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Right arrow Musculoskeletal System

PEDIATRICS Vol. 103 No. 6 June 1999, p. e84

ELECTRONIC ARTICLE:
Flexible Flat Feet in Children: A Real Problem?

Received May 11, 1998; accepted Jan 28, 1999.

Antonio García-Rodríguez*, Felipe Martín-JiménezDagger , Manuel Carnero-Varo*, Enrique Gómez-Gracia*, Jorge Gómez-Aracena*, and Joaquín Fernández-Crehuet*

From the * Department de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Málaga, Spain; and Dagger  Servicio de Traumatología, Hospital Clínico Universitario, Málaga, Spain.

Objectives  To estimate the prevalence of flexible flat feet in the provincial population of 4- to 13-year-old schoolchildren and the incidence of treatments considered unnecessary.

Setting.  Province of Málaga, Spain.

Methods.  We examined and graded by severity a sample of 1181 pupils taken from a total population of 198 858 primary schoolchildren (CI: 95%; margin of error: 5%). The sample group was separated into three 2-year age groups: 4 and 5 years, 8 and 9 years, and 12 and 13 years. The plantar footprint was classified according to Denis1 into three grades of flat feet: grade 1 in which support of the lateral edge of the foot is half that of the metatarsal support; grade 2 in which the support of the central zone and forefoot are equal; and grade 3 in which the support in the central zone of the foot is greater than the width of the metatarsal support. The statistical analysis for the evaluation of the differences between the groups was performed with Student's t and chi 2 tests as appropriate.

Results.  The prevalence of flat feet was 2.7%. Of the 1181 children sampled, 168 children (14.2%) were receiving orthopedic treatment, but only 2.7% had diagnostic criteria of flat feet. When we inspected the sample, we found that a number of children were being treated for flat feet with boots and arch supports. Most of them did not have a flat plantar footprint according to the criteria that we used for this work. Furthermore, in the group of children that we diagnosed as having flat feet, only 28.1% were being treated. We found no significant differences between the number of children receiving orthopedic treatments and the presence or absence of a flat plantar footprint. Children who were overweight in the 4- and 5-year-old group showed an increased prevalence for flat feet as diagnosed by us.

Conclusion.  The data suggest that an excessive number of orthopedic treatments had been prescribed in the province. When extrapolated to the 1997 population of schoolchildren within the age groups studied the figures suggested that ~28 167 children in Málaga province probably would have been receiving orthopedic treatments with boots and insoles at the time of our study. Consequently, the total expenditure on orthopedic boots and insoles that year could be estimated as 676 008 000 pesetas ($4 447 422 in US currency).  Key words:  children, flexible flat feet, treatment cost effectiveness.




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A. M. Evans
The Flat-Footed Child--To Treat or Not to Treat: What Is the Clinician to Do?
J Am Podiatr Med Assoc, September 1, 2008; 98(5): 386 - 393.
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