Pediatric Flatfoot: When Do You Treat It?

Start Page: 62
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Author(s): 
Russell G. Volpe, DPM

Recommendations For When To Treat Pediatric Flatfoot

The following guidelines should prove useful in determining when a child with a flatfoot/pes plano valgus should undergo treatment.
• Symptoms (frequent changes in activity level and function before pain develops) of any kind that are attributable to abnormal foot posture
• A non-physiologic flatfoot at any age
• Abnormal weightbearing position of the foot based on the child’s age with associated signs of abnormal foot posture such as midfoot abduction, talar deviation and frontal plane hallux deviation
• The presence of comorbidities linked to pedal compensations
• Changes in dynamic function in gait associated with flatfoot

   Following these guidelines should enable clinicians to recognize the at-risk pediatric foot and offer management recommendations to parents who are often eager to improve their child’s quality of life. Parents are also eager to embrace preventative measures that will increase the likelihood of their children growing ever more active and reaching maturity with feet prepared to serve an ever increasing average life expectancy. By following the principles outlined in this article, you can help them achieve these goals.

   Dr. Volpe is a Professor in the Department of Orthopedics and Pediatrics at the New York College of Podiatric Medicine. He is in private practice in New York City and Farmingdale, N.Y.

References

1. Meredy C, Dolan C, Luskin R. Evaluation of the University of California Biomechanics Laboratory shoe insert in ‘flexible’ pes planus. Clin Orthop. 1972; (82):45-58.
2. Kirby K, Green D. Evaluation and nonoperative management of pes valgus. In DeValentine SJ (ed.): Foot and Ankle Disorders in Children, Churchill Livingstone, 1992, pp. 295-327.
3. Rose GK, Welton EA, Marshall T. The diagnosis of flat foot in the child. J Bone Joint Surg. 1985; (67-B):71-78.
4. Valmassy RL. Biomechanical evaluation of the child. Clin Podiatry. 1984; 1(3):563-79.
5. Bresnahan P. Letter to the editor. Journal Am Podiatr Med Assoc 2009; 99(2):178.
6. D’Amico JC. Letter to the editor. Journal Am Podiatr Med Assoc 2009; 99(3):267-8.
7. Evans AM. The flat-footed child – to treat or not to treat, what is the clinician to do? J Am Podiatr Med Assoc. 2008; 98(5):386-93.

   Editor’s note: For further reading, see “Point-Counterpoint: Asymptomatic Flatfoot In Kids: Should You Treat It?” in the January 2010 issue of Podiatry Today or “When Pediatric Flatfoot Requires Surgical Correction” in the January 2010 issue.

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