title: Flatfoot in Indian population.
abstract: OBJECTIVE
  To compare outcomes of different conservative treatments for flatfoot using the foot print index and valgus index.
  
  
  METHODS
  150 symptomatic flatfoot patients and 50 controls (without any flatfoot or lower limb deformity) aged older than 8 years were evaluated. The diagnosis was based on pain during walking a distance, the great toe extension test, the valgus index, the foot print index (FPI), as well as eversion/ inversion and dorsiflexion at the ankle. The patients were unequally randomised into 4 treatment groups: (1) foot exercises (n=60), (2) use of the Thomas crooked and elongated heel with or without arch support (n=45), (3) use of the Rose Schwartz insoles (n=18), and (4) foot exercises combined with both footwear modifications (n=27).
  
  
  RESULTS
  Of the 150 symptomatic flatfoot patients, 96 had severe flatfoot (FPI, >75) and 54 had incipient flatfoot (FPI, 45-74). The great toe extension test was positive in all 50 controls and 144 patients, and negative in 6 patients (p=0.1734, one-tailed test), which yielded a sensitivity of 96% and a positive predictive value of 74%. Symptoms correlated with the FPI (Chi squared=9.7, p=0.0213). Combining foot exercises and foot wear modifications achieved best outcome in terms of pain relief, gait improvement, and decrease in the FPI and valgus index.
  
  
  CONCLUSIONS
  The great toe extension test was the best screening tool. The FPI was a good tool for diagnosing and grading of flatfoot and evaluating treatment progress. Combining foot exercises and foot wear modifications achieved the best outcome.
authors: Department of Orthopaedics, Moti Lal Nehru Medical College, Allahabad, India.
authors: Sudhakar
authors: S
authors: Pandey
authors: Chandra Prakash
authors: CP
authors: Pal
authors: Deepak
authors: D
authors: Kumar
authors: Pulkesh
authors: P
authors: Singh
mesh_terms: D002648:Child; D005413:Flatfoot / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007194:India; D016037:Single-Blind Method
keywords: flatfoot; foot orthoses