Changes in Resting Calcaneal Stance Position Angle Following Insole Fitting in Children With Flexible Flatfoot

Abstract

ObjectiveTo clarify the relationship of the initial radiologic and a biomechanical parameter at first clinical visit, and define the effectiveness of modified insole, following insole fitting in children with flexible flatfoot.MethodsChildren aged less than 13 years with flexible flatfoot were enrolled. The total number of subjects was 66 (33 boys, 33 girls). The subjects were divided into 5 subgroups, based on age: 1–2, 3–4, 5–6, 7–9, and 10–12 years. The mean time period between the initial & final examination for their resting calcaneal stance position angle (RCSPA) was 24 months. Radiography quantified the deformity by measuring angles, including the talometatarsal angle, the metatarsal angle, and the calcaneal pitch angle.ResultsFrom the angles measured on radiographs, only the talometatarsal angle showed a statistically significant correlation to the initial RCSPA (r=-0.578 for right side, r=-0.524 for left side; p<0.01). The mean RCSPA improved in all subgroups of subjects following insole fitting. Moreover, in children younger than 7 years, the improvement in RCSPA from the insole fitting was greater compared to children aged 7 years and older.ConclusionThe insole has additionally beneficial effects in all populations younger than 13 years. However, there might exist a hidden effect of normal structural pedal alignment during growth accompanied with bony maturation and developmental process. To date, it is controversial whether the treatment of flexible flatfoot is necessary in the vast majority of cases, or simple observation and advice to parents would suffice.

Changes in calcaneal pitch and heel fat pad thickness in static weight bearing radiographs while wearing shoes with arch support and heel cup orthotics

“…The longitudinal arch of the foot, composed of medial and lateral parts, acts as a unit with the transverse arch, spreading the weight in all directions 6 . The collapse of the medial longitudinal arch (MLA) leads to the clinical condition of flatfoot, which can be evaluated by indirect methods such as analyzing a footprint 15 . However, direct methods such as radiographic parameters were defined as the gold standards by Saltzman and colleagues 16 .…”

“…However, direct methods such as radiographic parameters were defined as the gold standards by Saltzman and colleagues 16 . Although there is still no consensus for MLA measurement in Orthopedics, there are suggested techniques such as the talo-horizontal angle, talo-first metatarsal angle (TFMA), and the calcaneal pitch 6 , 15 . These radiographic parameters provide useful therapeutic guidance in clinical practice 17 .…”

“…The radiographic parameter used to assess the effect of the arch support feature of the insole was the calcaneal pitch (Fig. 2), which was an angle formed by a line drawn extending from inferior portion of the calcaneocuboid joint to the inferior border of the calcaneus, a second line extending from the inferior aspect of the medial sesamoid bone to the inferior border 4 , 15 . The difference in calcaneal pitch with and without the orthosis for each foot was then determined.…”

Comparison of multiple flatfoot indicators in 5–8-year-old children

“…Another biomechanical parameter is widely used to diagnose resting foot posture – RCSP [ 1 , 5 , 13 ]. The RCSP has a high degree of reliability, independent of age, height, and weight [ 13 ].…”

“…Another biomechanical parameter is widely used to diagnose resting foot posture – RCSP [ 1 , 5 , 13 ]. The RCSP has a high degree of reliability, independent of age, height, and weight [ 13 ]. According to studies, validity and reliability of RCSP angle are relatively less common than those of FPI-6 [ 5 ], especially at different ages of the child.…”