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Prevalence of flat foot in preschool-aged children

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  #1  
Old 3rd August 2006, 05:40 AM
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Default Prevalence of flat foot in preschool-aged children

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Prevalence of flat foot in preschool-aged children.
Pediatrics. 2006 Aug;118(2):634-9
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OBJECTIVES. Our aim with this study was to establish the prevalence of flat foot in a population of 3- to 6-year-old children to evaluate cofactors such as age, weight, and gender and to estimate the number of unnecessary treatments performed.

METHODS. A total of 835 children (411 girls and 424 boys) were included in this study. The clinical diagnosis of flat foot was based on a valgus position of the heel and a poor formation of the arch. Feet of the children were scanned (while they were in a standing position) by using a laser surface scanner, and rearfoot angle was measured. Rearfoot angle was defined as the angle of the upper Achilles tendon and the distal extension of the rearfoot.

RESULTS. Prevalence of flexible flat foot in the group of 3- to 6-year-old children was 44%. Prevalence of pathological flat foot was <1%. Ten percent of the children were wearing arch supports. The prevalence of flat foot decreases significantly with age: in the group of 3-year-old children 54% showed a flat foot, whereas in the group of 6-year-old children only 24% had a flat foot. Average rearfoot angle was 5.5 degrees of valgus. Boys had a significant greater tendency for flat foot than girls: the prevalence of flat foot in boys was 52% and 36% in girls. Thirteen percent of the children were overweight or obese. Significant differences in prevalence of flat foot between overweight, obese, and normal-weight children were observed.

CONCLUSIONS. This study is the first to use a three-dimensional laser surface scanner to measure the rearfoot valgus in preschool-aged children. The data demonstrate that the prevalence of flat foot is influenced by 3 factors: age, gender, and weight. In overweight children and in boys, a highly significant prevalence of flat foot was observed; in addition, a retarded development of the medial arch in the boys was discovered. At the time of the study, >90% of the treatments were unnecessary.
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Old 3rd August 2006, 05:47 AM
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Related threads:
Bibliography wanted on children foot problems in schools
Research info on prevalence of pronated feet

Foot orthoses and asymptomatic pediatric flatfoot
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Old 3rd August 2006, 06:56 AM
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Originally Posted by NewsBot
Prevalence of flat foot in preschool-aged children.
Pediatrics. 2006 Aug;118(2):634-9
It's always interesting to me that the pediatricians' favorite line to concerned parents is "don't worry, flatfoot in children is normal" unless it is their own child, and then they make it a point to have their own child put into orthoses.

How did they determine that 90% of treatments were unnecessary??
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Old 3rd August 2006, 06:01 PM
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How did they determine that 90% of treatments were unnecessary??
Its actually quite bizarre - they collect and present some good data, then the last part of the discussion is below, that is not supported by the data - its just a rant:
Quote:
Ten percent of the children were treated with arch supports, most without having the diagnostic criteria for a pathological flat foot. Less than 1% of our pupils had a rearfoot valgus >20° or had a rigid flat foot. Indication for an orthopedic treatment of physiological flat foot remains controversial. Traditionally, flat foot has been treated with arch supports or corrective shoes, but recent studies have failed to prove the effectiveness of such treatment.4,6 Our data confirm that the physiological flat foot improves naturally with age, and we agree with Wenger et al6 and Hefti and Brunner,5 who state that a flexible flat foot does not need therapy. In addition, Roa and Joseph2 and Sachithanandam and Joseph19 postulated an association between wearing shoes and the prevalence of flat foot. The authors state that children who wear shoes in early childhood showed a higher prevalence of flat foot than those who where unshod before 6 years of age. By wearing shoes during this critical time, intrinsic foot muscles are weakened and the medial arch improves inappropriately.

Arch supports and corrective shoes are uncomfortable for the child. Authors have failed to prove an effect of arch supports on the development of the medial arch of flexible flat foot; on the contrary, some authors state that arch supports weaken the foot muscles and perpetuate the problem.4,6,8 Treatment of children with physiological flat foot is ineffective and produces enormous costs for parents and health service providers.8 Children with typical flexible flat foot should not be burdened with arch supports or corrective shoes. We recommend orthopedic treatment for children with symptomatic flat foot or with pathological flat foot according to the criteria we used in this work; appropriate treatment depends on the nature of the pathology.
At least we know that this bit is not true:
Quote:
some authors state that arch supports weaken the foot muscles and perpetuate the problem
See this thread: Do foot orthoses weaken "arch" muscles?
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Old 29th August 2006, 02:11 AM
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Default pediatric flat foot

Very interesting data

My caseload is around 85% pediatrics. I tend to err on the side of issueing orthotics if i am in any doubt as to whether they are needed or not. I am certain that many of these are issued to children who would indeed get better by themselves with no help at all. My thinking is that i rarely see an older child and wish they had NOT been given orthotics earlier. I frequently see teenagers with fixed forefoot inversion or some other secondary pathology and wish somebody had caught them before they reached that point!

Is that wrong of me?


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Old 29th August 2006, 05:14 PM
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Originally Posted by Robertisaacs
Very interesting data

My caseload is around 85% pediatrics. I tend to err on the side of issueing orthotics if i am in any doubt as to whether they are needed or not. I am certain that many of these are issued to children who would indeed get better by themselves with no help at all. My thinking is that i rarely see an older child and wish they had NOT been given orthotics earlier. I frequently see teenagers with fixed forefoot inversion or some other secondary pathology and wish somebody had caught them before they reached that point!

Is that wrong of me?


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Robert:

I don't see a problem with making custom or using prefabricated orthoses in children that have significant pathology or symptoms. Of course, there are some podiatrists that feel that treatment of asymptomatic flatfooted children with foot orthoses is "unethical". However, I don't agree and have no problem whatsoever with treating children with foot orthoses if they have significant flatfoot deformity or there is a family history of flatfoot and/or significant mechanical foot symptoms. I do have a problem with podiatrists that make custom foot orthoses for every child with a flatter than normal arch shape since I think this is wasteful and unneccessary.
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  #7  
Old 29th August 2006, 11:01 PM
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Default Pediatric flatfoot

Kevin et al

Thanks for that. I think a lot of the dispute and angst over whether or not to treat asymptomatic children boils down to the root of all evil, money. Even if the clinician acts with the very purest of motives and honestly beleives in treating a higher proportion of children, eyebrows are bound to raise if he / she is making a small fortune in the process. Motive and oppertunity alone are by no means proof of guilt however they do inevitably raise suspicions! We live in a sad and blighted world where it is hard to trust anyone who is selling anything!

Witness to, the proliferation of commercial labs manufacturing "different", "breakthrough" or "new paradigm" varieties of orthotic. Most claim to be a breakthrough in the care of patients but i for one will admit to starting from a position of extreme suspicion if the breakthrough is going to make the clinician rich!

Perhaps this is why we hold the academic side of the profession in such high regard?

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Old 9th September 2008, 01:34 AM
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Default Re: Prevalence of flat foot in preschool-aged children

What is the best method for child longitudinal plantar arch assessment and when does arch maturation occur?
Andrea Naomi Onodera, Isabel Camargo Neves Sacco, Eliana Harumi Morioka, Priscila Saraiva Souza, Márcia Regina de Sá and Alberto Carlos Amadio
The Foot; Volume 18, Issue 3, September 2008, Pages 142-149
Quote:
Background
The medial longitudinal arch modifies significantly during growth. Nevertheless, authors differ on the age at which the foot acquires the adult-like shape. The best method to assess this arch in children is also controversial.

Objectives
Characterize the longitudinal arch of children between 3 and 10 years and compare the applicability of five evaluation methods.

Methods
Plantar prints were acquired from 391 healthy preschools children from the University of Sao Paulo, Brazil. We calculated the arch indexes of: Cavanagh and Rodgers, Chipaux-Smirak, Staheli and the Alfa Angle, and compared them with the feet posture assessment. Non-parametric tests were used to compare among methods and ages. Spearman correlation was used to establish relationships among indexes.

Results
3 and 4 years old showed a high prevalence of low arches (36–86%). Between 4 and 5 years old, significant difference was observed for all indexes. The indexes presented good correlation among them, although the proportions of the different arch types were different for each age group (p < 0.001).

Conclusions
The longitudinal arch acquires an adult-like shape progressively, being statistically notorious the moment of medial longitudinal arch's formation between 4 and 5 years old. The Chipaux-Smirak Index is the best index to assess children's feet; it provides a better classification for lower arches and is easily calculated.
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Old 9th September 2008, 12:27 PM
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Default Re: Prevalence of flat foot in preschool-aged children

Why oh why do we see study upon study that does not take into consideration pain and the effect of the foot upon gross motor skills and general development. This study is a classic example.

The child's ability to keep up and develop within the range of normal, based on their tone and foot position (amongst other things) is something that the physio's and OT's are good at considering. How much do we as podiatrists do this? Why aren't we utilizing developmental tools to aid our decision making process, it should be us doing these sort of studies with our allied health collegues that are skilled in the child as a whole rather than a foot at the end of the body.
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Old 10th September 2008, 11:25 AM
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Default Re: Prevalence of flat foot in preschool-aged children

Interesting. Was the methodology vigorous, and were validity and reliability ensured?
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Old 14th November 2008, 03:55 AM
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Default Re: Prevalence of flat foot in preschool-aged children

HI I am wondering for a tilte re my Masters project. I am a Maltese podiatrist and re foot health education in my country nothing has been done yet. I might go for the prevelance of lower limb conditions in maltese obese children aged 8 -12 years(high rate internationally). Can anyone givve me a hint or tools I can use? Your help is more than appreciated

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Maltapod
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  #12  
Old 19th September 2012, 03:37 PM
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Default Re: Prevalence of flat foot in preschool-aged children

Prevalence of flatfoot in school between 3 and 10 years. Study of two
different populations geographically and socially

Vergara-Amador Enrrique, Rafael Fernando Serrano Sáncheza, Juan Rafael Correa Posadaad, Adriana Carolina Molanoa, Oscar A. Guevaraa
Colombia Médica - Vol. 43 Nº 2, 2012 (Abril-junio)

Quote:
Children present with flatfoot from birth and it resolves along infancy. There have been several risk factors identified for
the development of flatfoot: male sex, young age, overweight and obesity. The prevalence of flatfoot decreases with age.
The aim of this study was to determine the prevalence of flatfoot in two different populations with different social, cultural
and geographically characteristics in Colombia.

Patients and methods: This is a cross sectional study made on school children between 3 to 10 years of age, from several
schools in Bogota and Barranquilla. From 940 total children 60% were from Bogota. Flatfoot was diagnosed according to
physical exam.

Results: We found a global prevalence of flatfoot of 15.74%, distributed 20,8% in Bogota and 7.9% in Barranquilla. The
children from 3 to 5 years had a prevalence of 30,9%, decreasing significantly after this age. It was found that children 3
to 5 years old from Bogota had a prevalence of flatfoot of 38.3% while children from Barranquilla only 17.3%, decreasing
significantly in children older than 6 years. In the multivariate analysis we found an association between flatfoot with age,
city, gender and body mass index.

Discussion: We found a bigger prevalence of flatfoot in the population of Bogota compared to Barranquilla suggesting an
influence of social, cultural and racial factors in the development of flatfoot. The diminished prevalence of flatfoot in children
over 6 years of age suggest that therapeutic measures before this age are not recommended.
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Old 9th November 2012, 03:59 PM
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Default Re: Prevalence of flat foot in preschool-aged children

Change in flatfoot of preschool-aged children: a 1-year follow-up study
Kun-Chung Chen, Li-Chen Tung, Chih-Jung Yeh, Jeng-Feng Yang, Jing-Fu Kuo, Chun-Hou Wang
European Journal of Pediatrics; November 2012
Quote:
The main purpose of this study is to investigate the changes in the signs of flatfoot of preschool-aged children in a 1-year follow-up study. This study performed follow-up on a total of 580 preschool-aged children (boys, 297 children; girls, 283 children) with a median age of 54 (range 36–71 months), and the average follow-up period was 11.8 months. This study used the Chippaux–Smirak index (CSI) of footprint as the assessment tool, and CSI > 62.70 % was used as the standard for determining whether preschool-aged children suffered from flatfoot. The results showed that the signs of flatfoot of preschool-aged children improved with increasing age. At the 1-year follow-up, the average CSI was 5.1 % lower, and the proportion of children with flatfoot was 14 % lower. The follow-up on the change in the signs of flatfoot showed that 37.6 % of the children originally with flatfoot had improved to normal, verifying that flatfoot indeed improves with increasing age. However, the results also showed that 9.9 % of the children who originally had normal feet had developed flatfoot with increasing age, which deserves subsequent investigation. The results of the follow-up also showed that children who were relatively younger, male, obese, and experiencing excessive joint laxity were more likely to experience the signs of flatfoot.

Conclusion: The 1-year follow-up found that some preschool-aged children with flatfoot may develop normal feet, while children with normal feet may begin to experience the signs. Relevant factors affecting flatfoot in preschool-aged children continue to require further clarification.
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Old 26th September 2013, 03:26 PM
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Default Re: Prevalence of flat foot in preschool-aged children

Prevalence of Flatfoot and Anthropometric Comparison Between Flat and Normal Feet in the Hausa Ethnic Group of Nigeria
Musa B. T. Umar and Rabiu U. Tafida
J Am Podiatr Med Assoc 103(5): 369–373, 2013
Quote:
Background: Flat arches in children usually become proper arches and high arches as the child progresses through adolescence and into adulthood. Only if the deformity persists or presents in adolescence or adulthood is it considered abnormal. We sought to determine the incidence of flatfoot in schoolchildren and to make an anthropometric comparison between flat and normal feet with respect to age and sex in the Hausa ethnic group of Nigeria.

Methods: Two hundred 9- to 14-year-old students (100 boys and 100 girls) were studied. Navicular height, medial malleolar height, lateral malleolar height, foot length, and transverse arch length were measured with a ruler, marker, and measuring tape. Statistical analysis was conducted using analysis of variance and independent-samples t tests (P < .05).

Results: The overall prevalence of flatfoot was 10% (n = 20) (7% in boys [n = 7] and 13% in girls [n = 13]). Statistically significant differences were found in all of the measured parameters except foot length. This study showed that flatfoot has a higher incidence in girls than in boys in the Hausa ethnic group, with the incidence decreasing with age.

Conclusions: Girls had a higher incidence of flatfoot than boys, and it was also influenced by age.
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Old 1st January 2015, 02:20 PM
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Default Re: Prevalence of flat foot in preschool-aged children

Flatfoot Diagnosis by a Unique Bimodal Distribution of Footprint Index in Children.
Chang C, Chen Y, Yang W, Ho P, Hwang A, Chen C, Chang J, Chang L.
PLoS One. 2014 Dec 31;9(12):e115808.
Quote:
BACKGROUND:
More than 1000 scientific papers have been devoted to flatfoot issue. However, a bimodal distribution of flatfoot indices in school-aged children has never been discovered. The purposes of this study were to establish a new classification of flatfoot by characteristic in frequency distribution of footprint index and to endue the classification with discrepancy in physical fitness.
METHODS/PRINCIPAL FINDINGS:
In a longitudinal survey of physical fitness and body structure, weight bearing footprints and 3 physical fitness related tests were measured in 1228 school-aged children. Frequency distribution of initial data was tested by Kolmogorov-Smirnov test for normality and a unique bimodal distribution of footprint index was identified. The frequency distribution of footprint index manifests two distinct modes, flatfoot and non-flatfoot, by deconvolution and bootstrapping procedures. A constant intersection value of 1.0 in Staheli's arch index and 0.6 in Chippaux-Smirak index could distinguish the two modes of children, and the value was constant in different age, sex, and weight status. The performance of the one leg balance was inferior in flatfoot girls (median, 4.0 seconds in flatfoot girls vs. 4.3 seconds in non-flatfoot girls, p = 0.04, 95% CI 0.404-0.484).
DISCUSSION:
The natural bimodality lends itself to a flatfoot classification. Bimodality suggests development of the child's foot arch would be a leap from one state to another, rather than a continuous growth as body height and weight. The underlying dynamics of the human foot arch and motor development will trigger research prospects.
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Old 2nd January 2015, 12:44 PM
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Default Re: Prevalence of flat foot in preschool-aged children

Foot arch shape in children aged 2-5 years according to the data of plantography and holographic interferometry
Morfologiia. 2014;146(4):64-9.
Quote:
25 children aged 2 to 5 years were examined orthopedically using the methods of plantometry and holographic interferometry of three-dimensional casts of footprints. The computer maps of the foot arch surface were obtained and the graphic reconstruction of the arch shape was performed in normal cases and in children with flatfoot. Most significant deviations of the foot arch shape, probably associated with the development delay, were detected in 4-5-year-old children under the dynamic load. Some additional advantages of holographic interferometry for the early diagnosis of flatfoot in children were demonstrated.
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