title: Flexible flat feet in children: a real problem?
abstract: OBJECTIVE
  To estimate the prevalence of flexible flat feet in the provincial population of 4- to 13-year-old schoolchildren and the incidence of treatments considered unnecessary.
  
  
  METHODS
  Province of Málaga, Spain.
  
  
  METHODS
  We examined and graded by severity a sample of 1181 pupils taken from a total population of 198 858 primary schoolchildren (CI: 95%; margin of error: 5%). The sample group was separated into three 2-year age groups: 4 and 5 years, 8 and 9 years, and 12 and 13 years. The plantar footprint was classified according to Denis1 into three grades of flat feet: grade 1 in which support of the lateral edge of the foot is half that of the metatarsal support; grade 2 in which the support of the central zone and forefoot are equal; and grade 3 in which the support in the central zone of the foot is greater than the width of the metatarsal support. The statistical analysis for the evaluation of the differences between the groups was performed with Student's t and chi2 tests as appropriate.
  
  
  RESULTS
  The prevalence of flat feet was 2.7%. Of the 1181 children sampled, 168 children (14.2%) were receiving orthopedic treatment, but only 2.7% had diagnostic criteria of flat feet. When we inspected the sample, we found that a number of children were being treated for flat feet with boots and arch supports. Most of them did not have a flat plantar footprint according to the criteria that we used for this work. Furthermore, in the group of children that we diagnosed as having flat feet, only 28.1% were being treated. We found no significant differences between the number of children receiving orthopedic treatments and the presence or absence of a flat plantar footprint. Children who were overweight in the 4- and 5-year-old group showed an increased prevalence for flat feet as diagnosed by us.
  
  
  CONCLUSIONS
  The data suggest that an excessive number of orthopedic treatments had been prescribed in the province. When extrapolated to the 1997 population of schoolchildren within the age groups studied the figures suggested that approximately 28 167 children in Málaga province probably would have been receiving orthopedic treatments with boots and insoles at the time of our study. Consequently, the total expenditure on orthopedic boots and insoles that year could be estimated as 676 008 000 pesetas ($4 447 422 in US currency).
authors.affiliation: Department de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Málaga, Spain. antoniogr@uma.es
authors.forename: A
authors.initials: A
authors.lastname: García-Rodríguez
authors.forename: F
authors.initials: F
authors.lastname: Martín-Jiménez
authors.forename: M
authors.initials: M
authors.lastname: Carnero-Varo
authors.forename: E
authors.initials: E
authors.lastname: Gómez-Gracia
authors.forename: J
authors.initials: J
authors.lastname: Gómez-Aracena
authors.forename: J
authors.initials: J
authors.lastname: Fernández-Crehuet
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003951:Diagnostic Errors / Q000191:economics; D005260:Female; D005413:Flatfoot / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D009989:Orthotic Devices / Q000191:economics; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012923:Social Class; D013030:Spain / Q000453:epidemiology