The flat-footed child -- to treat or not to treat: what is the clinician to do?
BACKGROUND
This article addresses the treatment of pediatric flatfoot with foot orthoses and explores the existing knowledge from an evidence-based perspective.


METHODS
Studies investigating the use of foot orthoses for pediatric flatfoot were reviewed and ranked on the evidence hierarchy model according to research designs. Clinical guidelines and efficacy rating methods were also reviewed.


RESULTS
Three randomized controlled trials exist, and a systematic review and possible meta-analysis of these studies is in progress. The results of these studies, although not definitive for the use of orthoses for pediatric flatfoot, provide useful direction. Clinical guidelines for the management of flatfoot are a useful supplement for clinical decision making and have been enhanced.


CONCLUSIONS
This article presents a pragmatic and evidence-based clinical care pathway for clinicians to use for pediatric flatfoot. It uses a simple "traffic light" framework to identify three subtypes of pediatric flatfoot. The clinician is advised to 1) treat symptomatic pediatric flatfoot, 2) monitor (or with discretion simply treat) asymptomatic nondevelopmental pediatric flatfoot, and 3) identify and advise asymptomatic developmental pediatric flatfoot. (Children with juvenile arthritis should receive customized foot orthoses.) This approach will dispel much of the contention surrounding the use of foot orthoses in children.
Evans
Angela Margaret
AM
Division of Health Sciences, Podiatry Research Group, School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, Australia. angela.evans@unisa.edu.au
D002648:Child; D002675:Child, Preschool; D005260:Female; D005413:Flatfoot / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D009989:Orthotic Devices