Factors influencing the flexible flatfoot in preschool children and analysis of the therapeutic effects of orthopedic insoles_West China Medical Journal

Authors：

BIAN Ruihao ^1,2 , JIA Guoqing ² , ZHU Liutao ³ , Aikebaier Ainiwa ³ , MO Xianjun ⁴ ,  WANG Haoxiang ¹

1. School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China;
2. Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China;
3. School of Rehabilitation Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China;
4. Department of Rehabilitation Therapy, Guangdong Sanjiu Brain Hospital, Guangzhou, Guangdong 510510, P. R. China;

Corresponding author：

WANG Haoxiang, Email: wanghx27@mail.sysu.edu.cn

Keywords：

Foot orthoses; flatfoot; preschool children; biomechanical phenomena

DOI：

10.7507/1002-0179.202402140

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Objective To explore the influencing factors of flexible flatfoot in preschool children and the therapeutic effects of orthopedic insoles intervention. Methods Convenient sampling method was used to select 1-to-6-year-old children who visited the Prosthetics and Orthotics, Department of Rehabilitation Medicine at the First Affiliated Hospital of Sun Yat-sen University between April 2019 and December 2023. According to the follow-up visits of children wearing orthopedic insoles after 1 year, the follow-up group was divided into the experimental group, and those who did not follow up were matched with the experimental group based on general information to form the control group. The degree of flatfoot of both feet, hallux valgus angle, heel valgus angle, knee valgus angle, navicular drop height, tibial torsion angle, foot posture index, and joint flexibility of children at the initial visit and follow-up were evaluated. Ordered multinomial logistic regression analysis was used to assess the factors influencing the degree of flatfoot of children’s feet. Results A total of 976 children were included at the initial visit, all wearing orthopedic insoles. Among them, there were 805 cases in the control group and 171 cases in the experimental group. There were no statistically significant differences in gender, age, height, or weight between the two groups (P>0.05). A comparison of the experimental group before and after wearing orthopedic insoles for 1 year showed that the degree of flatfoot of both feet, heel valgus angle, knee valgus angle, foot posture index, and joint flexibility were lower at the follow-up visit than those at the initial visit (P<0.05); the remaining parameters showed no statistically significant differences (P>0.05). At the follow-up visit of the experimental group, both heel valgus angle, knee valgus angle, and foot posture index were lower than those in the control group (P<0.05); the other parameters showed no statistically significant differences (P>0.05). Age and tibial torsion angle were negatively correlated with the degree of flatfoot (P<0.001), while hallux valgus angle, heel valgus angle, knee valgus angle, navicular drop height, foot posture index, and body mass index were positively correlated with the degree of flatfoot (P<0.05). There was a difference in the degree of flatfoot between male and female children (χ²=99.76, P<0.001). The results of the logistic regression analysis showed that navicular drop height, male gender, foot posture index, body mass index, heel valgus angle, and age were influencing factors of the degree of flatfoot (P<0.05). Conclusions The flexible flatfoot in preschool children is influenced by factors such as navicular drop height, gender, foot posture index, body mass index, heel valgus angle, and age, and it will be somewhat alleviated as they grow. Wearing orthopedic insoles can correct related biomechanical abnormalities of heel valgus and knee valgus to some extent, but it cannot significantly reduce the degree of flatfoot.

Citation： BIAN Ruihao, JIA Guoqing, ZHU Liutao, Aikebaier Ainiwa, MO Xianjun, WANG Haoxiang. Factors influencing the flexible flatfoot in preschool children and analysis of the therapeutic effects of orthopedic insoles. West China Medical Journal, 2024, 39(6): 884-890. doi: 10.7507/1002-0179.202402140 Copy

1.	韩炳善, 袁媛. 西安市 2074 名学龄前儿童扁平足发生情况. 中国学校卫生, 2019, 40(7): 1097-1098.
2.	张英杰, 吴桐, 黄家峥, 等. 昆明市学龄期儿童扁平足筛查及影响因素分析. 中国学校卫生, 2023, 44(5): 765-768.
3.	翟俊娜, 邵丽娜. 扁平足诊疗评估方法总结及某高校女生扁平足发病率调查. 按摩与康复医学, 2022, 13(14): 56-58.
4.	Turner C, Gardiner MD, Midgley A, et al. A guide to the management of paediatric pes planus. Aust J Gen Pract, 2020, 49(5): 245-249.
5.	Pfeiffer M, Kotz R, Ledl T, et al. Prevalence of flat foot in preschool-aged children. Pediatrics, 2006, 118(2): 634-639.
6.	Kosashvili Y, Fridman T, Backstein D, et al. The correlation between pes planus and anterior knee or intermittent low back pain. Foot Ankle Int, 2008, 29(9): 910-913.
7.	Neal BS, Griffiths IB, Dowling GJ, et al. Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. J Foot Ankle Res, 2014, 7(1): 55.
8.	Siu WS, Shih YF, Lin HC. Effects of Kinesio tape on supporting medial foot arch in runners with functional flatfoot: a preliminary study. Res Sports Med, 2020, 28(2): 168-180.
9.	Carr JB 2nd, Yang S, Lather LA. Pediatric pes planus: a state-of-the-art review. Pediatrics, 2016, 137(3): e20151230.
10.	熊怒, 王旭, 黄加张, 等. 儿童柔韧性扁平足的矫形鞋垫治疗研究进展. 中国矫形外科杂志, 2022, 30(7): 630-634.
11.	Kodithuwakku Arachchige SNK, Chander H, Knight A. Flatfeet: biomechanical implications, assessment and management. Foot (Edinb), 2019, 38: 81-85.
12.	Alam F, Raza S, Moiz JA, et al. Effects of selective strengthening of tibialis posterior and stretching of iliopsoas on navicular drop, dynamic balance, and lower limb muscle activity in pronated feet: a randomized clinical trial. Phys Sportsmed, 2019, 47(3): 301-311.
13.	Jeong DW. The effects of the visual feedback short foot exercise on foot alignment in adults with flexible flatfoot. Int J Psychosoc Rehabil, 2019, 23(1): 220-226.
14.	Elataar FF, Abdelmajeed SF, Abdellatif NMN, et al. Core muscles’ endurance in flexible flatfeet: a cross-sectional study. J Musculoskelet Neuronal Interact, 2020, 20(3): 404-410.
15.	Menz HB, Dufour AB, Riskowski JL, et al. Foot posture, foot function and low back pain: the framingham foot study. Rheumatology (Oxford), 2013, 52(12): 2275-2282.
16.	Kim HW, Park KB, Kwak YH, et al. Radiographic assessment of foot alignment in juvenile hallux valgus and its relationship to flatfoot. Foot Ankle Int, 2019, 40(9): 1079-1086.
17.	Tsai CC, Chih YC, Shih CL, et al. Joint hypermobility and preschool-age flexible flatfoot. Medicine (Baltimore), 2022, 101(31): e29608.
18.	Fuentes-Venado CE, Ángeles-Ayala A, Salcedo-Trejo MS, et al. Comparative assessment of flatfoot in preschool children. Bol Med Hosp Infant Mex, 2020, 77(6): 312-319.

1. 韩炳善, 袁媛. 西安市 2074 名学龄前儿童扁平足发生情况. 中国学校卫生, 2019, 40(7): 1097-1098.
2. 张英杰, 吴桐, 黄家峥, 等. 昆明市学龄期儿童扁平足筛查及影响因素分析. 中国学校卫生, 2023, 44(5): 765-768.
3. 翟俊娜, 邵丽娜. 扁平足诊疗评估方法总结及某高校女生扁平足发病率调查. 按摩与康复医学, 2022, 13(14): 56-58.
4. Turner C, Gardiner MD, Midgley A, et al. A guide to the management of paediatric pes planus. Aust J Gen Pract, 2020, 49(5): 245-249.
5. Pfeiffer M, Kotz R, Ledl T, et al. Prevalence of flat foot in preschool-aged children. Pediatrics, 2006, 118(2): 634-639.
6. Kosashvili Y, Fridman T, Backstein D, et al. The correlation between pes planus and anterior knee or intermittent low back pain. Foot Ankle Int, 2008, 29(9): 910-913.
7. Neal BS, Griffiths IB, Dowling GJ, et al. Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. J Foot Ankle Res, 2014, 7(1): 55.
8. Siu WS, Shih YF, Lin HC. Effects of Kinesio tape on supporting medial foot arch in runners with functional flatfoot: a preliminary study. Res Sports Med, 2020, 28(2): 168-180.
9. Carr JB 2nd, Yang S, Lather LA. Pediatric pes planus: a state-of-the-art review. Pediatrics, 2016, 137(3): e20151230.
10. 熊怒, 王旭, 黄加张, 等. 儿童柔韧性扁平足的矫形鞋垫治疗研究进展. 中国矫形外科杂志, 2022, 30(7): 630-634.
11. Kodithuwakku Arachchige SNK, Chander H, Knight A. Flatfeet: biomechanical implications, assessment and management. Foot (Edinb), 2019, 38: 81-85.
12. Alam F, Raza S, Moiz JA, et al. Effects of selective strengthening of tibialis posterior and stretching of iliopsoas on navicular drop, dynamic balance, and lower limb muscle activity in pronated feet: a randomized clinical trial. Phys Sportsmed, 2019, 47(3): 301-311.
13. Jeong DW. The effects of the visual feedback short foot exercise on foot alignment in adults with flexible flatfoot. Int J Psychosoc Rehabil, 2019, 23(1): 220-226.
14. Elataar FF, Abdelmajeed SF, Abdellatif NMN, et al. Core muscles’ endurance in flexible flatfeet: a cross-sectional study. J Musculoskelet Neuronal Interact, 2020, 20(3): 404-410.
15. Menz HB, Dufour AB, Riskowski JL, et al. Foot posture, foot function and low back pain: the framingham foot study. Rheumatology (Oxford), 2013, 52(12): 2275-2282.
16. Kim HW, Park KB, Kwak YH, et al. Radiographic assessment of foot alignment in juvenile hallux valgus and its relationship to flatfoot. Foot Ankle Int, 2019, 40(9): 1079-1086.
17. Tsai CC, Chih YC, Shih CL, et al. Joint hypermobility and preschool-age flexible flatfoot. Medicine (Baltimore), 2022, 101(31): e29608.
18. Fuentes-Venado CE, Ángeles-Ayala A, Salcedo-Trejo MS, et al. Comparative assessment of flatfoot in preschool children. Bol Med Hosp Infant Mex, 2020, 77(6): 312-319.

West China Medical Journal

Factors influencing the flexible flatfoot in preschool children and analysis of the therapeutic effects of orthopedic insoles

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