When, why and how foot orthoses (FOs) should be prescribed for children with flexible pes planus: a Delphi survey of podiatrists

Abstract

BackgroundFlexible pes planus (flat feet) in children is a common reason parents and caregivers seek health professionals consult and a frequent reason podiatrists prescribe foot orthoses. Yet no universal agreement exists on the diagnosis of this condition, or when and how foot orthoses should be prescribed. The aim of this study was to garner consensus and agreement among podiatrists on the use of FOs for paediatric flexible pes planus.MethodsA three round Delphi consensus survey was undertaken with 15 podiatry experts from Australia, New Zealand and the United Kingdom. Round One gathered consensus on the diagnosis and intervention into paediatric pes planus with specific questions on types of FOs and prescription variables used. Round Two and Three were based on answers from Round One and gathered agreement (rationale for choices) on a five point Likert scale. 70% of respondents had to agree to a statement for it to be accepted as consensus or agreement.ResultsConsensus and agreement was achieved for 83 statements directing the diagnosis of pes planus (using FPI-6 and/or rearfoot measures), common signs and symptoms (e.g., pain, fatigue, abnormal gait and other functional concerns) that direct when to intervene into paediatric flexible pes planus. Prefabricated orthoses were the preferred intervention where adequate control is gained with their use. When customised orthoses are prescribed, a vertical [heel] cast pour (71.4%) and minimal arch fill (76.9%) are the prescription variables of choice, plus or minus additional variables (i.e., medial heel (Kirby) skive, the use of a University of California Biomechanical Laboratory device or a medial flange) dependent on level of disorder and plane of excessive motion.ConclusionsThis study identified consensus and agreement on a series of diagnosis methods and interventions for the paediatric flexible pes planus. A clinical protocol was developed from the resultant consensus statements which provides clinicians with a series of evidenced-informed statements to better guide them on when, how and why FOs are used specific to this population.

Development and use of the PodEssential and Paeds‐PodEssential triage tools to define “essential” podiatry services. A Delphi survey, scoping review, and face validity testing study

“…Statements were accepted as reaching consensus where 70% of participants indicated the same themed statement, statements where 50–69% of participants indicated the same themed statement were reviewed by the participants in Round 2 to ensure adequate consideration, and statements where less than 50% of participants indicated the same concept were excluded from future rounds. Using this percentage was consistent with existing literature on the modified Delphi technique [ 8 , 57 ].…”

Trends in hospitalization for paediatric flatfoot: an Italian nationwide study from 2001 to 2016

“…The use of orthotics in symptomatic form is contentious [ 26 , 27 ] and there is currently insufficient data to support this approach. Only a few non-comparative studies assessed the advantages of orthotics in patients with flexible flatfoot [ 10 , 28 ]. On the other hand, surgery may be useful in children who are in discomfort, with or without a short Achilles tendon [ 29 – 31 ].…”

Effectiveness of therapeutic footwear for children: A systematic review

“…It must be noted three studies, considering pes planus appeared to only acknowledge the postural presentation with no apparent symptoms or other underlying pathology identified [11,12,37]. Therapeutic interventional studies should consider expanding on the descriptors of inclusion for pes planus in children [51][52][53] to avoid the possibility of medicalising healthy physiological development [54] and potential detriment to the health economy and the individual [55,56]. The effects of footwear as a therapeutic intervention on other noteworthy conditions that impact on children's mobility such as joint hypermobility syndrome [57], spina bifida [58], developmental coordination disorder [59], juvenile idiopathic arthritis [60], and Charcot Marie Tooth [61] were not considered in the included studies.…”