Children Flat Foot and Lower Limb Rotational Profile: A Cross-Sectional Descriptive Study (original) (raw)
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Flat foot and femoral anteversion in children—A prospective study
The Foot, 2009
Flat foot in children during the first years of life evokes significant parental concern. Flat foot, intoeing and femoral anteversion may well be differential dimensions of developmental pathodynamics with potential for inter-related developmental correction. While correlation of femoral anteversion with intoeing is documented, its relationship with flat foot remains unclear.The aim of this prospective study is to investigate the relationship between flat foot and internal rotation of hip, indirectly femoral anteversion.651 Children, 339 boys and 312 girls, aged 3–6 years, were examined and Contact Index II for flat foot as well as internal rotation of hip measured. 82 children with other foot and leg deformities were excluded from further analysis.Out of 569 children, 95 (16.7%) had flat feet – 56 bilateral, 39 unilateral – with Contact Index II of 0.88 or above. All children with flat feet (and none of the normal 474) had raised internal rotation of hip (mean 69.9°, range 62–80°).Regression analysis established an unequivocal and highly significant statistical relationship between flat foot and increased internal rotation of hip (F = 168.1, p < 0.001, r = 0.53) in children between 3 and 6 years.
Introduction: There is no consensual agreement on the strict clinical or radiographic criteria for defining a flatfoot. Traditionally, a flatfoot has been defined subjectively as a weight-bearing foot with an abnormally low or absent longitudinal arch. This definition is based solely upon the static anatomic comparison of the height of the arch within a population. It fails to take into consideration the etiology of the flatfoot, the functional relationships between the bones, and the presence or evidence-based expectation of future pain or disability. Methodology: All patients in the study were evaluated thoroughly using detailed history and complete physical examination with special emphasis on weight, family history, findings like tight tendoachilles, ligamentous laxity, intermalleolar distance and gait analysis. The examination included biomechanical examination of hip, knee, foot and ankle. Associated conditions were also given importance to rule out any syndromic flat foot. Results: The younger the age group the better they respond to orthotic treatment. More severe the deformity the better they respond to orthotic treatment. Symptomatic fff have better results than asymptomatic fff. Early the orthotic treatment received better is the result. Arch support helps in relieving clinical features like pain and out toeing. Conclusion: Arch index may help in improvement of radiographical angles like cp, tca and tma. There is no short term and long term complications related to using of arch support.
Srpski arhiv za celokupno lekarstvo, 2009
The authors describe flatfoot, as one of very frequent deformities in everyday medical practice. A special condition of the deformity associated with a calcaneal valgus position and complicated by a knee valgus position (as a consequence of non-treatment) is described. Also, the precise anatomy of the longitudinal foot arches (medial and lateral), definition and classification of the deformity, clinical findings and therapeutic protocols are proposed. The authors especially emphasise that the need for having extensive knowledge on the differences between a flexible and rigid flatfoot, having in mind that the treatment of flexible flat foot is usually not necessary, while the treatment of rigid flatfoot is usually unavoidable.
Rotational profile of the lower limb in 1319 healthy children
Gait & Posture, 2008
Lower limb rotational profile in children may cause great concern to parents and relatives. In order to give parents clear information, there is a need for referential studies giving normative data of lower limb rotational profile and its normal changes expected over growth. Our aim was to collect a large clinical series of healthy children, out of a clinic, selected from a non-consulting population and to analyse Tibial Torsion and Femoral Anteversion according to age and gender.
Flat Foot and Postural Harmony in 6-Year-Old Caucasians: What is Their Relationship?
Annals of Rehabilitation Medicine
Objective To determine whether asymptomatic flexible flat feet show specific postural assessment with respect to neutral feet in 6-year-old children.Methods In this cross-sectional observational study, 164 subjects were observed and divided into two groups: 57 with flexible flat feet and 107 with neutral feet. A non-quantitative inspection by podoscopy and baropodometry were performed to evaluate plantar support, and a clinical examination to assess postural setting.Results The prevalence of flexible flat feet was 34.8%. The differenceinthe mean centre of pressure (CoP) between the two groups was significant (p=0.028), regarding the antero-posterior direction of CoP only. There was no significant differencein the presence of postural growth disharmony between the neutral and flat-feet groups.Conclusion The flattening of the plantar archseems to be linked to a displacement of CoP Y, more posterior in flat feet than in neutral feet; on the other hand, postural harmony in 6-year-old ch...
The typically developing paediatric foot: how flat should it be? A systematic review
Journal of Foot and Ankle Research
Background: All typically developing children are born with flexible flat feet, progressively developing a medial longitudinal arch during the first decade of their lives. Whilst the child's foot is expected to be flat, there is currently no consensus as to how flat this foot should be. Furthermore, whilst feet are observed to decrease in flatness with increasing age, it is not known how flat they should be at each age increment. The objective of this systematic review is to define the postural characteristics of the 'typically' developing paediatric foot. Methods: The PRISMA protocol was applied to compare all data currently published describing the typical development of the paediatric foot. The Epidemiological Appraisal Instrument (EAI) was used to assess the risk of bias of the included studies. Results: Thirty four epidemiological papers pertaining to the development of the paediatric foot were graphically compared. Sixteen different foot posture assessments were identified of which footprint based measures were the most reported outcome. Conclusion: Firstly, the use of the term normal in relation to foot posture is misleading in the categorisation of the paediatric foot, as indeed a flat foot posture is a normal finding at specific ages. Secondly, the foot posture of the developing child is indeed age dependent and has been shown to change over time. Thirdly, no firm conclusion could be reached as to which age the foot posture of children ceases to develop further, as no two foot measures are comparable, therefore future research needs to consider the development of consensus recommendations as to the measurement of the paediatric foot, using valid and reliable assessment tools.
Flatfoot in School-Age Children
Foot & Ankle Specialist
Background. Flatfoot has been shown to cause abnormal stresses on the foot and lower extremity. The altered mechanical stresses on these structures can aggravate the foot deformity. Screening of the flatfoot and its associated factors helps detect underlying risks influencing the stresses on the foot. The purpose of this study was to analyze the structure of the medial foot arch and investigate its associated factors in students, aged 7 to 14 years. Methods. Multistage cluster sampling was used and each cluster included 2 their random sampling levels. A total of 667 Iranian school children were recruited and their feet were bilaterally evaluated using a static footprint while standing in a fully weightbearing position. The footprint, an observational measurement, and a questionnaire were used for the foot assessment. Results: The prevalence of flatfoot was 17.1% in the population studied. There was no gender difference but the prevalence of flatfoot did decrease with age. The signif...
Normal and Abnormal Torsional Development in Children
Clinical Orthopaedics and Related Research, 1994
This study presents findings in a series of 123 children with intoeing gait. The intoeing was caused by increased femoral anteversion (IFA) in 70% of the cases, and internal tibial torsion (ITT) in 30%. Rotation of the hips, thigh-foot angle, Q-angle, and computed tomography measured anteversion and tibial torsion divided the two groups very clearly. In the IFA group, 40.3% of the patients presented with an externally rotated tibia and 59.7% had an internally rotated tibia. In the ITT group, the anteversion was normal for age and the tibial torsion was significantly decreased. Eighty children who corrected their intoeing gait, and of whom 83.4% had IFA, were also reviewed: a decrease in anteversion was observed in 20.5% of the patients; 62.9% showed no decrease in anteversion.
Educational Review - Rotational Deformities of the Lower Limb in Children
Rotational deformities are common lower extremity abnormalities in children. Rotational problems include in-toeing and out-toeing. In-toeing is caused by one of the three types of deformity: metatarsus adductus, internal tibial torsion, and increased femoral anteversion. Out-toeing is less common than intoeing, and its causes are similar but opposite to those of intoeing. These include femoral retroversion and external tibial torsion. An accurate diagnosis can be made with careful history and physical examination, which includes torsional profile (a four-component composite of measurements of the lower extremities). Charts of normal values and values with two standard deviations for each component of the torsional profile are available. In most cases, the abnormality improves with time. A careful physical examination, explanation of the natural history, and serial measurements are usually reassuring to the parents. Treatment is usually conservative. Special shoes, cast, or braces are rarely beneficial and have no proven efficacy. Surgery is reserved for older children with deformity from three to four standard deviations from the normal.