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BSCOS Consensus statements on the “Management of flexible flatfeet in children”.
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Assessment
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- The flexible flatfoot is defined as a normally functioning foot, where the medial longitudinal arch is absent or minimal when standing.
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- Observation of gait and lower limb alignment should be incorporated into the overall assessment of flatfeet.
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- Reconstitution of the medial longitudinal arch on tip-toeing or during examination differentiates between flexible and stiff flatfeet.
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- Pain assessment should be carried out including location and severity.
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- The calf muscle should be assessed for tightness.
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- X-rays or scans are NOT required for the assessment of pain-free flexible flatfeet.
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- Anterior-posterior and lateral weight bearing views as well as standard oblique radiographs should be considered for the assessment of painful flatfeet.
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- The pain-free flexible flatfoot needs reassurance and NOT referral or treatment.
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- Foot pain, stiffness or calf muscle tightness should prompt a referral for further assessment.
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- Unilateral, asymmetric presentation of a flatfoot is a red flag requiring further assessment.
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Conservative Treatment
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- Pain-free flexible flatfeet are a normal finding in children.
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- Children with pain-free flexible flatfeet are unlikely as adults to develop joint symptoms, due to their feet.
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- Pain-free flexible flatfeet do NOT require referral to orthotists and/or podiatrists and/or physiotherapists.
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- The presence of calf tightness in painful flatfeet warrants management by orthotists and/or podiatrists and/or physiotherapists as required.
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- Children with painful flexible flatfeet can be referred to an allied health professional with appropriate experience.
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- There is no evidence to support the use of orthotics as prophylaxis against long term pain or disability in the presence of pain-free flexible flatfeet.
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- The development of the medial longitudinal arch is not influenced by the use of orthotics.
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Surgical Treatment
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- Surgery has NO role in the treatment of pain-free flatfeet.
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- Management of painful flatfeet by orthotists and/or podiatrists and/or physiotherapists should always precede orthopaedic surgery.
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- Surgical treatment of paediatric painful flatfeet should ONLY be undertaken by medically qualified Orthopaedic Surgeons with experience of treating children.
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- Persistent pain, resistant to non-operative treatment, is the main indication for surgery in flexible flatfeet.
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- Severe deformity causing pain is an indication for surgery in flexible flatfeet.
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- Children with ongoing, resistant symptoms of painful flexible flatfeet, despite conservative treatment, should be referred to an orthopaedic surgeon.
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- Hindfoot osteotomies and/or midfoot osteotomies and/or soft tissue procedures can be considered to treat paediatric painful flexible flatfeet.
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- Calf tightness should be addressed as required during flatfeet surgery.
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- Fusions should NOT be performed for painful flexible flatfeet in children without a syndromic or neuromuscular diagnosis.
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