Skip to main content
SpringerLink
Log in

Rehabilitative treatment in flexible flatfoot: a perspective cohort study

  • Review
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Paediatric valgus flexible flatfoot is a common childhood paramorphism. Its treatment options consist of rehabilitation, corrective footwear and, if necessary, surgical intervention. The aim of our study was to compare a group of children who followed a rehabilitative programme versus a historical group of children who had been treated with insoles and orthopaedic footwear. Over a 2 year period (1995–1997), 300 children (mean age was 3.4–184 male, 116 female) with bilateral flexible flatfoot (600 feet) were recruited and underwent a rehabilitative programme for a mean period of 2.75 years. The feet were classified according to Viladot’s method: 386 feet presented a type III degree deformity and 214 feet presented a type II degree deformity. The rehabilitative programme consisted of simple therapeutic exercises, which could be easily learnt by both patients and their caregivers. These children were compared to a historical group of children (674 feet) who had been treated in our department for infantile flexible flatfoot with the use of orthosis. In these groups, 396 feet presented a type III degree deformity and 278 feet presented a type II degree deformity. In the group of children who underwent the rehabilitative protocol, during follow-up at the age of eight, 352 of the 386 type III degree feet could be classified as normal and 210 of the 214 type II degree cases became normal. In the historical cohort of children treated with orthosis, at the age of eight, 214 of the 396 type III degree feet could be classified as normal; and 248 of the 278 type II degree cases became normal. Our results show that comparing the percentage of success (changing from type III or II degree to type I or N) in the two groups (children treated with rehabilitation and children treated with orthosis), the rehabilitative approach seems to be more effective. Probably it has a marginal influence on the natural history of paediatric valgus flexible flatfoot even though it plays a role in maintaining good flexibility of the flatfoot thus limiting functional impairment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Aharonson Z, Arcan M, Steinback TV (1992) Foot ground pressure pattern of flexible flatfoot in children, with and without correction of calcaneovalgus. Clin Ortthop May 278:177–182

    Google Scholar 

  2. Zhu HS, Wetsch JJ, Harris GF, Loftsgaarden JD, Price MB (1991) Foot pressure distribution during walking and shuffing. Arch Phys Med Rehabil 72(6):390–397

    CAS  PubMed  Google Scholar 

  3. Dutoit M (1993) Screening for foot disease in children. When to refer to the Orthopedist. Rev Med Suisse Romande 113(5):405–408

    CAS  PubMed  Google Scholar 

  4. Kilmartin TE, Wallace WA (1992) The significance of pesplanus in juvenile halluxvalgus. Foot-Ankle 13(2):53–56

    CAS  PubMed  Google Scholar 

  5. Rose GK, Welton EA, Marshall T (1985) The diagnosis of flatfoot in the child. J Bone Joint Surg Br 67(1):71–78

    CAS  PubMed  Google Scholar 

  6. El O, Akcali O, Kosay C, Kaner B, Arslan Y, Sagol E, Soylev S, Iyidogan D, Cinar N, Peker O (2006) Flexible flatfoot, related factors in primary school children: a report of a screening study (2006). RheumatolInt 26(11):1050–1053

    Article  Google Scholar 

  7. Leung AK, Cheng JC, Mak AF (2005) A cross-sectional study on the development of foot arch function of 2715 Chinese children. ProsthetOrthot Int 29(3):241–253

    Article  CAS  Google Scholar 

  8. Lin CJ, Lai KA, Kuan TS, Chou YL (2001) Correlating factors and clinical significance of flexible flatfoot in preschool children. J Pediatr Orthop 21(3):378–382

    Article  CAS  PubMed  Google Scholar 

  9. Meary R (1969) Symposium sur le piede plat. AnnOrth De L’ovest 1:57–71

    Google Scholar 

  10. Morley AJM (1957) Knock-knee in children. Br Med J 26(2):976–979

    Article  Google Scholar 

  11. Pace N et al (1993) Piede piatto valgo: evoluzione naturale. In: Progressi in medicina e chirurgia del piede. Aulo Gaggi ed

  12. Pisani G (2002) Piede valgo evolutivo dell’infanzia (PVEI). ARHS Symposium de ReumatologieVenezia

  13. Pizzetti M, Caruso I (1987) Piede piatto dell’infanzia. In: Medicina Fisica e Riabilitazione Edilombardo, pp 213–125

  14. Gimigliano R, Riccio V, Carbonari A, Docimo E (1984) Il trattamento chinesiterapico nel piede piatto valgo del bambino. Chir del piede 8:1–6

    Google Scholar 

  15. Guida G, Riccio V, Gatto S, Castelluccio A, Capezzuto C (1984) Il trattamento ortopedico del piede piatto-valgo lasso del bambino. Chir del piede 8:1–4

    Google Scholar 

  16. Jani L (1986) Pediatric flatfoot. Orthopade 15(3):199–204

    CAS  PubMed  Google Scholar 

  17. Malerba F, De Marchi F, Monforte S (1997) Risultati di un’indagine conoscitiva internazionale sul trattamento delle sindromi pronatorie, con riferimento all’utilizzo della metodica del “caalcaneo-stop”. Rivista Italiana di Ortopedia e Traumatologia Pediatrica 3(1):185–190

    Google Scholar 

  18. Riccardi G, Matera L, Monorchio AM, Russo F, Cicale G, Riccio V (1997) Il trattamento con ortesi e calzature del piede piatto. Ital J Pediatr Orthop 13(1):109–116

    Google Scholar 

  19. Riccio V, Peretti G (1997) Simposio sul piede piatto. Rivista Italiana di Ortopedia e Traumatologia Pediatrica 23bis, pp 19–276

  20. Wenger DR, Mauldin D, Speck G, Morgan D, Lieber RL (1989) Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am 71(6):800–810

    CAS  PubMed  Google Scholar 

  21. Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L (2008) Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. Gait Posture 27(1):51–59

    Article  PubMed  Google Scholar 

  22. Zollinger H, Wiasmitinow NP (1979) Foot deformities of infants. Results after 10 or more years. Long-term results of children with supple flat feet treated conservatively. Orthopade 8(2):141–144

    CAS  PubMed  Google Scholar 

  23. Cigala F, Capuano L (1997) Storia naturale del piede piatto valgo idiopatico. Rivista Italiana di Ortopedia e Traumatologia Pediatrica 23(1):58–61

    Google Scholar 

  24. Fixen JA (1995) Natural history of flatfoot in children. In: Madrid Vicente A (ed) Epeldegui “Pie plano y anomalies del Antepiè”, pp 38–142

  25. Pfeiffer M, Kotz R, Ledl T, Hauser G, Sluga M (2006) Prevalence of flatfoot in preschool-aged children. Pediatrics 118(2):634–639

    Article  PubMed  Google Scholar 

  26. Staheli LT, Chew DE, Corbett M (1987) The longitudinal arch: a survey of eight hundred and eight-two feet in normal children and adults. JBJS Am 69:426–428

    CAS  Google Scholar 

  27. Mickle KJ, Steele JR, Munro BJ (2008) Is the foot structure of preschool children moderated by gender. J Pediatr Orthop 28(5):593–596

    PubMed  Google Scholar 

  28. Viladot A (1954) Nuovo metodo de esploraciòn estatica del pie, elfotopodograma. Clin Y Lab 57:114–117

    Google Scholar 

  29. Staheli LT (1987) Evaluation of planovalgus foot deformities with special reference to the natural history. J Am Podiatr Med Assoc 77(1):2–6

    CAS  PubMed  Google Scholar 

  30. Volpon JB (1994) Footprint analysis during the growth period. J Pediatr Orthop 14(1):83–85

    CAS  PubMed  Google Scholar 

  31. Hernandez AJ, Kimura LK, Laraya MHF, Favaro E (2007) Calculation of Staheli’s plantar arch index and prevalence of flat feet: a study with 100 children aged 5–9 years. ActaOrtop Bras 15(2):68–71

    Google Scholar 

  32. Di Meglio A, de Rosa V (1997) La crescita del piede. Riv. Ital Ort TraumPed 13(1):19–25

    Google Scholar 

  33. Rao UB, Joseph B (1992) The influence of footwear on the prevalence of flatfoot. A survey of 2300 children. J Bone Joint Surg Br 74(4):525–527

    CAS  PubMed  Google Scholar 

  34. Sachithanandam V, Joseph B (1995) The influence of footwear on the prevalence of flatfoot. A survey of 1846 skeletally mature persons. J Bone Joint Surg Br 77(2):254–257

    CAS  PubMed  Google Scholar 

  35. García-Rodríguez A, Martín-Jiménez F, Carnero-Varo M, Gómez-Gracia E, Gómez-Aracena J, Fernández-Crehuet J (1999) Flexible flat feet in children: a real problem? Pediatrics 103(6):e84

    Article  PubMed  Google Scholar 

  36. Harris RI, Beath T (1948) Hypermobile flat-foot with short tendoachillis. J Bone Joint Surg Am 30(1):116–140

    Google Scholar 

  37. Giladi M, Milgrom C, Simkin A, Danon Y (1991) Stress fractures. Identifiable risk factors. Am J Sports Med 19(6):647–652

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

The authors declare that they have no conflict of interest related to the publication of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedics Traumatology Rehabilitation and Plastic-Surgery, Second University of Naples, Via L. De Crecchio, 4, 80100, Naples, Italy

    Ilaria Riccio, Francesca Gimigliano, Raffaele Gimigliano, Giovanni Porpora & Giovanni Iolascon

  2. Intensive Neuro-Rehabilitation Care Unit, Casa di Cura Santa Maria del Pozzo Via Pomigliano, 40-Somma Vesuviana, 80041, Naples, Italy

    Ilaria Riccio & Raffaele Gimigliano

Authors
  1. Ilaria Riccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca Gimigliano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raffaele Gimigliano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Porpora
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovanni Iolascon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesca Gimigliano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Riccio, I., Gimigliano, F., Gimigliano, R. et al. Rehabilitative treatment in flexible flatfoot: a perspective cohort study. Musculoskelet Surg 93, 101–107 (2009). https://doi.org/10.1007/s12306-009-0037-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-009-0037-z

Keywords

Search

Navigation