Effect of Insoles Treatment on School-Age Children with Symptomatic Flexible Flatfoot: A 2-Year Follow-Up Study

The F-words relating to symptomatic flexible flat feet: A scoping review

Flexible flat feet are one of the most common musculoskeletal concerns presenting to paediatric health services, despite this being an expected finding in children under 10 years and only requiring management when symptoms are associated. Understanding which symptoms are associated with symptomatic presentations of flexible flat foot in children will provide clarity in identifying those that require further assessment and/or intervention. A scoping review of the literature was conducted to gather all known symptoms related to symptomatic flexible flat foot in the child. Data was mapped using the 'F-words' framework, a child friendly, six-item tool based on the International Classification of Functioning, Disability and Health Framework 11 (ICF-11). This review identified 42 individual symptoms relative to symptomatic presentations of flexible flat foot, which were allocated into five of the six 'F-words' categories (fitness, functioning, friends, family and future). Of these, pain was the most reported symptom, identified in 124 (of 133) included citations, followed by symptoms associated with reduced lower limb function (altered gait patterns, reduced balance and stability and increased tripping), fatigue and reduced participation. Other less frequently reported symptoms include callus formation, night pain and cramps. When present, these symptoms may occur independently or may co-exist at the same time. No symptoms were allocated to the fun category of the 'F-words'. A multitude of symptoms are reportedly associated with symptomatic flexible flatfoot in the child, with no discernible pattern or coherence noted. Further research should examine development and progression of symptoms and seek to better understand causality of relationship between symptoms and foot posture.

Efficacy of Plantar Orthoses in Paediatric Flexible Flatfoot: A Five-Year Systematic Review

Paediatric flexible flatfoot (PFF) is a very common condition and a common concern among parents and various healthcare professionals. There is a multitude of conservative and surgical treatments, with foot orthoses (FO) being the first line of treatment due to their lack of contraindications and because the active participation of the child is not required, although the evidence supporting them is weak. It is not clear what the effect of FO is, nor when it is advisable to recommend them. PFF, if left untreated or uncorrected, could eventually cause problems in the foot itself or adjacent structures. It was necessary to update the existing information on the efficacy of FO as a conservative treatment for the reduction in signs and symptoms in patients with PFF, to know the best type of FO and the minimum time of use and to identify the diagnostic techniques most commonly used for PFF and the definition of PFF. A systematic review was carried out in the databases PubMed, EBSCO, Web of Science, Cochrane, SCOPUS and PEDro using the following strategy: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) on child patients with PFF, compared to those treated with FO or not being treated, assessing the improvement of signs and symptoms of PFF. Studies in which subjects had neurological or systemic disease or had undergone surgery were excluded. Two of the authors independently assessed study quality. PRISMA guidelines were followed, and the systematic review was registered in PROSPERO: CRD42021240163. Of the 237 initial studies considered, 7 RCTs and CCTs published between 2017 and 2022 met the inclusion criteria, representing 679 participants with PFF aged 3-14 years. The interventions of the included studies differed in diagnostic criteria, types of FO and duration of treatment, among others. All articles conclude that FO are beneficial, although the results must be taken with caution due to the risk of bias of the included articles. There is evidence for the efficacy of FO as a treatment for PFF signs and symptoms. There is no treatment algorithm. There is no clear definition for PFF. There is no ideal type of FO, although all have in common the incorporation of a large internal longitudinal arch.