Pediatric Flat Feet: A 2020 Guide for Clinicians to Identify the Boomerangs

Area of Science:

• Pediatrics
• Orthopedics
• Podiatry

Background:

• Pediatric flatfoot is a common concern with historical debate regarding its clinical significance.
• Previous research has explored the developmental changes in pediatric foot posture and the justification for treatment.
• Overdiagnosis and overtreatment of pediatric flatfoot remain prevalent issues in the 21st century.

Purpose of the Study:

• To provide a contemporary, evidence-based approach to managing pediatric flatfoot in primary care.
• To introduce a pragmatic "boomerang" concept to differentiate between symptomatic and asymptomatic cases.
• To offer a structured, eight-step strategy for evaluating and managing pediatric flatfoot concerns.

Main Methods:

• Review of normative pediatric foot posture data and prospective findings on age-related changes.
• Development of the "boomerang" concept based on research identifying factors predictive of symptomatic pediatric flat feet.
• Incorporation of differential diagnoses and gait assessment as key outcome measures.

Main Results:

• Prospective data confirm that pediatric flat feet tend to lessen with age.
• The "boomerang" concept identifies three key factors that delineate symptomatic from asymptomatic pediatric flat feet.
• An eight-step strategy is proposed to guide clinical decision-making and intervention.

Conclusions:

• A structured, evidence-based approach is necessary to address the overdiagnosis and overtreatment of pediatric flatfoot.
• The "boomerang" factors provide practical criteria for identifying pediatric flat feet requiring intervention.
• Improved clinical guidelines can ensure appropriate management of pediatric flatfoot, focusing on symptomatic cases and gait outcomes.