A Cross-sectional Study Investigating the Impact of Corrected Flatfeet on Children’s Outcomes Assessing Gait and Pain Incidence among School-aged Children

Abstract

Introduction: Flatfoot is a common foot condition among children that can cause pain and impair function if left untreated. While surgical correction aims to restore arch alignment, evidence on long-term outcomes is limited. This study investigated the impact of early flatfoot surgery on school-aged children’s gait patterns and pain incidence. Methods: A cross-sectional study compared 724 children aged 1–12 years who underwent flatfoot surgery before age 5–60 controls with mild-to-moderate untreated flatfeet, matched for age and gender. Clinical evaluation assessed residual rearfoot alignment. Gait analysis used motion capture to analyse temporal-spatial gait parameters. Questionnaires evaluated function (FAAM-C) and foot pain (FLACC). SPSS version 26 was used to enter the data. Paired t-tests were used in the statistical analysis to compare questionnaire ratings and gait between groups. Correlation study evaluated relationships between outcomes and residual abnormalities. Function and pain factors modelled using multiregression. At P < 0.05, significance was established. Results: Surgically corrected children showed generally normalised gait compared to controls on metrics except step width. FAAM-C scores averaged 90.5 ± 7.5 versus 80.3 ± 10.4 for controls (P < 0.001), and FLACC pain scores were lower in the surgical group at 1.5 ± 1.7 versus 3.4 ± 2.5 (P = 0.002). Residual hindfoot valgus/limited dorsiflexion moderately correlated with worse function/higher pain. Conclusion: Early flatfoot surgery resulted in long-term gait patterns approximating peers without flatfeet. Surgically treated children also reported better function and less frequent/severe pain compared to mild–moderate untreated flatfeet controls. Residual transverse/sagittal plane deformities moderately correlated with poorer outcomes. This provides novel insights supporting early surgical intervention.