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kkirby52
09-18-2007, 02:40 PM
Pediatric flatfoot deformity may be rigid or flexible and has multiple
etiologies. However, most commonly pediatric flatfoot deformity is of a
flexible nature and is seen as a congenital disorder that comes in
varying levels of deformity and clinical presentations (Kirby KA, Green
DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327,
in DeValentine, S.(ed), /Foot and Ankle Disorders in Children/.
Churchill-Livingstone, New York, 1992).

The most common clinical characteristics of pediatric flatfoot deformity
include:

1. A maximally pronated subtalar joint
2. An everted calcaneus
3. A flatter than normal medial longitudinal arch
4. Convexity in the medial border of the midfoot
5. Abducted angle of gait (which may not be readily apparent if combined
with an internal femoral or internal tibial torsion/position)
6. A subtalar joint axis spatial location that is medially deviated

A "short Achilles tendon", or "equinus deformity", is not always present
with pediatric flatfoot deformity since many of these children also have
some form of familial ligamentous laxity syndrome where they have a
greater range of ankle joint dorsiflexion than normal, with their
flatfoot deformity being their most noticeable structural expression of
the increased ligamentous compliance within their bodies. However, it
has long been suspected that some children with congenital equinus
deformity (i.e. restricted ankle joint dorsiflexion during clinical
examination), may develop flatfoot deformity over time due to their
increased ankle joint dorsiflexion stiffness.

Children with flatfoot deformity may be asymptomatic or may be quite
symptomatic with complaints ranging from low back pain, leg cramps, knee
pain, leg pain, ankle pain and/or foot pain that generally is worse with
prolonged walking or running activities. There is great clinical
controversy within both the orthopedic and podiatric communities about
how these children should be treated and/or whether treatment should
occur at all. This controversial subject may require another posting is
anyone expresses interest in discussing it further on this list.

Dr. Jain wrote "We are interested to perform a research study on gait
analysis of pediatric flatfoot patients & particularly interested to
determine the clinical outcome of flatfoot under gait studies for
children under the age group of 2 to 5 years, using custom ankle foot
orthosis."

This type of study is definitely needed since, to my knowledge, the
kinematics and kinetics of the gait patterns of pediatric flatfoot
deformity, compared to normal children, has never been studied using the
more advanced technologies present in modern biomechanics laboratories.
However, there have been many static radiographic studies done of
pediatric flatfoot deformity, which, in my opinion, are useless for
gaining a deeper understanding of the dynamics present within this
common pediatric disorder.

Ideally, if the children could cooperate for the research study, having
both flatfoot children and normal arched children walk over a force
plate and/or pressure mat along with 3D kinematic analysis markers in
place, this would be ideal. The greatest difference between these two
subject groups would likely not be the kinematics but would rather be
the kinetics of the foot. If the changes in medial arch height during
gait could also be measured between these two subject groups, then more
useful data could be gathered regarding the positional changes which
occur within the midtarsal/midfoot joints in these feet.

Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA

Voice: (916) 925-8111 Fax: (916) 925-8136
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