single-stage reconstruction of symptomatic flexible flatfoot.MethodsThe current study was a prospective study of patients with symptomatic flexible flatfoot treated by single-stage reconstruction in the form of tibialis anterior tendon rerouting combined with calcaneal lengthening osteotomy. The American Orthopaedic Foot and Ankle Society score (AOFAS) was utilized to evaluate the functional outcomes. The evaluated radiological parameters included the standing anteroposterior (AP) and lateral talo-first metatarsal angle, talar head coverage angle, and calcaneal pitch angle.Results The current study included 16 patients (28 feet) with a mean age of 11.6 ± 2.1 years. There was a statistically significant improvement in the mean AOFAS score from 51.6 ± 5.5 preoperatively to 85.3 ± 10.2 at final follow-up. Postoperatively, there was a statistically significant reduction in the mean AP talar head coverage angle from 13.6 ± 4.4° to 3.9 ± 3°, the mean AP talo-first metatarsal angle from 16.9 ± 4.4° to 4.5 ± 3.6°, and the mean lateral talo-first metatarsal angle from 19.2 ± 4.9° to 4.6 ± 3.2°, P < 0.001. Additionally, the mean calcaneal pitch angle increased significantly from 9.6 ± 1.9° to 23.8 ± 4.8°, P < 0.001. Superficial wound infection occurred in three feet and was treated adequately by dressing and antibiotics.Conclusion Symptomatic flexible flatfoot in children and adolescents can be treated with combined lateral column lengthening and tibialis anterior rerouting with satisfactory radiological and clinical outcomes.Level of evidence Level IV.

Comparison of 2 Conservative Treatment Approaches for the Flat Foot in Children Aged 5 to 10: Foot Orthoses Versus Foot Orthoses Supplemented With Zukunft-Huber Manual Therapy.

The aim was to find if foot orthotics alone can improve flat feet in children and analyze how the addition of Zukunft-Huber manual therapy and corrective bandaging changes the outcome. Forty-nine children aged 5 to 10 with asymptomatic flexible flat feet were divided into 2 groups. The first was treated with foot orthoses alone, in the second wearing foot orthoses was supplemented with Zukunft-Huber manual therapy and corrective bandaging. Pedobarography during gait was performed before the therapy and after a year. In the first group decrease in arch index, width, force, and area of midfoot, increase in force MH2 and area hindfoot was found, in the second decrease in arch index, width, force, and area of midfoot, increase in force under metatarsal head second, third, fourth, and fifth, area metatarsal head fourth and area hindfoot. Both methods showed positive changes, but foot orthoses with additional intervention were more effective.

Results of the first Russian Delphi survey on the diagnosis and treatment of flatfoot in children

BACKGROUND: To date, there is no consensus regarding the diagnostics of flatfoot in children and approaches to its classification and treatment.&#x0D; AIM: This study aimed to demonstrate the results of the first Russian consensus, performed according to the Delphi method, for the diagnostics and treatment of flatfoot in children.&#x0D; MATERIALS AND METHODS: The study was conducted in accordance with the principles of the Delphi survey and the RAND/UCLA and participated by 22 experts in their field. The questionnaire consisted of four main sections, namely, general clinical assessment, flatfoot diagnosis, classification approach, and treatment, including 179 close-ended and 11 open-ended statements in both rounds. A 5-point Likert scale was used to rank responses. The level of agreement was determined as follows: 70% of the experts agrees, the statement is accepted; 55%, rejected; 55%69%, reassessment by experts in subsequent rounds. To assess agreement among experts, parameters such as general agreement, agreement without doubt by experts, and percentage of doubting experts were calculated. Mean (M), standard deviation (SD), and Cronbachs alpha were calculated.&#x0D; RESULTS: The statement was accepted with an agreement without doubt by experts 70%, with Cronbachs alpha of 0.8. According to the survey data, in the two rounds using 179 close-ended statements, 96 statements were accepted, 63 were rejected, and no consensus was reached on 20.&#x0D; CONCLUSIONS: This scientific work presents the results of the first Russian Delphi survey on the diagnosis and treatment of flatfoot in children with a unique number of experts (n = 22). The lack of agreement on some of the statements, even among experts, showed that consensus was a necessary first step toward standardizing the diagnosis and treatment of flatfoot in children.

Footprint analysis in flatfoot assessment

BACKGROUND: A flatfoot is the most common condition in the practice of a pediatric orthopedist. A flatfoot is primarily diagnosed based on the assessment of the degree of the foot flattening. Along with clinical examination, footprint analysis is often used in practice due to the safety of this study and convenience and ease of implementation.&#x0D; AIM: This study aimed to determine how much footprints can correlate with the clinical assessment of flatfoot in children and which footprint indices are the most valuable in flatfoot assessment.&#x0D; MATERIALS AND METHODS: The study included the survey results of 76 children aged 715 years of the St. Petersburg 49th school School of Health for 20212022. In this study, anthropometric data, clinical parameters (value of the heel valgus, arch angle, and Friedland index) and footprint indices and angles (Schwartz and Clarke angle, ChippauxSmirak index, Staheli index, Cavanagh and Rodgers index, and Irwin index) were analyzed. In the study, the average values were calculated, and correlation and regression analyses were performed.&#x0D; RESULTS: The footprint parameters did not have moderate and strong correlations with clinical parameters. Footprint parameters that assessed the area of the barefoot zone on the footprints (Irwin index and Cavanagh and Rodgers index) showed statistically significant moderate and strong correlations among plantographic parameters. Among linear and angular footprint parameters, the ChippauxSmirak index showed statistically significant moderate and strong correlations.&#x0D; CONCLUSIONS: The footprint criteria weakly correlated with the foot shape criteria in a clinical assessment, which does not allow us to interpolate the footprints data to the clinical evaluation data of the foot. The Cavanagh and Rodgers index, Irwin index, and ChippauxSmirak index had statistically significant moderate and strong correlations with other indices, which makes them more valuable in the assessment of feet according to the footprint analysis.