Pediatric Flatfoot Research Articles

Self-perceived foot function and pain in children and adolescents with flexible flatfeet – Relationship between dynamic pedobarography and the foot function index

BackgroundThere is considerable debate as to which parameters to include in the assessment of paediatric flatfeet. Dynamic pedobarography is an objective, dynamic method to measure foot function. Information about its associations to patient-reported measures may help to focus on the most relevant parameters. Research questionWhat is the association between the Foot Function Index and pedobarographic assessments in flatfeet of children and adolescents? MethodsA consecutive clinical case series of 51 participants with idiopathic flexible flatfeet aged 7–17 years underwent barefooted pedobarography during gait and completed the Foot Function Index Questionnaire. Pedobarographic data categorized into values related to area, peak pressure and force with respect to the hind-, mid- and forefoot were extracted. To test the associations between the Foot Function Index and pedobarographic assessments, bivariate partial correlations were tested and contact times served as co-variate. ResultsSeveral significant associations between peak pressure or forces beneath the hindfoot, midfoot and hallux to self-perceived function were found (|rho| = 0.28–.46, P < 0.05). In particular, reduced peak forces and pressures underneath the hindfoot and hallux, a lateral shift (smaller medio-lateral ratios) of hindfoot pressure and force and a medial shift (larger medio-lateral ratios) of midfoot pressure seem to be negatively associated with foot-related disability. Overall, less evidence was noted for associations to pain scores. Area related outcomes (including the arch index) contained no information for function while a larger BMI was the strongest thread for disability (rho = 0.42, P = 0.002) and pain (rho = 0.31, P = 0.027). SignificanceWhen using pedobarography for the assessment of flexible flatfeet of children and adolescents, less attention should be paid to area related measurements which do not provide information about self-perceived function or disability. Instead, peak pressures or forces in the hind- or midfoot or beneath the hallux may be focussed. Weight reductions are potentially an effective strategy to reduce or prevent symptoms.

Validity and diagnostic accuracy of foot posture Index-6 using radiographic findings as the gold standard to determine paediatric flexible flatfoot between ages of 6–18 years: A cross-sectional study

BackgroundDiagnosis of flexible flatfoot is usually based upon radiographic or clinical measures. Radiographic measures pose a potential risk of radiation exposure especially in Paediatric population. Clinicians need a valid, accurate, easily used, noninvasive and cost effective measure to evaluate static foot posture clinically. Although, foot posture index-6 (FPI-6) are commonly used in clinical practice, its validity and diagnostic accuracy in evaluation of paediatric flexible flatfoot have not been fully proven yet. ObjectivesTo investigate validity and diagnostic accuracy of FPI-6 to determine Paediatric flexible flatfoot between ages of 6–18 years using radiographic findings as the gold standard measure. Study designCross-sectional study. MethodsA cross-sectional study conducted on 612 participants (1224 feet) with flexible flatfoot aged 6–18 years (mean age ± standard deviation of 12.36 ± 3.39 years). The results of FPI-6 were compared to the gold standard radiographic measures and displayed on the receiver operating characteristic curve. Intra-rater reliability, sensitivity, specificity, predictive values and likelihood ratios were calculated. Posttest probability was calculated from Fagan nomogram. ResultsFPI-6 demonstrate high intra-rater reliability (ICC = 0.96) with p value < 0.001. FPI-6 showed a sensitivity of 83.7%, a specificity of 80.4, a positive predictive value of 64.7, a negative predictive value of 92, a positive likelihood ratio of 4.62 and a negative likelihood ratio of 0.20. FPI-6 shows moderate diagnostic accuracy [AUC = 0.82; 95%CI (0.78–0.85)]. ConclusionFPI-6 is valid with moderate diagnostic accuracy to determine paediatric flexible flatfoot between ages of 6–18 years.

Efficacy of Customized Foot Orthoses in Children Aged 6 - 7 Years Old with Symptomatic Flexible Flat Foot (SFFF)

Introduction: Pediatric Flat Foot (PFF) is a deviation consisting of loss of the Medial Longitudinal Arch in children. Purpose: Aim of this study is to collect information on the recent literature and to investigate through clinical assessment and parental observations the effectiveness of the use of foot orthotics by children with SFFF. Method: 20 children aged 6 - 7 years old with mobility difficulties were evaluated before and after a six-month treatment with orthotics regarding pain, post-game pain, fatigue during game, balance impairment, gait deviations, falls, clumsiness, activity avoidance and worn soles. Results: Study results indicate that foot orthotics (FOs) appears to have a positive impact on the advance of pain, post game pain, gait deviations and worn insoles. It is implied that orthoses have a great potential as a treatment for SFFF. Thorough comprehension of the literature evidence, as well as composition of supplementary studies of larger pediatric populations is essential in order to reach a consensus on the use of foot orthotics (FOs) by children SFFF.

Serum Calcium, Vitamin D Levels in Pediatric Flatfoot Patients Which were Brought to Clinic with or without in-toeing complaint

The Anatolian Journal of Family Medicine is an international periodical on family medicine and primary health care, published three times a year on independent, unbiased, double-blinded and peer-review principles.

Clinical and Radiological Outcomes of Subtalar Kalix II Arthroereisis for a Symptomatic Pediatric Flexible Flatfoot.

Background. The purpose of this study is to evaluate functional and radiological outcomes of subtalar arthroereisis in the treatment of symptomatic pediatric flexible flatfeet. Methods. A total of 16 patients (26 feet) were treated with a Kalix II as subtalar motion blocker between 2009 and 2014. Calcaneal pitch (CP) and Meary's angle (MA) were measured on radiographs preoperatively, directly postoperatively, and at follow-up 47 ± 17 (range 19-79) months. Patient satisfaction surveys were used to assess functional outcome and patient satisfaction. Results. Surgery was performed mostly for pain, walking problems, or a combination of both at a mean age of 12.5 ± 1.5 (range 10-15) years. Symptoms were relieved in 62.5% of patients in the postoperative phase and increased to 68.75% at follow-up. A statistically significant increase in CP of 2.8° and decrease in MA of 14.0° was observed directly postoperatively, which persisted during the follow-up period irrespective of Kalix removal. Revision surgery was necessary in 6 cases (23%) because of arthroereisis migration. Conclusion. Subtalar Kalix II arthroereisis significantly reduced clinical symptoms and improved the CP and MA directly postoperatively, which persisted during follow-up, irrespective of Kalix removal. Therefore, subtalar arthroereisis is a considerable intervention to reduce symptoms in children with symptomatic flexible flatfeet.Levels of Evidence: Level IV: Case series.

Structural Effect of Long-Term Use of Medial Arch Support Insole on Children with Pediatric Flexible Flatfoot

Category:Midfoot/ForefootIntroduction/Purpose:This prospective study aimed to rule out the effect of the normal physiologic maturation in applying medial arch support insole for patients with pediatric flexible flatfoot (PFFF).Methods:From January 2005 to June 2015, 18 patients (34 feet) in group 1 (insole was continuously applied) and 16 patients (32 feet) in group 2 (untreated group) were enrolled. A medial arch support insole was applied from age 10-11 years until radiographic physeal closure.Results:In group 1, the talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, and medial cuneiform height were significantly changed at final follow-up, although all values were still within the abnormal range. Moreover, no significant differences were found in any of the increments of the radiographic parameters between groups 1 and 2.Conclusion:Radiographic improvements were found in both medial arch support insole-treated and untreated groups even if all radiographic values were still within the abnormal range. This means that PFFF could be somehow improved with heel stretching exercise until the physes were closed. Further, hindfoot alignment remained unchanged regardless of the medial arch support insole application.

The relationship between foot posture index and resting calcaneal stance position in elementary school students

BackgroundStatic foot assessment is commonly performed in clinical practice to classify foot type for prescribing therapeutic interventions. Foot posture index is known to be a reliable indicator for foot position. Resting calcaneal stance position angle is used widely to determine foot posture and manufacture orthoses for pediatric flat foot patients. However, the relationship between foot posture index and resting calcaneal stance position angle in elementary school students is currently unclear. Research questionTo investigate the relationship between foot posture index and resting calcaneal stance position angle in elementary school students. MethodsBetween January 2016 and December 2017, 208 elementary school students (average age, 10.3 years; range, 8–13 years) were enrolled for this study. All students were examined physically by one practitioner to measure foot posture index and resting calcaneal stance position angle. Age, gender, and body mass index were analyzed for factors associated with flat foot prevalence. This study was conducted as a retrospective comparative study. Associations between foot posture index and resting calcaneal stance position angle were determined by Pearson's correlation analysis. Results and SignificanceWhen measured by foot posture index and resting calcaneal stance position angle, the overall prevalence of flatfoot was 29% and 24% in the right foot and 26% and 23% in the left foot, respectively. Resting calcaneal stance position angle and foot posture index score showed moderate correlation in Pearson’s correlation analysis (left side foot: kappa value = 0.710; right side foot: kappa value = 0.704). ConclusionThere is a moderate correlation between foot posture index and resting calcaneal stance position angle in elementary school students. Thus, both foot posture index with proven validity and reliability and resting calcaneal stance position widely used in the manufacture of insoles can be used as important biomechanical evaluation tools for feet in clinical settings.

Body Weight Effects on Extra-Osseous Subtalar Arthroereisis

Implant extrusion in subtalar arthroereisis is a common complication for pediatric flexible flatfoot. However, there were a limited number of articles addressing the body weight effects on implant extrusion after the procedure. We conducted a 24-month follow-up assessment after subtalar arthroereisis. Surgical patients who underwent the Vulpius procedure were retrospectively collected from May 2010 to January 2017, including 59 cases of both feet having implants in situ and 43 cases of both feet having implant extrusion. The average age of 102 patients was 9 years old. The mean body mass index (BMI) of the implant in situ group was 19.5, whilst the extrusion group was 21.2 (p = 0.035). The inter-observer correlation was excellent. There were 11 cases (39.3%) of bilateral extrusion in the overweight group (BMI ≥ 24) and 13 cases (23.2%) in the low body weight group (BMI ≤ 18.5) (p < 0.0004). Postoperative radiographic angles were corrected in both the implant in situ group and the extrusion group. Nonetheless, the implant in situ group revealed better postoperative outcomes of Meary’s angle and the talonavicular angle from an anterior-posterior view, and the talar inclination angle from a lateral view. We conclude that a higher BMI is related to implant extrusion and worse results after subtalar arthroereisis. Further prospective study to investigate whether preoperative weight loss results in improved surgical outcomes is warranted in the future.

Radiographic and Functional Results following Subtalar Arthroereisis in Pediatric Flexible Flatfoot.

Introduction Flexible flatfoot (FFF) is one of the most common skeletal disorders in children. In symptomatic patients who do not respond to conservative measures, surgery may be an option. Subtalar arthroereisis consists of limiting excessive eversion of the subtalar joint through different types of implants. Materials and Methods We carried out a retrospective study of 16 patients (32 feet) intervened for FFF with a subtalar device (arthroereisis), across the period of 2008-2015 with a minimum follow-up period of one year. Pre- and postoperative measures of the Moreau-Costa-Bartani angle, dorsoplantar (DP) and lateral (L) talocalcaneal angle, talonavicular coverage angle, and naviculocuboid overlap were used to evaluate correction of the deformity. Two expert surgeons from the Pediatric Orthopedics Unit took separate measurements of these angles for subsequent analysis purposes and to obtain the interobserver correlation coefficient for quantitative variables. Pre- and postoperative differences in the measurement of angles were ascertained using Student's t-test for paired samples; and a functional evaluation of the patients intervened was carried out pre- and postoperatively by administering the parent version of the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) during a clinical interview. All statistical analyses were performed using the SPSS v. 19.0 program (SPSS, Chicago, IL), with values being deemed statistically significant at p<0.05. Results A breakdown of the study population showed 81.25% (13 patients) males and 18.75% (3 patients) females, with mean age of 9 years (7-11). The interobserver coefficient for quantitative variables displayed a very high degree of concordance (0.7-0.9), indicating that the validity of the measures was adequate. Pre- and postoperative analysis of differences in the measurement of angles was statistically significant (p<0.005). In terms of functional evaluation, the postoperative results were positive, with statistical significance for the “school and play”, “emotional”, and “footwear” domains of the OxAFQ-C scale and no differences in the “physical” domain. Conclusion Subtalar arthroereisis is a valid option for the treatment of symptomatic pediatric flatfoot, with good postoperative functional and radiographic results.

Cluster analysis to identify foot motion patterns in children with flexible flatfeet using gait analysis—A statistical approach to detect decompensated pathology?

IntroductionThe paediatric flexible flatfoot constitutes the major cause of clinic visits for orthopaedic foot problems. It shows variations of deformities in different planes and locations of the foot and its indication for treatment have been extensively discussed. Despite its high prevalence there exists no classification of flatfeet during walking as a prerequisite for treatment decision. Therefore, the aim of this study is to classify flexible flatfeet based on 3D foot kinematics during walking. MethodsPatients age 7–17 years with flexible flatfeet (N = 129, 255 feet) of non-neurogenic or syndromic origin, were retrospectively included. Patients underwent gait analysis using the Oxford Foot Model after standard clinical examination. A k-means cluster analysis was performed on 3 scores derived from the principal component analysis of the foot kinematic waveforms over the gait cycle. Gait and clinical parameters were then statistically tested between clusters. ResultsCluster analysis revealed two groups of flexible flatfeet that were discriminated best by the inversion at push-off during walking. Cluster 2, including 110 feet, showed an average eversion instead of an inversion at push-off and a lower number of heel rises in the clinical test. Both was significantly different between clusters (p < 0.001). DiscussionBased on the findings, the resultant clusters can be interpreted as describing compensated and decompensated feet, with the latter presenting a group that may require surgical interventions, even if they are not yet present with pain. The hindfoot inversion capability at push-off is the most important variable in the 3D gait analysis to classify flexible flat feet.

Fluoroscopy and Dynamic Pressure-Based Foot Orthoses for Children With Flatfoot

ABSTRACT Introduction The current nonsurgical treatment for pediatric flatfoot includes shoe modification, inserts, and foot orthoses (FOs). However, these methods do not affect the course of flatfoot in children and have only limited evidence of correction of foot pronation. The goals of this study are 1) to describe how to design novel customized FOs using plantar pressure and fluoroscopic measurements; and 2) to assess kinematics and kinetics of the foot and ankle joint and functional outcomes at baseline and 12-month follow-up. Materials and Methods One child with bilateral flatfeet received trio-pressure measurements, including dynamic plantar pressure, single sensor pressures on the lateral calcaneus, and medial talar head. The two-dimensional (2D) foot motion in the sagittal plane during the stance phase using single gantry fluoroscopy was recorded. Three-dimensional (3D) surface images of the entire foot and distal lower limb were registered. Results A total of 14 pressure metrics and three-dimensional (3D) foot and ankle topography were used to design the new orthoses and generate a computer-aided design model. Data from the fluoroscopic images were used to evaluate the orthotic design. Finally, two orthoses were designed and manufactured with a rapid prototype system (SLS). Discussion The gait-based software was successfully developed to design the new orthoses. Features included use of navicular height, talar and calcaneal alignment, pressure metrics, and foot geometry. This case study had 12-month follow-up and showed that the new FOs reduced pain and improved functional outcomes. Conclusions Use of gait-based software allows a further approach directly into the rapid prototype systems for orthoses designed to address pes valgus deformity.

Effectiveness of subtalar arthroereisis with endorthesis for pediatric flexible flat foot: a retrospective cross-sectional study with final follow up at skeletal maturity

BackgroundPediatric flexible flatfoot is sometimes asymptomatic but it can rarely cause physical impairment, pain, and difficulty walking. We evaluated the radiographic effectiveness of intervention of subtalar arthroereisis with endorthesis for pediatric flexible flatfoot with final follow-up at skeletal maturity. MethodsThis is a retrospective cross-sectional study. 56 consecutive patients (112 feet) who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot (mean age at final follow-up 15.5±1.2 years, 39.3% female) were enrolled. All the radiographic studies were performed in the hospital. Radiographs (standard weight-bearing radiographs of the foot with anteroposterior and lateral view) were used to measure lateral talocalcaneal angle (LTC), calcaneal pitch angle (CP), Meary’s angle (MA), anteroposterior talonavicular angle (APTN), talonavicular uncoverage percent (TNU). Minimum follow-up was 18 months. Measures were assessed pre-operatively and at the final follow-up. Clinical and functional parameters were assessed at the final follow-up. ResultsChildren who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot exhibited a statistically significant improvement in all radiographic measurement parameters at the last follow-up at skeletal maturity (all, p<0.004). Mean follow-up was 40.1±23.6months. Clinical parameters were not correlated with the foot radiographic parameters at follow up period. ConclusionsOur results suggest that endorthesis in pediatric flexible flatfoot was effective for improving radiographic parameters at skeletal maturity. The amount of the morphologic correction at the end of the skeletal growth should be expected mainly for lateral tarso-metatarsal alignment and talo-navicular congruency (MA, APTN, TNU). Level of evidenceLevel III, retrospective study.

Evaluation of Clinical and Radiological Results of Calcaneal Lengthening Osteotomy in Pediatric Idiopathic Flexible Flatfoot.

Flexible idiopathic flatfoot is the most common form of flatfoot. First line treatments are parental reassurance and conservative measures; however, surgical treatment may be needed in some cases. A number of surgical techniques with varying results have been described in the literature. Here, we present our clinical and radiological outcomes of calcaneal lengthening osteotomy for pediatric idiopathic flexible flatfoot. Calcaneal lengthening osteotomy was performed in 20 patients, 30 feet, with idiopathic flexible flatfoot that were resistant to conservative treatment between 2007 and 2011. Patients were evaluated according to ACFAS universal evaluation scoring scale and radiographic indexes. The mean follow up duration was 23.1 ± 9.9 months. The average age was 10.4 ± 0.9 years. Achilles tendon lengthening was performed in 28 feet. ACFAS score at the final follow up had improved significantly compared to pre-operative score (37 to 88, P<0.0001). Radiographic parameters also showed significant improvement after surgery ((P<0.0001)). Distal segment displacement and hardware irritation as postop complications were observed in 2 and 3 cases, respectively, with no long-term clinical impact. Calcaneal lengthening osteotomy is an appropriate and safe operation in symptomatic idiopathic flexible flat foot that is resistant to conservative treatment.

Short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children: A randomized controlled trial.

Background:Limited evidence is available regarding the effects of insoles on pediatric flexible flatfoot because of the heterogeneity and low methodological quality of previous studies. The purpose of this prospective trial is to examine the short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children by using the International Classification of Functioning, randomized controlled Disability, and Health (ICF) framework.Methods:This study was conducted in a rehabilitation outpatient clinic of a teaching hospital. Fifty-two children with symptomatic flexible flatfoot were included. The children in the treatment group wore customized arch support insoles for 12 weeks, whereas those in the control group did not wear the insoles. Both clinical and radiographic measurements, including the navicular drop, foot posture index, Beighton hypermobility score, talonavicular coverage angle, calcaneal inclination angle, and calcaneal-first metatarsal angle, were used for diagnosing flexible flatfoot. Physical activity (10-m normal and fast walking, stair ascent, stair descent, and chair rising), physical function, and psychometric properties (Pediatric Outcome Data Collection Instrument and Pediatric Quality of Life Inventory) were evaluated at the baseline and 12 weeks after the intervention.Results:Compared with the control group, the treatment group exhibited significant improvement in pain/comfort (P = .048), physical health (P = .035), stair ascent time (P = .015), upper extremity and physical function (P = .016), and transfer and basic mobility (P = .042) during the intervention period.Conclusion:Children with flexible flatfoot who wore customized arch support insoles for 12 weeks exhibited significantly improved pain/comfort, physical health, stair ascent time, upper extremity and physical function, and transfer and basic mobility. These variables belong to the domains of body functions and structures and activity and participation in the ICF framework. However, because the groups were not comparable, additional studies with larger sample sizes should be conducted.

S2-Guideline: Pediatric Flat Foot

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.

Foot posture development in children aged 5 to11 years: A three-year prospective study

BackgroundThe paediatric flatfoot is a common presentation but it is unclear whether the condition will resolve on its own as the child gets older or whether treatment is required. Therefore, the study objective was to evaluate paediatric foot posture, and anthropometry, in children at two time points, three years apart. Material and methodsA sample of 1032 healthy children (505 boys, 527 girls; aged 5–11 years) was recruited for foot posture index (FPI) and anthropometry assessment (weight, height and body mass index, BMI). Assessment was repeated when the children were aged 8 years to 14 years. Paired t-tests, Anova, frequency tables and a multiple regressions were conducted. ResultsInitially, approximately 70% had a neutral FPI range, 20% pronated, 3% highly pronated, and 4% supinated. Initial mean FPI was 3.6 ± 2.8, being higher in boys 3.7 ± 2.8 than in girls 3.4 ± 2.7 (p = 0.034). All FPI categories changed over time, with supinated and neutral FPI increased by 19.5% and 4.7% respectively. In contrast, pronated and highly pronated FPI reduced by 10.6% and 55.6% respectively. Regression showed only 1% FPI change was explained by increased height. FPI scores were significantly reduced after three years (3.57 to 3.33; p < 0.001). ConclusionChildren’s foot posture shifts toward neutral as age increases. There is minimal relationship with weight, height or BMI. Appreciation of developing foot posture could reduce over diagnosis and unnecessary treatment of paediatric flatfeet.

Evaluation of Results of Calcaneo-Stop Procedure in Treatment of Pediatric Flexible Flatfoot

AbstractBackground: Flexible flatfoot is a common finding in pediatrics. It is usually amenable to conservative treatment but in less frequent occasions, some cases are not optimally responsive to conservative measures. Calcaneo-stop procedure is minimally invasive and safe resort for this cases after failure of conservative measures.Objective: Evaluate the results of treatment of pediatric flexible flatfoot by Calcaneo-stop procedure only after ex-haustion of six months of supervised conservative management.Study Design and Setting: A prospective randomized clinical trial in a tertiary care center.Patients and Methods: 20 cases of pediatric flexible flatfoot (ten patients) were operated on after failure of six months of conservative treatment. All patients were evaluated pre-operative and post-operative via Kite's angle, Meary's angle and according to American college of Foot and Ankle Society score (ACFAS). A p-value of less than 0.001 was considered statistically significant.Results: There was statistically significant improvement in Meary's, Kite's angle. While ACFAS score measurement was better than preoperative score in all cases but not statis-tically significant.Conclusion: Calcaneo-stop is safe, minimally invasive and effective in treatment of pediatric flexible flatfoot also it doesn't burn bridges for other adjuvant procedures later on.

Return to sport activities after subtalar arthroereisis for correction of pediatric flexible flatfoot.

The aim of this study was to establish whether children treated with subtalar arthroereisis for flexible flatfoot were able to return to sport activities. We reviewed 49 patients with a mean age at the time of surgery of 10.7 years. The type of sport activities, the number of sessions per week, the time dedicated to each session, and the level achieved were assessed preoperatively and at the last follow-up. Overall, 45 patients returned to sports after surgery. Surgery did not alter the duration, frequency, and type of sporting activities, but the participation in physical activities as well as the emotional status and footwear issues improved.

Subtalare Screw Arthroereisis for the Treatment of Symptomatic, Flexible Pes Planovalgus

The purpose of this study was to determine the functional outcomes and radiographic results of the talus-stop screw method as minimally invasive subtalar arthroereisis in pediatric and juvenile flexible flatfoot. We retrospectively evaluated 73 feet from 41 children using the talus stop-screw method, for the period between 2002 and 2011. The age at time of surgery ranged between nine and 14 years. The radiological assessment included measuring the calcaneal pitch, talar declination, talo-first metatarsal angle (Meary) and calcaneal-first metatarsal angle (Costa-Bartani) in the lateral view. To evaluate talo-navicular alignment in the anteroposterior view, the talo-first metatarsalbase angles were measured. To describe the amount of planovalgus deformity in lateral and anteroposterior view, we determined a tarsometatarsal-index by adding the talo-first metatarsal and talo-first metatarsal base angles. 95% of patients were satisfied or very satisfied with postoperative results for morphology, pain and activity level. 95% of patients exhibited no limitations in daily life or sports activity due to foot pain, fatigue or repetitive distorsion. 96% of patients would undergo the surgery again, if necessary. Full weight bearing could be achieved after a mean time of 8.1 (range, 2 - 21) days. All measured postoperative angles improved significantly, except talar inclination. The talus-stop screw method as a minimally invasive subtalar arthroereisis is a safe and effective treatment for the flexible pes planovalgus deformity in children and adolescents. It preserves canalis tarsi and its proprioceptive structures. The major complication rate is low and, with a vertically inserted cancellous screw, this is an economic procedure. The TMT-index incorporating both planes in pes planovalgus feet appears to be a more precise method to determine this multiplanar deformity and to evaluate treatment options and results.

O2: Cluster analysis to identify foot motion patterns in children with flexible flatfeet – A statistical approach to detect decompensated pathology

The incidence of flatfoot is approximately 5% in children and adults. The symptomatic form of a flexible flatfoot produces subjective and objective complaints, including gait disturbances. Surgical intervention is considered when conservative management fails. The arthroereisis procedure provides a stable foot and durable correction. However, to the best of our knowledge, no study has evaluated the effectiveness of this procedure on gait parameters.Fifteen children with painful flatfeet (10 males; 5 females) with a mean age of 12 years and 6 months underwent the calcaneo stop procedure. Radiographic, gait analysis and functional measures were evaluated to assess the changes pre- and post-operatively.All children were followed up for a mean period of 4 years and 6 months. The overall results of the study exhibited statistically significant improvement for all radiographic variables, functional measures and range of motion investigated in the study (p < 0.05). Although the study showed improvement in all temporal parameters (p < 0.05) measured in the gait analysis, the results demonstrated there were no statistically significant differences in the kinematic and kinetic variables (p > 0.05) before and after surgery.Although there was no significant improvement in the kinematic and kinetic variables investigated, this study supports the calcaneo-stop procedure as a reliable and effective procedure for treating paediatric flexible flatfoot.