Original article
Do corrective shoes improve the development of the medial longitudinal arch in children with flexible flat feet?

https://doi.org/10.1016/j.jos.2016.04.014Get rights and content

Abstract

Background

Flexible flatfoot, as the most prevalent foot deformity in pediatric population still has no standardized strategy for its management hence some orthopedic surgeons have the tendency to use orthotic devices. The objective of this study is to evaluate whether orthotic shoes effect the natural course of the developing medial longitudinal arch in children diagnosed with moderate flexible flatfoot.

Methods

Fourty-five children (33 boys and 12 girls) with moderate flexible flatfoot were enrolled in this study. They were followed up for 34.6 ± 10.9 months (24–57 months). Patients in group 1 were treated with corrective shoes whereas group 2 was left untreated. Patients were evaluated according to; general joint laxity, arch index, lateral talo-first metatarsal (TM), talo-horizontal (TH), calcaneal pitch (CP), lateral and anterior talocalcaneal (TC) angles.

Results

Although there was a significant decrease in general laxity in both groups, decrease of laxity percentage was not significant between groups (p = 0.812). TM, TH and anterior TC angles were found to be decreased in groups whereas there was no difference between group 1 and 2. The arch index was found to be correlated with TM and TH angles in both groups (p = 0.004, p = 0.013).

Conclusions

Corrective shoes for flexible flatfoot was found not effective on development of foot arches. Therefore, they should be limited only for selected cases.

Introduction

Pes planus in general can clinically be defined as absence of the medial longitudinal arch. Pes planus, commonly referred as flatfoot, is a combination of foot and ankle deformities. Mostly the main deformity is the subtalar joint complex [1].

Flatfoot is especially common in 0–3 years of age, due to ligamenteous laxity and the plantar fat that hasn't been resorbed yet. The first 6 years is important for the longitudinal arch development. It can be explained by the influence of three factors; the neurovascular system, decrease in joint laxity and increase in ossification of the foot.

Pes planus can be flexible or rigid and congenital or acquired. Although rigid pes planus almost always require surgical treatment, flexible pediatric pes planus can be mainly considered as a common benign childhood condition, but also having the potential to result in pain and altered gait in adulthood.

Pediatric flatfoot has been observed for many years by orthopedic surgeons but there is still no standard strategy for its management and an ongoing debate whether flexible flatfoot is a pathologic condition and whether or not to use orthoses [2].

Flatfoot in children are initially suspected by their parents mostly because of shoe wear or inability to perform complex physical tasks [3], [4].

Treatment mainly consists of conservative and surgical management. Existence of pain, age, gender, body mass index, joint laxity, alignment of the lower extremity, neurological disorders, existence of achilles contracture are all factors that should be taken in account before initiating the appropriate treatment [3], [5]. Strengthening therapy, nonsteroidal anti-inflammatory medication, braces, inserts, night splints and modified shoes compromise conservative treatment options [6], [7], [8]. Pfeiffer and colleagues reported that 10% of the children diagnosed with flatfeet are wearing arch supports [9], [10].

Aggressive long-term orthotic managements are still being advocated by some orthopedic surgeons for flexible flatfoot with moderate deformity. The question is; what happens to the medial longitudinal arch when left to its natural course and if orthotic shoes are necessary to achieve a asymptomatic, functional foot.

The purpose of the study was to evaluate the impact of corrective shoes over the natural course of flexible flatfoot in the pediatric population.

Section snippets

Material and methods

45 children (33 boys and 12 girls), mean age 39.5 months (17–72 months) with moderate flexible flatfoot were enrolled in this study. They were followed up for 34.6 ± 10.9 months (24–57 months). All patients were pain free. Patients were randomized and separated in two groups. Randomization was made by weekly basis. Patients that fulfilled the inclusion criteria during even number weeks consisted group 1 and in odd number weeks consisted group 2. The study was initiated with an odd number week

Data analysis

Statistical comparisons were generated using Statistical package for Social Sciences-16 for Windows programme (SPSS, Chicago,IL,USA). All data are expressed as median (min–max). The percentage changes in radiologic angle measurements and ligamanteous laxity of the feet between treated and control groups were evaluated using Mann Whitney-U test. The difference between the initial and last values for radiologic angle measurements in groups were analyzed using Wilcoxon test. The relationship

Results

The decrease of talo–first metatarsal, talo–horizontal and anterior talocalcaneal angles were found to be statistically significant in both groups whereas there was no statistically significant difference between the two groups of those measurements (Table 1). The lateral talocalcaneal angle was also found to be decreased in both groups but this was not statistically significant (p = 0.736, p = 0.113). Though a statistically significant increase in calcaneal pitch angle was observed in both

Discussion

Pediatric flexible flatfoot is a pathomechanically complex deformity and may become confusing for orthopedic surgeons especially if they are symptomatic. There is little argument about the need to treat the forms of flatfoot that are clearly pathologic, the controversy is about moderate forms of flexible flatfoot.

There is still no consensus whether orthopedic shoes are necessary for its treatment and a specific treatment algorithm does not exist. Gould et al. studied 225 beginning walkers and

Conflict of interest

The authors declare that they have no conflict of interest.

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