Heel seats and shoe wear

Do corrective shoes improve the development of the medial longitudinal arch in children with flexible flat feet?

BACKGROUND

Flexible flatfoot, as the most prevalent foot deformity in pediatric population still has no standardized strategy for its management hence some orthopedic surgeons have the tendency to use orthotic devices. The objective of this study is to evaluate whether orthotic shoes effect the natural course of the developing medial longitudinal arch in children diagnosed with moderate flexible flatfoot.

METHODS

Fourty-five children (33 boys and 12 girls) with moderate flexible flatfoot were enrolled in this study. They were followed up for 34.6 ± 10.9 months (24-57 months). Patients in group 1 were treated with corrective shoes whereas group 2 was left untreated. Patients were evaluated according to; general joint laxity, arch index, lateral talo-first metatarsal (TM), talo-horizontal (TH), calcaneal pitch (CP), lateral and anterior talocalcaneal (TC) angles.

RESULTS

Although there was a significant decrease in general laxity in both groups, decrease of laxity percentage was not significant between groups (p = 0.812). TM, TH and anterior TC angles were found to be decreased in groups whereas there was no difference between group 1 and 2. The arch index was found to be correlated with TM and TH angles in both groups (p = 0.004, p = 0.013).

CONCLUSIONS

Corrective shoes for flexible flatfoot was found not effective on development of foot arches. Therefore, they should be limited only for selected cases.

Flexible flatfoot in children and adolescents

Flexible flatfoot is a normal foot shape that is present in most infants and many adults. The arch elevates spontaneously in most children during the first decade of life. There is no evidence that a longitudinal arch can be created in a child's foot by any external forces or devices. Flexible flatfoot with a short Achilles tendon, in contrast to simple flexible flatfoot, is known to cause pain and disability in some adolescents and adults. Joint-preserving, deformity-correcting surgery is indicated in flexible flatfeet with short Achilles tendons when conservative measurements fail to relieve pain under the head of the plantar flexed talus or in the sinus tarsi area. Osteotomy is the fundamental and central procedure of choice. In almost all cases, Achilles tendon lengthening is required. In some cases, rigid supination deformity of the forefoot is present, requiring identification and concurrent treatment.

A cross-sectional study on the development of foot arch function of 2715 Chinese children

A cross-sectional study was conducted to investigate the foot arch function of Chinese children. A total of 2715 children, 1246 girls, and 1369 boys, 4-18 years of age were recruited from kindergartens, primary, and secondary schools. The dynamic footprints of the children were collected using a portable pressure-sensing mat. The Contact Force Ratio (CFR, i.e. the ratio of the mid-foot loading to the total loading of the contacted foot, with the toes ignored) of each age group was calculated. In general, the CFR decreased from 4 to 10 years and plateaued at 10-12 years and then increased until 15-16 years. An abnormal low arch foot was defined as the foot that had a CFR value larger than the corresponding age mean plus one standard deviation. The cut-off CFR values of each age group were calculated. With the exception of the 17 years age group, which consisted of a relatively small number of subjects, the percentage of low arch subjects of all the other age groups ranged from 15 to 20%.