The attitude of doctors of various specialties to the problem of flatfoot

Abstract

Purpose: to assess the subjective perception of flatfoot’s prevalence in children, its age dynamics and the main approaches to the diagnosis and treatment by doctors of various pediatric specialties with different medical experience and working in medical facilities at various levels by anonymous questionnaire.

Materials and methods. Questionnaire data from 80 orthopedists (50 outpatient doctors, 30 doctors from a specialized scientific research institute and orthopedic departments of city hospitals (research institutes / hospitals) and 30 neurologists (polyclinic).

Results: our study demonstrated that outpatient orthopedists diagnose the flatfoot on average in half of the cases. The orthopedists diagnose flatfoot only by means of visual examination in 46.1% of cases (neurologists — in 85.7% of cases). According to our data, 58.9 % of outpatient doctors recommend wearing special orthopedic shoes (46.1 % — only if the foot alone is affected) and 95.1 % of specialists recommend wearing individual orthopedic insoles (53.6 % — if there are complaints). While 88.2 % of the orthopedic surgeons from specialized research institutes and hospitals do not recommend wearing orthopedic shoes; 26.7 % of experts recommend wearing individual orthopedic insoles only in the presence of complaints. On the other hand, the neurologists recommend wearing orthopedic shoes 5.3 times more often than the orthopedists do.

Conclusion: our study demonstrates that the specialty of the doctor (orthopedist, neurologist) and the type of health care facilities in which the specialist works have the greatest impact on his subjective perception of the prevalence and age dynamics of flatfoot in children, tactics of diagnostics and treatment. The outpatient orthopedists diagnose “flatfoot” 4.2 times more often than the orthopedic surgeons from the specialized research institute and hospitals. Also, the outpatient orthopedists prescribe wearing orthopedic shoes 4.9 times more often (insoles — 3.6 times more often) in comparison with the orthopedic surgeons of the specialized research institute and orthopedic hospitals. Summarizing the above mentioned, we would like to note that due to the fact that the current assessment of the age limits of the arch height feet is ambiguous, there is a need to introduce a unified system for assessing the foot’s shape and posture with defining the concepts of “average height” and “typically developing foot”.

Keywords

flatfoot / frequency of occurrence / diagnostics / orthopedic shoes / individual insoles / questioning of doctors

References

[1] Banwell HA, Paris ME, Mackintosh S, Williams CM. Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review. J Foot Ankle Res. 2018;11:21. https://doi.org/10.1186/s13047-018-0264-3.

[2] Chen KC, Yeh CJ, Tung LC, et al. Relevant factors influencing flatfoot in preschool-aged children. Eur J Pediatr. 2011;170(7):931-936. https://doi.org/10.1007/s00431-010-1380-7.

[3] Harris RI, Beath T. Hypermobile flat-foot with short tendo achillis. J Bone Joint Surg Am. 1948;30(1):116-150. https://doi.org/10.2106/00004623-194830010-00013.

[4] Gould N, Moreland M, Alvarez R, et al. Development of the child’s arch. Foot Ankle. 1989;9(5):241-245. https://doi.org/10.1177/107110078900900506.

[5] Uden H, Scharfbillig R, Causby R. The typically developing paediatric foot: how flat should it be? A systematic review. J Foot Ankle Res. 2017;10:37. https://doi.org/10.1186/s13047-017-0218-1.

[6] Evans AM. The flat-footed child – to treat or not to treat – what is the clinician to do? J Am Podiatr Med Assoc. 2008;98(5):386-393. https://doi.org/10.7547/0980386.

[7] Dars S, Uden H, Banwell HA, Kumar S. The effectiveness of non-surgical intervention (Foot Orthoses) for paediatric flexible pes planus: A systematic review: Update. PLoS One. 2018;13(2):e0193060. https://doi.org/10.1371/journal.pone.0193060.

[8] Dars S, Uden H, Banwell HA, Kumar S. When, why and how foot orthoses (FOs) should be prescribed for children with flexible pes planus: a Delphi survey of podiatrists. PeerJ. 2018;6:e4667. https://doi.org/10.7717/ peerj.4667.

[9] Хекхаузен Х. Мотивация и деятельность: пер. с нем. – М.: Педагогика, 1986. – С. 234−248. [Khekkhauzen Kh. Motivatsiya i deyatel’nost’. Transl. from German. Moscow: Pedagogika; 1986. P. 234-248. (In Russ.)]

[10] Darley JM, Batson CD. “From Jerusalem to Jericho”: a study of situational and dispositional variables in helping behavior. JPSP. 1973;27(1):100-108. https://doi.org/10.1037/h0034449.

[11] Кенис В.М., Димитриева А.Ю., Сапоговский А.В. Вариабельность частоты плоскостопия в зависимости от критериев диагностики и способа статистической обработки // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2019. – Т. 7.– № 2. – С. 41–50. [Kenis VM, Dimitrieva AYu, Sapogovskiy AV. The variability of the flatfoot frequency depending on the diagnostic criteria and the method of statistical analysis. Pediatric traumatology, orthopaedics and reconstructive surgery. 2019;7(2):41-50. (In Russ.)]. https://doi.org/10.17816/PTORS7241-50.

[12] Hernandez AJ, Kimura LK, Laraya HF, Fávaro E. Cálculo do índice do arco plantar de staheli e a prevalência de pés planos: estudo em 100 crianças entre 5 e 9 anos de idade. Acta Ortop Bras. 2007;15(2):68-71. https://doi.org/10.1590/S1413-78522007000200001.

[13] Staheli LT, Giffin L. Corrective shoes for children: a survey of current practice. Pediatrics. 1980;65(1):13-17. https://doi.org/10.1136/bmj.280.6231.1556-a.

[14] Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br. 1992;74(4):525-527. https://doi.org/10.1302/0301-620x.74b4.1624509.

[15] Abolarin T, Aiyegbusi A, Tella A, Akinbo S. Predictive factors for flatfoot: the role of age and footwear in children in urban and rural communities in south West Nigeria. Foot (Edinb). 2011;21(4):188-192. https://doi.org/10.1016/j.foot.2011.07.002.

[16] Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flat foot: a survey of 1846 skeletally mature persons. J Bone Joint Surg Br. 1995;77(2):254-257. https://doi.org/10.1302/0301-620x.77b2.7706341.

[17] Pfeiffer M, Kotz R, Ledl T, et al. Prevalence of flat foot in preschool-aged children. Pediatrics. 2006;118(2):634-639. https://doi.org/10.1542/peds.2005-2126.

[18] Wenger DR, Mauldin D, Speck G, et al. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am. 1989;71(6):800-810. https://doi.org/10.2106/00004623-198971060-00002.

[19] Garcia-Rodriguez A, Martin-Jimenez F, Carnero-Varo M, et al. Flexible flat feet in children: a real problem. Pediatrics. 1999;103(6):e84. https://doi.org/10.1542/peds.103.6.e84.

[20] Rose GK, Welton EA, Marshall T. The diagnosis of flat foot in the child. J Bone Joint Surg Br. 1985;67(1):71-78. https://doi.org/10.1302/0301-620x.67b1.3968149.

[21] Круминь К.А., Ласунская М.Т., Рийсалу Л.П., и др. О профилактике плоскостопия у детей // III пленум Междуведомственной комиссии по рациональной обуви и Центрального института травматологии и ортопедии по вопросам обеспечения населения рациональной обувью и лечения заболеваний и деформации стоп: материалы докладов; Москва, 23–25 апреля 1968 г. – М.: ЦИТО, 1968. – С. 120−122. [Krumin’ KA, Lasunskaya MT, Riysalu LP, et al. O profilaktike ploskostopiya u detey. (Plenary session) III plenum Mezhduvedomstvennoy komissii po ratsional’noy obuvi i TSentral’nogo instituta travmatologii i ortopedii po voprosam obespecheniya naseleniya ratsional’noy obuv’yu i lecheniya zabolevaniy i deformatsii stop; Moscow, 1968 April 23–25. Moscow: Tsentral’nyy nauchno-issledovatel’skiy institut travmatologii i ortopedii imeni N.N. Priorova; 1968. P. 120-122. (In Russ.)]

[22] Staheli LT, Chew DE, Corbett M. The longitudinal arch. A survey of eight hundred and eighty-two feet in normal children and adults. J Bone Joint Surg Am. 1987;69(3):426-428. https://doi.org/10.2106/00004623-198769030-00014.

RIGHTS & PERMISSIONS

Kenis V.M., Dimitrieva A.J., Sapogovskiy A.V.