Analysis of factors influencing improvement of idiopathic flatfoot
Byung-Joon Shin1, Kyoung Min Lee2, Chin Youb Chung3
1Department of Orthopedic Surgery, Soon Chun Hyang University Seoul Hospital, Seoul, South Korea.
Insights
Idiopathic flatfoot in children typically resolves by age 12. Factors like higher body mass index and Achilles tendon contracture negatively impact this natural improvement, suggesting personalized treatment approaches.
Area of Science:
- Pediatric Orthopedics
- Biomechanical Engineering
- Developmental Pediatrics
Background:
- Idiopathic flatfoot is a common condition in children, often leading to orthopedic referrals.
- While generally a physiologic process, understanding its spontaneous resolution rate is crucial for clinical management.
Purpose of the Study:
- To estimate the rate of spontaneous improvement in pediatric idiopathic flatfoot.
- To identify factors correlating with the progression and resolution of flatfoot in children.
Main Methods:
- Retrospective review of pediatric patients with idiopathic flatfoot (under 12 years) with over 6 months follow-up.
- Analysis of weight-bearing bilateral foot radiographs (AP and lateral) including talo-first metatarsal and calcaneal pitch angles.
- Linear mixed-effects modeling to assess radiographic changes adjusted for sex, BMI, and Achilles tendon contracture.
Main Results:
- Radiographic measurements showed significant improvement in AP talo-first metatarsal angle, talonavicular coverage angle, and lateral talo-first metatarsal angle with age.
- Calcaneal pitch angle did not show significant changes.
- Higher body mass index and Achilles tendon contracture were negatively correlated with flatfoot improvement (P<.001).
Conclusions:
- Pediatric idiopathic flatfoot demonstrates a trend toward spontaneous improvement by age 12.
- Clinicians should utilize radiographic indices and correlating factors to predict outcomes, manage expectations, and prevent unnecessary interventions.
- Understanding these factors can reduce medical costs and psychological distress for children and families.
Abstract:
Idiopathic flatfoot is common in infants and children, and patients with this condition are frequently referred to pediatric orthopedic clinics. Flatfoot is a physiologic process, and that the arch of the foot elevates spontaneously in most children during the first decade of life. To achieve a consensus as the rate of spontaneous improvement of flatfoot, the present study aimed to estimate the rate of spontaneous improvement of flatfoot and to analyze correlating factors.We reviewed the records of patients examined between May 2013 and May 2019 so as to identify those factors associated with idiopathic flatfoot below 12 years of age. We included patients with who had been followed for >6 months, and those for whom ≥2 (anteroposterior and lateral) weight-bearing bilateral radiographs of the foot had been obtained. The progression rates of the anteroposterior (AP) talo-first metatarsal angle, talonavicular coverage angle, lateral talo-first metatarsal angle, and calcaneal pitch angle were adjusted by multiple factors using a linear mixed model, with sex, body mass index, and Achilles tendon contracture as the fixed effects and age and each subject as the random effects.We found that 4 of the radiographic measurements improved as patients grew older. The AP talo-first metatarsal angle, talonavicular coverage angle, and the lateral talo-first metatarsal angle decreased, while the calcaneal pitch angle increased. The AP talo-first metatarsal angle (P < .001), talonavicular coverage angle (P < .001), and lateral talo-first metatarsal angle (P < .001) improved significantly; however, the calcaneal pitch angle (P = .367) did not show any significant difference. In general, the flatfeet showed an improving trend; after analyzing the factors, no sex difference was observed (P = .117), while body mass index (P < .001) and Achilles tendon contracture (P < .001) showed a negative correlation.The study demonstrated that children's flatfeet spontaneously improved at the age of 12 years. It would be more beneficial if the clinician shows the predicted appearance of the foot at the completion of growth by calculating the radiographic indices and identifying the correlating factors in addition to explaining that flatfoot may gradually improve. This will prevent unnecessary medical expenses and the psychological adverse effects to the children caused by unnecessary treatment.
