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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.
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??
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
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
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
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?
Regards
Robert Isaacs
The Following User Says Thank You to Robertisaacs For This Useful Post:
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?
Regards
Robert Isaacs
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.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
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?
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.
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.
__________________
Cheers,
Cylie.... in a permanent state of confusion
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
Prevalence of flat foot in preschool-aged children
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