Effect of Foot Orthoses in Children With Symptomatic Flexible Flatfoot Based on Ultrasonography of the Ankle Invertor and Evertor Muscles

The resting calcaneal stance position (RCSP): an old dog, with new tricks

The objective of this study was to establish the accuracy of the resting calcaneal stance position (RCSP) for the assessment of flat foot (FF) in children, aligned to the validity of the foot posture index (FPI). The RCSP cut-off point was explored, in context of both FF prevalence and the relationship between FF and body weight. A total of 205 healthy children, aged 5 to 10 years, participated in a cross-sectional study. Correlation was performed between RCSP and FPI. ROC curve technique was calculated to assess differentiation between groups. A score equal to or greater than 7 on the FPI was used as the 'gold standard' for analysis. The correlation between FPI and RCSP was significant (r = 0.63; p < 0.01). The discrimination score on the ROC curve (6 points/degrees) shows that the model can be used to identify FF through RCSP, with a sensitivity of 67% and specificity of 85% returned.  Conclusion: The results of this study indicate the role of RCSP for simple, accessible and quick screening of paediatric FF. This is especially pertinent for non-podiatric healthcare professional without specialised paediatric foot knowledge. What is Known: • Most children develop a normal arch quickly, and flat feet usually resolve on their own between 2 and 6 years of age. • The measurement used to diagnose flat foot in children must be accurate, consistent, and valid to characterize the standard foot position. The Resting Calcaneal Stance Position (RCSP) is another widely used measure to evaluate the position of the flat foot in children. What is New: • The RCSP cut-off point 6 shows a sensitivity of 67% and a specificity of 85% thanks to the FPI as the Gold standard. • The RCSP is useful for health professionals who are not specialised in pediatric foot health. The RCSP is useful to detect flat foot in children.

Relation of Flatfoot Severity with Flexibility and Isometric Strength of the Foot and Trunk Extensors in Children

BACKGROUND

Flatfoot is a deformity in which the foot is flattened due to a decrease in or loss of the medial longitudinal arch.

STATEMENT OF THE PROBLEM

Few studies have investigated the relationship between the severity of flat feet, trunk strength, and joint flexibility.

PURPOSE

The aim of this study is to investigate the relationship between the severity of flatfoot and joint flexibility and foot and trunk strength in children with flexible flatfoot.

METHODS

This study included 16 children (boys, 12; girls, 4; age, 4~8 years) with flexible flatfeet. We examined the resting calcaneal stance position angle (RCSPA) and foot posture index (FPI) scores for clinical severity and radiographic parameters, such as calcaneal pitch angle, talometatarsal angle (TMA), and talocalcaneal angle (TCA). Muscle thicknesses of the tibialis posterior (TP), peroneus longus (PL), and L1 multifidus were measured by sonography. Isometric contraction of ankle inversion, eversion in a seating position, and lumbar extension at a prone position were induced using a handheld dynamometer to measure the maximum muscle strength for each muscle. Beighton's scoring system was used to assess joint flexibility by evaluating the hyperextension of the joint for each category when performing stretching motion. Spearman's rank correlation coefficient for nonparametric data was used.

RESULTS

The FPI showed a moderately negative correlation with the muscle thickness of TP (r = -0.558, p = 0.009) and L1 multifidus (r = -0.527, p = 0.012), and the strength of the ankle inverter (r = -0.580 p = 0.005) and lumbar extensor (r = -0.436 p = 0.043). RCSPA showed a moderately positive correlation with TCA (r = 0.510, p = 0.006). Beighton's score showed no significant correlation with all parameters.

CONCLUSION

In children with flatfoot, FPI reflected the clinical severity; thus, the more severe the symptoms, the weaker the ankle inverter and lumbar extensor.

Monitoring the Role of Physical Activity in Children with Flat Feet by Assessing Subtalar Flexibility and Plantar Arch Index

Flat foot is a common pediatric foot deformity which involves subtalar flexibility; it can affect the plantar arch. This study analyzes the evolution of two parameters, i.e., plantar index arch and subtalar flexibility, before and after physiotherapy and orthoses interventions, and examines the correlation between these two parameters. Methods: The study included 30 participants (17 boys, 12 girls, average age 9.37 ± 1.42 years) with bilateral flat foot. We made two groups, each with 15 subjects. Assessments of the subtalar flexibility and plantar arch index used RSScan the platform, and were undertaken at two time points. Therapeutic interventions: Group 1—short foot exercises (SFE); Group 2—SFE and insoles. Statistical analyses included Student’s t-test, Cohen’s D coefficient, Pearson and Sperman correlation. Results: Group 1—subtalar flexibility decreased for the left and right feet by 28.6% and 15.9% respectively, indicating good evolution for the left foot. For both feet, a decrease of the plantar index arch was observed. Group 2—subtalar flexibility decreased for the right and left feet by 43.4% and 37.7% respectively, indicating a good evolution for the right foot. For both feet, a decrease of plantar index arch was observed. Between groups, subtalar flexibility evolved well for Group 2; this was attributed to mixt intervention, physical therapy and orthosis. For plantar arch index, differences were not significant between the two groups. We observed an inverse correlation between subtalar flexibility and plantar arch index. Conclusions: Improvement of plantar index arch in static and dynamic situations creates the premise of a good therapeutic intervention and increases foot balance and postural control. The parameter which showed the most beneficial influence was the evolution is subtalar flexibility.