Definition

Pediatric flatfoot is a pathology that is characterized by a low, longitudinal medial arch and everted calcaneus. It is often accompanied by the presence of equinus. Pediatric flatfoot is commonly classified as either flexible or rigid. We focus on the flexible pediatric flatfoot since the fixed nature of rigid pediatric flatfoot does not respond well to functional orthoses.

Overview

Orthotic treatment for flexible pediatric flatfoot has been a topic of great debate for decades. While the theory that intervention may mitigate midlife symptoms is currently accepted by many practitioners, it remains unsubstantiated in clinical trials. The question that most practitioners deal with is if and when treatment should be instituted. Assuming the child will simply outgrow the problem, particularly if they are experiencing symptoms, ignores the current well-being of the child and the fact that untreated flatfoot likely contributes to foot pathology later in life.

Based on current evidence, children with symptomatic flexible flatfoot require treatment. The asymptomatic children with flexible pediatric flatfoot who are obese, have extreme hypermobility, or systemic or genetic abnormalities should also receive treatment. No treatment is currently recommended for the child with hypermobile flatfoot who has no symptoms and normal development. Normal development is commonly considered to be the presence of a vertical resting calcaneal stance position by age seven.

Clinical Goal for Orthotic Treatment

The goal of the prescribed device is to reduce pain and deformity associated with pediatric flatfoot by reducing the excessive pronatory forces across the subtalar joint. The orthoses must be rigid enough to support and realign the subtalar and midtarsal joints, while increasing supinatory torque across the subtalar joint axis.

Prescription

To prescribe this device, check “Pediatric Flatfoot” under the Pathology Specific Orthoses section (Part A) of the prescription form.

Pediatric Flatfoot Prescription Recommendations

• Polypropylene Shell – rigid to semirigid
• Deep Heel Cup
  • The deep heel cup increases surface area medial to the STJ axis, increasing supinatory torque
• Wide Width and Medial Flange
  • A wider distal width with a medial flange through the arch significantly increases surface area under the arch, effectively supporting the arch and limiting excessive pronation.
• Minimum Cast Fill
  • Minimum fill results in an orthosis that conforms closely to the arch of the foot and provides superior midtarsal joint control
• Medial Skive – 4mm
  • The medial heel skive creates a greater force medial to the axis of the subtalar joint helping to reduce excessive STJ pronation and heel eversion.
• Inversion – 4 degrees
  • Inversion creates tighter control of the medial arch and applies a varus wedge effect in the heel cup
• 4/4 Rearfoot Post – extra long
  • The post acts to stabilize the orthosis in the shoe. The increased distal length provides more effective stabilization in the midfoot.

Summary

This orthosis is designed to reduce the extreme pronatory forces associated with the pediatric flatfoot. The increased width, the deep heel cup and the medial heel skive contribute to increased supinatory force across the subtalar joint axis. If you have further questions, ProLab clients can contact a Medical Consultant.

References

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