Rehabilitative treatment in flexible flatfoot: a perspective cohort study

Abstract

Paediatric valgus flexible flatfoot is a common childhood paramorphism. Its treatment options consist of rehabilitation, corrective footwear and, if necessary, surgical intervention. The aim of our study was to compare a group of children who followed a rehabilitative programme versus a historical group of children who had been treated with insoles and orthopaedic footwear. Over a 2 year period (1995-1997), 300 children (mean age was 3.4-184 male, 116 female) with bilateral flexible flatfoot (600 feet) were recruited and underwent a rehabilitative programme for a mean period of 2.75 years. The feet were classified according to Viladot's method: 386 feet presented a type III degree deformity and 214 feet presented a type II degree deformity. The rehabilitative programme consisted of simple therapeutic exercises, which could be easily learnt by both patients and their caregivers. These children were compared to a historical group of children (674 feet) who had been treated in our department for infantile flexible flatfoot with the use of orthosis. In these groups, 396 feet presented a type III degree deformity and 278 feet presented a type II degree deformity. In the group of children who underwent the rehabilitative protocol, during follow-up at the age of eight, 352 of the 386 type III degree feet could be classified as normal and 210 of the 214 type II degree cases became normal. In the historical cohort of children treated with orthosis, at the age of eight, 214 of the 396 type III degree feet could be classified as normal; and 248 of the 278 type II degree cases became normal. Our results show that comparing the percentage of success (changing from type III or II degree to type I or N) in the two groups (children treated with rehabilitation and children treated with orthosis), the rehabilitative approach seems to be more effective. Probably it has a marginal influence on the natural history of paediatric valgus flexible flatfoot even though it plays a role in maintaining good flexibility of the flatfoot thus limiting functional impairment.

Peer Review #2 of "When, why and how foot orthoses (FOs) should be prescribed for children with flexible pes planus: a Delphi survey of podiatrists (v0.1)"

“…However, this review was based on only three randomised control trials (Powell et al 2005;Wenger et al 1989;Whitford & Esterman 2007), with only one of the studies using a symptomatic population. Indeed, much of the research on the use of FOs for flexible pes planus in children, to date, has been focussed on non-symptomatic populations Manuscript to be reviewed (Aboutorabi et al 2014;Bleck & Berzins 1977;Bok et al 2014;Bordelon & Lusskin 1980;Capasso 1993;Riccio et al 2009;Valmassy & Terrafranca 1986). The findings of this research demonstrate that it is the presenting symptoms of a child with flexible pes planus that guide the podiatrists' decision to intervene along with clinical signs of the condition (observations and measurements).…”

An investigation into the aetiology of flexible flat feet

“…Muscle strengthening regimes have been used, with a suggestion that these may improve foot posture. 27 Further work is required to evaluate dynamic stabilisation as a potential form of treatment.…”

Comparison of Foot Taping Versus Custom-Made Medial Arch Support on Pronated Flatfoot in School Going Children

“…35 As a pragmatic approach, these factors have been categorized as 'easy' or 'difficult' to influence clinically. Strength 36,37 , obesity or overweight 38 and shoe use 39 are the 'easy' factors which may be altered so as to possibly influence foot posture and resulting gait.…”