Paediatric flexible flatfoot: a new stance - beyond static assessment

Abstract

Flatfoot is often asymptomatic but sometimes presents with symptoms, even in children. This thesis aimed to discover if there was a difference between children with and without symptoms, in the hope that this might aid treatment decisions. Firstly, an audit was performed to discover the prevalence and type of symptoms, as well as current treatment protocols. Secondly, 107 volunteers from the general population and 20 patients were assessed in more detail. The participants were divided into groups and ANOVA tests were used to find the significant differences. Pain and parental concern were frequently reported in the audit population. The majority of this population had moderate bilateral flexible flatfoot with an active Windlass mechanism and static heel valgus. Treatment was dependent on department. The symptomatic group displayed reduced passive ankle dorsiflexion indicating tightness of the tendo-Achilles, as well as increased frequency of severe knee hyperextension and knee valgus upon clinical examination. During static stance, three differences were found between symptomatic and asymptomatic groups, two differences between flat feet and neutral feet. During dynamic trials, the symptomatic group showed reduced stride length and percentage time spent in swing. The ground reaction profiles showed differences in early and late stance. Further investigation supported the idea that decreased late stance vertical ground reaction force peak was evidence of instability in the symptomatic group. Four kinematic parameters demonstrated significant differences at foot strike, five at midstance, and seven at foot off. In terms of kinetics, after controlling for relative stride length, four differences were found, but none between the asymptomatic and symptomatic flat feet. Plantar pressure was successfully used to estimate truncated foot length. The flat feet did not display increased peak midfoot pressure; it was actually lower in flat footed groups. Arch Index and Modified Arch Index were successfully used for instantaneous and continuous assessment of foot posture over stance. The differences found between symptomatic and asymptomatic flat feet (particularly at foot off) shed some light upon the potential causes of symptoms.This thesis is not currently available via ORA