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The Flat-Footed Child
- To Treat or Not to Treat |
This article
written by Evans (2008) is
the first meta-analysis
published on the treatment
of pediatric flatfoot.
The author analyzed a number
of research articles that
included use of functional
foot orthoses to treat
pediatric flatfoot. The
articles were ranked based
on the quality of evidence
each presented. In addition
to the meta-analysis, Evans
also uncovers important
demographic information,
distills the
current knowledge base
regarding treatment of
flatfooted children, and
makes definitive
recommendations for the
clinician.
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Significance of the Article |
Approximately
three percent of the
pediatric population has
flat feet requiring
treatment. The flatfooted
incidence decreases with age
from three to six years in
about half of these
children. There is a
predisposition in boys for
flat feet. Fifty percent of
overweight children have
flat feet and 62% of obese
children are flatfooted.
The author identifies three
prominent articles, each
which ultimately recommends
orthoses for the treatment
of pain and function
disorders related to flat
feet. None of these articles
demonstrated a change in
morphology secondary to
treatment intervention.
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Significance for
Orthotic Therapy |
Based on the
information gained from the
meta-analysis, a treatment
algorithm for typical
pediatric flexible flatfoot
is established. The
algorithm first recommended
that patients be categorized
as symptomatic or
asymptomatic. If
asymptomatic, they are
further divided into those
who seem to be developing
normally and those whose
feet remain flat. No
treatment is recommended for
the asymptomatic normally
developing foot, while
monitoring is advised for
the asymptomatic flat foot
that remains flat or becomes
flatter as the child ages.
When indicated, treatment
with orthoses, stretching,
and rigid footwear are
recommended for the
symptomatic patient. The
author recommends the use of
prefabricated or generic
orthoses for treatment.
Evans cautions that
undertreatment can be as
detrimental as "overprescription"
of foot orthoses. The
algorithm presented may help
guide clinicians to more
appropriate decision-making
in regards to the typical
pediatric flexible flatfoot.
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Orthoses for Pediatric
Flatfoot |
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