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  • Pediatric Flatfoot

    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

    ************************************************** **************************
    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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