Pediatric Flatfoot and Orthoses 

Issue  No. 1         
Welcome to the ProLab E-Journal Club. Twice a month we provide a summary of a peer-reviewed article and highlight how the research findings are signficant to orthotic therapy. The topic for this week is Pediatric Flatfoot and Orthoses. The article that we are discussing is "The Flat-Footed Child - To Treat or Not to Treat" by A.M. Evans (JAPMA 2008).  
Cherri Choate, DPM
Larry Huppin, DPM
Alona Kashanian, DPM
Paul R Scherer, DPM
E-Journal Review
The Flat-Footed Child
Significance of the Article
Significance for Orthotic Therapy
Orthoses for Pediatric Flatfoot
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.
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. 
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.
Orthoses for Pediatric Flatfoot
ProLab used evidence-based research to develop two orthoses for pediatric flatfoot:
P3 Prefabricated Functional Kiddythotics and Custom Pathology Specific Pediatric Flatfoot Orthoses. They include a deep heel cup, a medial flange, and a medial skive to provide superior control over excessive subtalar joint pronation. Both of these orthoses provide exceptional outcomes for patients. 
For more information on ProLab, visit our website at
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