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Foot problems in children presented to the family physician: a comparison between 1987 and 2001
Marjolein Krul1, Johannes C van der Wouden, François G Schellevis
1Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Room Ff304, PO Box 2040, Rotterdam 3000 CA, The Netherlands. m.krul@erasmusmc.nl
Insights
The incidence of common childhood foot problems seen by family physicians significantly decreased between 1987 and 2001. Referrals also shifted towards primary care professionals.
Area of Science:
- Pediatrics
- Podiatry
- General Practice
Background:
- Studies suggest many childhood foot problems do not require treatment.
- The impact of these findings on clinical practice remains unclear.
Purpose of the Study:
- To compare the incidence and referral rates of pediatric foot problems in 1987 versus 2001.
- To assess changes in the management of common foot conditions in children.
Main Methods:
- Analysis of two large, consecutive Dutch general practice surveys (1987 and 2001).
- Inclusion of representative samples of children aged 0-17 years.
- Calculation and stratification of incidence and referral rates by age and gender.
Main Results:
- Overall incidence of foot problems presented to family physicians (FP) decreased from 80.0 to 17.4 per 1000 person-years (P < 0.0001).
- Incidence of flat feet decreased from 4.9 to 3.4 per 1000 person-years (P = 0.001).
- Referral patterns shifted significantly towards primary care professionals.
Conclusions:
- A substantial decrease in the incidence of musculoskeletal foot problems in children was observed between 1987 and 2001.
- The findings suggest a potential shift in clinical practice regarding pediatric foot conditions.
Background:
In recent decades, studies on the management of common foot problems in children have suggested that in many cases, there is no indication for treatment. It is not known whether these studies have changed daily practice.
Objective:
Our aim was to establish and compare incidence and referral rates for foot problems in children in 1987 and 2001.
Methods:
A comparison was made of two large consecutive surveys in Dutch general practice performed in 1987 (86 577 children aged 0-17 years) and 2001 (87 952 children aged 0-17 years), which were carried out by The Netherlands Institute for Health Services Research. Both surveys included a representative sample of the Dutch population. Incidence and referral rates were calculated and, data were stratified for age group and gender.
Results:
Compared to 1987, in 2001 the overall incidence rate of foot problems presented to the family physician (FP) decreased substantially from 80.0 [95% confidence interval (CI) 77.0-84.7] to 17.4 (95% CI 16.5-18.3) per 1000 person-years (P < 0.0001). The incidence rate of flat feet decreased from 4.9 (95% CI 4.0-5.9) per 1000 person-years in 1987 to 3.4 (95% CI 3.0-3.8) per 1000 person-years in 2001 (P = 0.001). The distribution of referrals to other primary health care professionals and medical specialists has almost reversed in favour of primary health care professionals.
Conclusion:
Total incidence rate of musculoskeletal foot problems seen by the FP has decreased substantially, between 1987 and 2001.
