Pediatric Foot Research Articles

Insole-Pressure Distribution for Normal Children in Different Age Groups

In measuring plantar pressures during gait, earlier methods have used a platform system that does not take into account the interactions feet have with orthotics and shoe wearing. The purpose of the study was to provide normal insole plantar pressure parameter data during stance phase using the Pedar pressure insole system. Twenty-nine normal children, age 6 to 16 years, were recruited and walked along the 25 m walkway at self-selected speeds. Patients were divided into 2 separate groups for statistical analysis--juniors (< 12 y old) and teenagers (> 13 y old). The pressure map was divided into 8 regions (masks) determined by anatomic landmarks and a total of 7 pressure parameters were analyzed of each mask. We did not detect significant differences in foot pressures between juniors and teenagers when regarding sex, or left and right feet for 7 parameters measured. This normative data will provide a basis with which to more accurately assess pediatric pathologic foot deformities and to distinguish dynamic foot deformities from anatomic foot deformities. THE LEVEL OF EVIDENCE: Level II.

Sehnentransfers bei kindlichen Fußdeformitäten

Tendon transfer surgery plays a central role in the treatment of pediatric foot deformities. Tendon transfers are essential for balancing in neurogenic deformities but also important for the treatment of congenital or idiopathic deformities. Furthermore tendon transfer represents an important management tool for revision surgery of failed treatment in foot deformities. Complications and pit-falls which can potentially lead to failure may occur during the indications and planning of the transfer as well as during the surgery. The identification and analysis of possible pitfalls and complications as well as their management is the central issue of this article. Knowledge about possible problems and their management are essential for successful treatment of pediatric foot deformities.

Day Surgery for Major Paediatric Foot and Ankle Procedures

To review outcomes in 19 children who underwent major foot and ankle procedures as day cases. A consecutive series of 24 major foot and ankle procedures in 19 children performed as day cases by a single surgeon were reviewed in terms of the immediate postoperative pain relief, severe swelling (necessitating cast removal), and complications. Parental satisfaction was assessed using a telephone survey with respect to pain relief of the patients, and their views on management as day cases. The 24 procedures comprised tendon transfers (n=18), posterior releases (n=3), and excisions of a tarsal coalition (n=3). During the post-discharge 24 hours, no patient developed complications that entailed hospital services. All parents of the patients were satisfied with the overall service provided. The analgesia prescribed at discharge was sufficient to control pain in 20 out of the 22 procedures. In the remaining 2 procedures (under caudal and general anaesthesia), the parents considered the analgesia insufficient, but did not contact the helpline for advice. One child bled through the bandages to a minor extent. Some major paediatric foot and ankle procedures can be safely performed as day cases and achieved adequate analgesia with appropriate advice. More such procedures can be added to the day case list, even on an afternoon list.

Clinical measures of paediatric foot posture: a critical review

Background: The paediatric flat foot is a common concern and has long been regarded as a problem, and feared to be potentially disabling. Definition of what exactly constitutes a flat foot remains surprisingly debatable, given its common presentation. Estimates of flat foot prevalence in children have been influenced by the varied the methods of assessment used to assess the foot posture, and the subsequent criteria employed to delineate feet as flat versus not flat. The aim of this literature review was therefore to evaluate the techniques of foot posture assessment in children and the reported reliability and validity of these measures. Method: A systematic search of electronic databases including Medline (1966-present), CINAHL, SportDiscus, Embase, Scopus and Pedro occurred between 02/01/10 and 14/08/10. Eligible articles were selected according to pre-determined criteria. Methodological quality was evaluated by use of the Quality Index as described by Downs & Black, followed by critical analysis according to outcome variables. Results: The most widely reported measures of paediatric foot posture were footprints and measures of the heel angle and arch height. The current evidence suggests that the reliability of all measures of paediatric foot posture is highly variable and mostly poor to moderate. The only measures on which validity has been explored are navicular height and footprints. Conclusion: Whilst no definitive conclusions can currently be drawn from the existing evidence, the trend from the current literature indicates that static paediatric foot posture may be best-assessed using RCSP, NH or FPI-6. However the relationship between static measures and pain, static measures and gait function remain largely unsubstantiated in children. The direction of future research is to establish a universal method of assessment of paediatric foot posture, and the subsequent relevance of foot posture to pain and function across age groups. Continuation of research in this field will enable targeting of design parameters towards variables that are supported by evidence, and which may directly advance clinical decision-making.

The paediatric flat foot and general anthropometry in 140 Australian school children aged 7 - 10 years.

BackgroundMany studies have found a positive relationship between increased body weight and flat foot posture in children.MethodsFrom a study population of 140 children aged seven to 10 years, a sample of 31 children with flat feet was identified by screening with the FPI-6. Basic anthropometric measures were compared between subjects with and without flat feet as designated.ResultsThe results of this study, in contrast to many others, question the association of flat feet and heavy children. A significant relationship between foot posture and weight (FPI (L) r = -0.186 (p < 0.05), FPI(R) r = -0.194 (p < 0.05), waist girth (FPI (L) r = -0.213 (p < 0.05), FPI(R) r = -0.228 (p < 0.01) and BMI (FPI (L) r = -0.243 (p < 0.01), FPI(R) r = -0.263 (p < 0.01) was identified, but was both weak and inverse.ConclusionsThis study presents results which conflict with those of many previous investigations addressing the relationship between children's weight and foot posture. In contrast to previous studies, the implication of these results is that heavy children have less flat feet. Further investigation is warranted using a standardized approach to assessment and a larger sample of children to test this apparent contradiction.

Interobserver Reliability of Radiographic Measurements of Contralateral Feet of Pediatric Patients with Unilateral Clubfoot

Radiographs have traditionally been used to describe and quantify foot deformities in infants and children. We hypothesized that the interobserver reliability of measurements obtained from radiographs of pediatric feet would be low, especially with regard to the infant foot, and that normal ranges and standard deviations would decrease in association with increasing patient age. We retrospectively reviewed 494 radiographs of 121 patients treated for unilateral clubfoot at our institution and studied the contralateral normal foot. All anteroposterior radiographs, lateral radiographs, and lateral radiographs made with the foot in maximum dorsiflexion were analyzed by three observers, and the values were recorded. The databases created by the three observers were statistically analyzed according to five predefined age groups (birth to less than three months, three months to less than twelve months, twelve months to less than three years, three years to less than seven years, and seven years to less than fourteen years). The anteroposterior talocalcaneal angle was rated as having good interobserver reliability (i.e., an intraclass correlation coefficient of 0.61 to 0.80) for all patients in each age group. Other angles that were associated with good interobserver reliability were the anteroposterior calcaneus-fifth metatarsal angle in the twelve months to less than three-year age group, the three-year to less than seven-year age group, and the seven-year to less than fourteen-year age group; the lateral talocalcaneal angle in the three-year to less than seven-year age group; the lateral tibiotalar angle in the three-year to less than seven-year age group; and the lateral talus-first metatarsal angle in the seven-year to less than fourteen-year age group. All other angles were rated as having very good interobserver reliability (i.e., an intraclass correlation coefficient of 0.81 to 1). The mean difference and the maximum difference among the observers decreased for all angles in nearly all age groups. Interobserver reliability with regard to the radiographic measurement of pediatric feet was higher than expected, although measurement discrepancies can be as great as 30° with the infant foot. Interobserver reliability tended to improve with increasing patient age. The standard deviation showed a trend toward a decrease as patient age increased, although the trend was less notable than expected.

Osteochondroses and Apophyseal Injuries of the Foot in the Young Athlete

With an increase in involvement in sports activities by children and adolescents, there has been a concomitant increase in both acute and overuse injuries. The pediatric skeleton lends itself to injuries unique to the young athlete, including various apophysites and osteochondroses. It is important for primary care and sports physicians treating the athlete to be aware of normal and abnormal variations in the pediatric skeleton, as well as common sites of injury in the pediatric foot. This article provides an overview of some of the most common skeletal foot injuries in the pediatric athlete, including Freiberg's infraction, Sever's disease, Kohler's disease, os navicularis, and Iselin's disease.

MRI Pathoanatomy Study of Congenital Vertical Talus

Prior reports regarding the pathologic anatomy for congenital vertical talus have noted some disagreement as to which elements of the pathologic anatomy are consistently present. The purpose of his study is to evaluate the 3-dimensional morphologic changes and pathoanatomy of the congenital vertical talus using magnetic resonance imaging. Nine patients with congenital vertical talus (ranging from 5 mo-11 y) underwent magnetic resonance imaging of both feet. A foot and ankle coil was used for the 1.5 T system. The protocol consisted of T1-weighted spin echo sequence image and T2-weighted fast spin echo sequence image in the sagittal, coronal, and axial planes. Slice thickness ranged from 3 to 4 mm with 0 to 1.0 mm interspace thickness. A descriptive analysis was performed based upon the T1-weighted image by physicians. At the level of the talonavicular joint, the navicular was seen significantly subluxed dorsally with associated wedging of the navicular. At the level of the calcaneocuboid joint, often there was a significant dorsal subluxation of the cuboid in relation to the calcaneus. Lateral obliquity of the calcaneocuboid joint could be present to varying degrees. The anterior calcaneus was significantly laterally displaced in relation to the talar head with an element of lateral translation and eversion of the calcaneus at the subtalar joint. Distal cavus at the cuneiform-first metatarsal joint was observed in 5 patients. This study suggests that there is significant pathology at the level of subtalar joint in congenital vertical talus. In addition to satisfactory reduction of the talonavicular joint, methods to ensure realignment of the calcaneus under the talus may be a crucial component of deformity correction and to prevent recurrence of deformity. A Level III diagnostic study using normal pediatric foot anatomy in magnetic resonance imaging as a reference.

Radiographic Assessment of Pediatric Foot Alignment: Self-Assessment Module

The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging spectrum of pediatric foot alignment issues.

Radiographic Assessment of Pediatric Foot Alignment: Review

Radiographic Assessment of Pediatric Foot Alignment: ReviewMahesh M. Thapa1 2, Sumit Pruthi1 2 and Felix S. Chew2Audio Available | Share

Analysis of ankle alignment abnormalities as a risk factor for pediatric flexible flat foot

Majority of paediatric flat feet are flexible and asymptomatic;less than 0.1% of all flat feet are rigid. If these can be diagnosed and managed early, then various complications can be prevented and they will remain asymptomatic. This study was conducted to analyse the ankle rotational malalignments in the natural course of flexible flat foot in children. Seventy-six patients of flexible flat foot and one hundred controls were included in this study. The height of foot arches was judged clinically by inspecting the height of the medial arch and by measuring the arch index on weight-bearing podograms. Tibial torsion and bimalleolar angle were assessed in all subjects. Tibial torsion was assessed in the first twenty subjects (ten cases and ten controls) both by clinical methods (foot-thigh angle) and CT. As no statistical difference in the two methods was observed, tibial torsion was measured by clinical methods only in the remaining subjects. Bimalleolar angle was measured on weight-bearing podograms in all subjects. For a minimum of two years, cases were followed up regularly with a standard conservative protocol and the height of the arches observed. Majority of cases of flexible flat foot were found to have increased tibial torsion and increased foot-bimalleolar angle (high talar spin). The severity of collapse of the medial arch and the response to conservative treatment was found to correlate with these rotational mal-alignments of the ankle. Ankle rotational mal-alignments were seen to make these flexible flat foot deformities more complex and less responsive to conservative treatment.KEY WORDS: Flat foot; Pediatric flat feet; Flexible flat feet

Prediction of Anthropometric Foot Characteristics in Children

The establishment of growth reference values is needed in pediatric practice where pathologic conditions can have a detrimental effect on the growth and development of the pediatric foot. This study aims to use multiple regression to evaluate the effects of multiple predictor variables (height, age, body mass, and gender) on anthropometric characteristics of the peripubescent foot. Two hundred children aged 9 to 12 years were recruited, and three anthropometric measurements of the pediatric foot were recorded (foot length, forefoot width, and navicular height). Multiple regression analysis was conducted, and coefficients for gender, height, and body mass all had significant relationships for the prediction of forefoot width and foot length (P < or = .05, r > or = 0.7). The coefficients for gender and body mass were not significant for the prediction of navicular height (P > or = .05), whereas height was (P < or = .05). Normative growth reference values and prognostic regression equations are presented for the peripubescent foot.

Treatment algorithm for complex injuries of the foot in paediatric patients

Background Complex injuries of the foot in the paediatric population present difficult treatment challenges. While standardised protocols exist for the adult population to achieve an optimal result in the treatment of such injuries, therapy in paediatric patients must be managed without a firm treatment algorithm. Methods Medical records of all patients with a complex trauma of the foot treated at our Department over a period of 13 years were evaluated. A complex trauma of the foot was defined using the scoring system developed by Zwipp et al. (1997). 24 Treatment and outcome were analysed. Additionally, our treatment algorithm of complex injuries of the foot in paediatric patients is presented. Results Twenty-nine patients were included in the study (79% m; 21% f, average age 12.1 years, ranging 2–16 years). Traffic accidents were the most common mechanism ( n = 14; 48.3%), followed by a fall from a height in five patients (17.2%). Lawn mower injuries were found in another 3 patients (10.3%) and other mechanisms of injury in 7 patients (24.2%). The mean score according to Zwipp et al. (1997) 24 was 5.8 points (range 5–8 points). While closed fractures were diagnosed in 20 (69%) patients, 9 patients (31%) presented open fractures. Operative intervention was necessary in 24 patients (82.8%). Fracture stabilisation could be realised using K-wires in 13 cases (54.2%), screws in 3 cases (12.5%) and plate fixation in 1 case (4.2%). Combined techniques including external fixation were applied in another 7 (29.1%) cases. The mean time between injury and latest follow-up examination was 5.7 years (range 13 months to 13 years). The mean functional outcome was 47.6 (29–56) points for the OAFQ, 15.1 (0–69) points for the FFI and 82.3 (59–100) points for the AOFAS Score. Discussion To regard the maxims in treating complex injuries and open fractures in the growing skeleton we developed a simple treatment algorithm for complex foot injuries in order to provide preservation of the soft tissue envelope, avoidance of infection, restoration of the axis and the articular surface. Conclusion A complex trauma of the paediatric foot is a rare and challenging injury. Avoidance of infection, preservation of the soft tissue envelope and fracture healing will provide good functional outcome despite the severity of trauma. Long time follow-up is essential to detect complications.

REVIEW FOR THE GENERALIST: EVALUATION OF PEDIATRIC FOOT AND ANKLE PAIN

REVIEW FOR THE GENERALIST: EVALUATION OF PEDIATRIC FOOT AND ANKLE PAIN

Inter‐rater reliability of the Foot Posture Index (FPI‐6) in the assessment of the paediatric foot

BackgroundReliability is an integral component of clinical assessment and necessary for establishing baseline data, monitoring treatment outcomes and providing robust research findings. In the podiatric literature traditional measures of foot assessment have been shown to be largely unreliable. The Foot Posture Index (FPI-6) is a clinical tool used in the assessment of foot and to date, there is limited research published which evaluates the reliability of this tool in children and adolescents.MethodThirty participants aged 5 - 16 years were recruited for the research. Two raters independently recorded the FPI-6 score for each participant.ResultsAlmost perfect agreement between the two raters was identified following weighted kappa analysis (Kw = 0.86).ConclusionThe FPI-6 is a quick, simple and reliable clinical tool which has demonstrated excellent inter-rater reliability when used in the assessment of the paediatric foot.

The paediatric flat foot proforma (p‐FFP): improved and abridged following a reproducibility study

BackgroundConcern about a child's flat foot posture is a common reason for frequent clinical consultations for an array of health care and medical professionals. The recently developed paediatric flatfoot clinical-care pathway (FFP) has provided an evidence based approach to diagnosis and management. The intra and inter-rater/measurer reliability of the FFP has been investigated in this study.MethodsFrom a study population of 140 children aged seven to 10 years, a sample with flat feet was identified by screening with the Foot posture index (FPI-6). Subjects who scored ≥ 6 on the FPI-6 for both feet became the study's flat foot sample. A same subject, repeated measure research design was used for this study which examined the reliability of the FFP in 31 children aged seven to 10 years, as rated by three examiners.ResultsApproximately half of the items of the FFP showed less-than-desirable inter-rater reliability, arbitrarily set at the conventional 0.7 level (intra-class correlations). Removal of the unreliable items has produced a shorter; more relevant instrument designated the paediatric flat foot proforma (p-FFP).ConclusionThe p-FFP is a reliable instrument for the assessment and resulting treatment actions for children with flat feet. Findings indicate that the simplified p-FFP is a reproducible instrument for the clinical assessment of flat foot in mid-childhood.

Evaluating Pediatric Foot and Ankle Pain

Lippincott's Bone and Joint Newsletter: July 2008 - Volume 14 - Issue 7 - p 77-78 doi: 10.1097/01.BONEJ.0000325568.39501.3e

Car tire injuries: a review of 35 patients

During the period from October 2001 to March 2007 (66 months), 35 patients, all pedestrians, were treated at the King Khalid Civil Hospital, Tabuk, Saudi Arabia for injury to the foot and ankle due to road traffic accidents. The injuries share common features and are grouped in a distinct entity known as "car tire injuries". The victim is always a pedestrian, usually a child, who while trying to escape from the car, gets his foot caught undl der the car tire when the driver is trying to stop the car. The resultant injuries are usually severe due to a combination of friction burns, crushing, shearing, and degloving. Language: en

Review for the generalist: evaluation of pediatric foot and ankle pain

Foot and ankle pain is common in children and adolescents. Problems are usually related to skeletal maturity and are fairly specific to the age of the child. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of foot and ankle pain in the pediatric population.

Arthroerisis with Giannini’s endo-orthotic implant and Pisani’s talocalcaneal arthroerisis. A comparison of surgical methods

In this paper the Authors report the results gained after the treatment of paediatric idiopathic flat foot by means of Pisani's talocalcaneal arthroerisis and arthroerisis with Giannini's endo-orthotic implant. Two groups of patients have been treated according to the two techniques. According to clinical, radiographic and functional tests, the Authors believe that both the techniques can offer good results to correct idiopathic flat foot of childhood and they highlight the lower invasivity and less damage for the structures of sinus tarsi when Pisani's talocalcaneal arthroerisis is applied.