In children, the appearance of flat foot is normal and extremely widespread. It mainly occurs under the influence of fats that surround the developing arch and partly as a result of the curve that is not fully developed. In children, the arch develops in early childhood as a part of normal bone development and growth (Blake 1991). In most children, flat foot occurs at the age of four to six years. Flat arches always become proper arches and high arches while the child develops in adolescence.
Since children are not able to identify flat foot by themselves, it will be necessary for parents to help in identifying the problem. Parents should be able to identify flat foot when a child begins to walk in a funny way, for instance, when edges of the feet turn outside or the child feels foot pain or fatigue while walking. Children who complain about pains around the foot area may be developing or having flat foot (Bleck and Berzins 1977).
Statement of the Problem
The paediatric flatfoot patient is common in podiatry practice. Frequently, paediatric flatfoot can be asymptomatic or even self-correcting along with the growth and development. Still, we have seen many children who are reluctant to exercise due to pain, or adults who did not receive treatment as adolescents and now have to face serious reconstructive surgery (Sullivan 1999). Most patients get to know about flat foot after the referral to paediatricians or when their concerned parent brought them to hospital to be examined when they were children. Most paediatricians consider paediatric flatfoot to be a benign process because most infants are born with a flexible flatfoot and certainly do not develop a normal arch until they are seven to ten years of age (Bordelon 1983). During childhood, flat foot is not easy to detect, since the true shape of the foot is hidden under a layer of fat. In the course of time, as the baby starts to walk, flat foot becomes more noticeable. As the child grows, a normal arch is evident at the age of four years. This commonly occurs when a child walks barefoot on an uneven landscape. Orthotics is one of the treatment procedures that are in practice in the correction of the condition. However, despite the wide use of this procedure, it is still unclear as to whether it is appropriate and effective especially when applied to children. The issue continues to spark off heated debates, and thus the research paper will seek to substantiate the views that are expressed by Cypriot podiatrists concerning flat foot.
Purpose of the Study
In most cases of the occurrence of flat feet in children, it is advisable to use orthotic treatment. This is possible for flexible paediatric flat feet (Bordelon 1983). The issue has been a topic of considerable debate for many years. However, the theory that intervention may influence midlife symptoms has been widely accepted by many practitioners. However, it remains unsubstantiated in most clinical trials. In most cases, there have been questions among most practitioners who deal with the issue of flat feet in children concerning the appropriate treatment method to be instituted. A child may evade the problem, especially when they are not experiencing symptoms. In this case, it is vital not to ignore the current well-being of a child. Moreover, untreated flat feet may lead to foot problems later in life (Bordin et al. 2001). According to current evidence, children who have developed flexible flatfoot require treatment. Consequently, children who have developed paediatric flat feet are overweight or suffer from obesity. On the other hand, in case of extreme hypermobility, systemic or genetic abnormalities, treatment must be also provided. However, there is no appropriate treatment that is recommended for a child with hypermobile flatfoot, since they do not show symptoms and the normal development is not affected.
The normal development in children is the presence of a vertical position by the age of four to seven. Studies have shown that approximately 52-70% of children aged from two to three have flat feet, yet only 17-26% of children at six are diagnosed. This demonstrates a natural correction with aging. A second study in paediatrics reported that only 2.7% of children aged 4-13 are flatfooted (Bordin et al. 2001). The main purpose of this research is to gain an understanding of the views that are expressed by Cypriot podiatrists with regards to the use of orthotics in the treatment of flat feet in children. The research will seek to understand the matters that are associated with the procedure, side effects if any, effectiveness and appropriateness of that procedure in addition to any other issue that is raised by Cypriot podiatrists (Garcia-Rodriguez et al. 1991).
Objectives of the Study
The main objective of this study will be to substantiate the views of Cypriot podiatrists with regard to the use of orthotics in the treatment of flat feet in children. In order to be able to objectively carry out the research, the following sub-objectives will be considered:
Be able to determine the appropriate procedure for the symptomatic paediatric flat feet in children
Be able to evaluate the plane of deformity in the symptomatic paediatric flat feet in children
To define the process that corresponds to different planes of deformity for the symptomatic paediatric flat feet
What are Cypriot podiatrists’ views on the use of orthotics in treating children with flat feet?
What are the strategies and credibility for treatment of acquired flatfoot in children?
Significance of the Study
It is necessary to keep in mind some points when it comes to solving the issue of flat feet in children. The initial detection is necessary, since it can avert many serious complications to other body parts such as knees and lower back later in life (Luhmann, Rich and Schoenecker 2000). Clinically, it is possible to treat flat feet in children. There is available evidence to indicate the validity of the procedure. Also, there are cases of people who did not undergo the treatment, yet the problem naturally resolved and thus it did not bother them in their later lives. The use of orthotics in children remains controversial owing to the fact that at that age, the majority of children have naturally flat feet, and thus it is difficult to detect the ones that are suffering from the condition. The main purpose of orthotic devices is to ensure that children with flat feet do not suffer from pain, as well as the deformity that is connected with the paediatric flatfoot in children are prevented from arising in future. Several Cypriot podiatrists have expressed their views concerning the use of orthotics, especially in children. The orthotic devices in general assist in reducing excessive pronatory forces that exist in the subtalar joint. Thus, to make these devices serve their purpose, they must be rigid enough in order to provide support as well as realign the subtalar and midtarsal foot joints. At the same time, these orthotic shoe insoles help in increasing the supinatory torque across the subtalar joint axis (Luhmann, Rich and Schoenecker 2000). The study will help in the general understanding of the matters that pertain to their use, especially in the treatment of flat feet in children.
Assumptions of the Study
The analysis of paediatric flexible flatfoot symptoms should start with the supposition that rigid flatfoot caused by tarsal coalition and vertical talus, without or with peroneal spasm, usually requires a surgical approach rather than functional orthoses. Significant equines deformity is also a primary cause of paediatric flatfoot. Without its primary correction, orthotic therapy is an unsuccessful and painful experience for the child. Other etiologic origins of paediatric flatfoot must be also identified and considered, especially genetic anomalies and upper and lower motor neuron disorders. As a result, treatment of paediatric flexible flatfoot with functional devices is a generally accepted treatment.
Flatfoot can be generally referred to as a disorder when the foot collapses, making individuals lose their arch height. A flatfoot could be flexible or rigid. A flexible flatfoot only becomes flat after exerting some pressure on the foot, while a rigid flatfoot remains flat even when the individual does not exert any pressure or undertake any activity. This division is very important, since the treatment is not the same either. Flexible flatfoot is not as severe as rigid flatfoot. However, this does mean that it should be taken any less seriously. This research paper identifies the important characteristics observed when the foot arch has deteriorated and lost its strength, and considers traditional treatment procedures like modern surgical techniques of curing it (El et al. 2006). Flatfoot has also been seen to develop among older people who showed no symptoms in their childhood. The condition though remains to be most prevalent in people whose skeletons are not mature. Most people think that they should be treated because their feet are flatter than usual. Flexible flatfoot differs significantly with age (Stately 1999).
Physiologic flatfoot develops for no apparent reason and in most cases, it is painless. Generally, flexible flatfoot can be caused by traumas that lead to arthrosis, skew foot, and malfunction of the bones and joints. Loosening of the joints is also a major contributor to the condition. It is important to note that flatfoot may lead to suprapedal problems like malalignment of the ankle, knee or hip. Flatfoot may also eventually cause collapsing of several articulations in the foot, as well as degeneration of the ankle. The malfunctioning of the part joining tibia and the rear tendon has also been associated with adult flatfoot. There is no doubt that this tendon provides the major muscular support to the arch (Mickle et al. 2006). It originates around the rear side of both fibula and tibia and goes around the ankle, then through navicular tuberosity with extensions all over the arch. The tendon lifts the arch up. In most cases when treatment is not taken seriously, the tibial-tendon joint of the foot develops problems over time due to flatfoot. However, early diagnosis and treatment have proved to prevent all these problems. In other rare cases, injuries and diseases that affect relevant parts of the body have been confirmed to cause flatfoot (Harris, Vanore and Thomas 2004).
The symptoms of Flatfoot
It is important to note that flatfoot does not cause pain. The resulting effects of the malposition of the foot normally cause pain. Some patients may come complaining of pain that is experienced underneath the arch. This happens after the skeleton of the foot has warped. In most cases, calluses are painful and normally pain develops particularly in areas that have any kind of pressure being applied to them. In this connection, the most common site where pressure is intense is under the navicular tuberosity (Stately 1999). The pain develops as a result of the foot abutting the ankle, which causes some swelling or pain on the outside of the foot and inside the sinus tarsi. Because of this, pain in the heel may be also felt and it will normally present itself at varying intensities. Due to the strain on the top of the rear tibia tendon, pain will develop at its tendious insertion. This is extended to the open tendinitis through warmth and irritation. Bunions might finally arise in a supple flatfoot. In this case, it may appear as being directly linked with ligamentous negligence and intense mobility of the medial piece of the foot (Mickle et al. 2006).
Though the term “flatfoot” is one and the same with arch flattening, it is however not the correct term to describe the real or actual pathological situation. Normally, flatfoot has three components: heel valgus, forefoot abduction, and the collapse of the foot. In some cases, all of these components can be present in flatfoot. Still, there may be one of these components, each component will occur in one plane, when the flat feet becomes planar (Mickle et al. 2006). The most detectable component is normally the flattening of the foot arch. This may explain the term “flatfoot” and its continued use referring to this disorder. When evaluation of a patient is done from the rear part, heel valgus is the most notable component of this pathological condition. Forefoot may also be notable from behind and the patient may seem to have more or many toes (Stately 1999).
An important point to note is the fact that children tend to exhibit symptoms of flat feet at the tender age owing to the body fats that accumulate at the base of their feet. The implication of this fact is that mere observation does not necessarily indicate the presence of the condition. It is during this stage that the paediatricians identify the real nature of the condition, and thus effective treatments can be administered. Since there are different kinds of the condition, Cypriot podiatrists will need to specifically ascertain the real nature of the condition so that the effective treatment procedure can be carried out. Flat foot especially the rigid type can result from conjential vertical talus. This disposition results in irregular positioning of the talus and the navicular is dorsally dislocated to the neck. The feet in that case may even bulge outwards. This is an example that actually requires surgical operation. The implication of that lies in the fact that specific conditions require distinctive treatments depending on their nature (225).
In evaluation of a painful flatfoot, it is important to use radiography while making diagnosis. Most of the factors that bring about stiff flatfoot such as tarsal coalitions are easily or immediately identifiable with simple radiography. They are further easily distinguishable as caused by flexible flatfoot. Obtaining a standing (weight bearing) x-ray is important during radiography, since several articulations in the foot may result in collapsing and subluxation of the foot. A keen examination or evaluation of flexible flatfoot is necessary so as to see the location of every segment of the bone, as well as the interaction of the forefoot and the rearfoot. This should also be the case with the ankle as well as the leg. Identification of arthritic joints is also fundamental, since the presence of arthrosis dictates what kind of surgical operation should be undertaken. Scanning with equipment that uses magnetic resonance is critical when flatfoot has been caused by the posterior tibia tendinopathy. The problem of this kind of tendon will be identifiable using the equipment mentioned above (Mickle et al. 2006).
There are several strategies that are advanced in the management of the condition. An example is a particular case whereby an immature child (with immature skeleton) with flexible flatfoot was observed. The case was treated using a joint located at subtalar and arthroereisis, and also through the method of lengthening discovered by Tendo Achlilles. The use of a metallic implant was meant to prevent the rear from collapsing. Radiographs taken before and after the operation demonstrated that there was an improvement in the alignment of the child’s rear foot (Whitford and Esterman 2007). In the flatfoot management, a step-by-step approach is taken so as to conservatively manage it. There are patient-driven and practitioner-driven aspects. Though different treatment modalities are used to simultaneously achieve clinical improvement, it has not been clear which meticulous procedure leads to a greater remedial benefit. Accepting the accessible management options for flat foot will always give the practitioner a better opportunity to treat the disorder. This will also help practitioners to provide their patients with the next and most suitable stage of management (Stately 1999).
Just like in any other disease or condition management, education about the management of flatfeet in children is necessary. The doctor will need to tell the child’s parents more about the condition and suggest any proactive way of treating it in which they may participate. Educating children with flat feet on this condition will help them live with it effectively and teach them to take care of the health of their feet. This may also help them to realise the need of having a medical intervention (Stately 1999). Adolescents and children may not oppose to any intervention being done on them, since they might have no discomfort and they will seek intervention simply as soon as their parents start to get concerned with the flattening of their feet. While educating parents and patients, it should be noted that the incidence of flatfoot does not always mean or indicate a pathological process. Practitioners should make it clear and illustrate this, and give the necessary recommendations (Whitford 2007).
The aim of a simple stretching program is as a rule to counteract the foot deforming force. In case of a flexible flat foot, a calf muscle is exceedingly tight. Stretching is aimed at making this muscle stronger and tougher. To be more precise, the type of stretching is centred on the superficial muscle and the gastrocnemius. When there is any inflammation that is connected with flexible flatfoot, oral non-steroidal anti-inflammatory drugs can be administered so as to reduce the inflammation (Mickle et al. 2006). However, patients should get used to handling sharp episodes of soreness, which is experienced only when there is a severe inflammation. Patients should be cautioned that these drugs are not the only treatment options for flexible flatfoot, and that they need to be used in combination with additional available treatment options or modalities. An intraoperative photo demonstrates enlarged hypertrophic degenerated tendon joining the tibia at the rear part of the foot. The flexor digitorumlongus tendon is accessed through the same incision and is harvested to be transferred to the tendon joining tibia (Whitford 2007).
Shoe Gear Selection
It’s very vital to provide education to the patients on good shoe selection on the basis of the condition of their feet. This is because by definition flexible flatfoot is ‘flexible’. Thus, while walking, it is important to provide the foot with a stable shoe. From experience, using inflexible shoes causes worsening of the pain during walking (Whitford 2007). A good shoe must have a stable and a fixed heel counter with a firm sole. The shoe should resist twisting, especially when torqued physically. A shoe ought not to bend at the midsole but only at the curve of the sole. This aspect of the shoe is very critical with regard to the flatfoot malformation, which happens because a flexible shoe at the upper part of the foot induces more stress and pain on the foot arch. To conclude, a good shoe is the one with an insole that is removable so as to hold an orthotic steadier than the one that shoe manufacturers produce.
As an intervention, it is important to place insoles in the shoe, since they offer a mechanical support to the flatfoot that is flexible. Although arch supports obtained from ordinary shops may be used, insoles that are prescribed by the physician provide a better balance to the foot. Modifications are usually made on insoles to prevent the collapsing of the upper part of the foot, especially the medial flanges as well as the heel aversion such as skives and heel posts. It is also useful to add spot cushioning, especially in the areas with much pressure which relate to a splayfoot (Mickle et al. 2006).
Even if the treatment deals with the flexible flatfoot that is mild and shows no symptoms, the case is usually controversial. A supportive insole is often prescribed when presented with less complication in more severe flatfoot condition. In the UCBL, for the deficiency of a better term, ‘cup’ the upper part of the foot and the heel in the neutral position (Mickle et al. 2006). It is usually created from the view of a foot, and, in general, it becomes the reproduction of the foot in adjusted position. The key advantage of using the UCBL shoe insert is that it fits very well inside the tennis shoe.
Ankle Foot Orthoses (AFOs)
These are supports that are usually used when there is a very severe or less mild form of flatfoot cases that have failed to respond to insole treatment. An AFO spreads on the ankle in an attempt to rectify the condition. It supports the lower part of the leg and the arch hence providing supports to the foot. They are also made to support the ankle, as well as the foot. Most braces usually bring together the advantages of AFOs and those of custom soles. This is usually very beneficial for patients whose joint between tibia and the adjoining tendon is not functional. Lepidus bunionectomy itself is a procedure on the midfoot fusion that usually stabilises the upper part of the foot. The radiograph taken before and after the operation usually indicates the presence of abnormal positioning of the forefoot.
Casting and Immobilisation
This is usually the last treatment option used for managing symptomatic flexible flatfoot patients. This treatment option is often designated for patients whose rear tibia has greatly deteriorated. In acute conditions of tibial tendinitis, the treatment tends to commence alongside immobilisation, which is then followed with conservative measures, but only when the inflammation problem is resolved. The main reason for casting is to eliminate the strain on the lower part of the tibia. Providing a good rest for the tendons is ideally achieved with a short-leg non-weight bearing cast. The majority of patients are best taken care of with walking casts, although this is largely dependent on how severe the tendinitis is. Controlling the motion of the ankle is a very beneficial alternative physical therapy if used concomitantly (Harris, Vanore and Thomas 2004).
This flexible flatfoot management is usually suggested for patients who have undergone an unsuccessful traditional treatment option. The aim of conducting an intervention through surgery is to provide an overall improvement in the alignment of the foot so as to reduce the pain. A wide range of procedures and techniques are usually applied in order to rebuild the flatfoot. They include bone cuts (osteotomy), tendon augmentation, tendon lengthening, implants meant to support the bone (arthroereisis devices), and bone fusions.
For a patient who undergoes the reconstruction of a foot with the flattened arch, the midfoot fusion procedure is usually performed and it involves the initial three tarso-metatarsal joints, the recession gastrocnemius, that is, the bone surrounded by the muscular aponeurosis and mediatising calcaneal osteotomy. The postoperative and preoperative radiographs show good progress in improving the alignment of the forefoot (yellow line) and the rearfoot (blue line) (Scranton et al. 1972).
When planning for the flatfoot reconstruction, the surgeon should take many factors into consideration. Skeletal maturity and age are very important in the flatfoot surgery decision-making process. For instance, if adolescents and children are still developing, the range of surgical operations that can be performed on them is directly impacted. From experience, young children especially those who are younger than 6 years of age are usually treated without being subject to surgery, but it usually depends on the medical condition of the patient. Older patients, who usually have substantial deformities, normally do undergo fusion procedures, since they are not growing anymore. Furthermore, fusion enhances better correction compared to osteotomy. Adult patients need to be evaluated for arthritis, which normally occurs due to the immediate result of chronic joint subluxations and flatfoot. Fusion is commonly used for treating these conditions. Flatfoot that is symptomatic and mild can be easily managed with fusion procedures and with tendon augmentations. When flatfoot deformities are considered to be severe, the rear foot fusions procedure is usually recommended (Harris, Vanore and Thomas 2004).
The surgical management of the equinus is normally performed together with flatfoot surgeries. This is usually done with a Tendo Achilles lengthening or with a gastrocnemius recession; these procedures are usually diagnosed by the medical investigation. There exist numerous gastrocnemius techniques and procedures. The most modern existing method that normally involves the muscular bound gastrocnemius aponeurosis lengthening only is GIAR, which is Gastrocnemius Intramuscular Aponeurotic Recession. Hypothetically, this technique only exhausts the pull of gastrocnemius, at the same time preserving anatomic insertion of a gastrocnemius attachment on the soleus. The lengthening of the Tendo Achilles may be also done percutaneously. The open procedure is of great benefit to surgeons, since they are able to define the exact lengthening amount, and consequently they are be able to protect the tendon to avoid postoperative over-lengthening, which normally occurs due to patient noncompliance. Advanced deterioration of subtalar and talonavicular joints causes severe flatfoot. Through this, subluxation of the above joints occurs. Clinically, the sagittal plane is observed to collapse leaving the foot with a large and visible talonavicular head. A triple arthrodesis is essential to rectify the back foot collapse observed in this case. The preoperative as well as postoperative radiographs reveal an advancement of the rearfoot (Kirby and Green 1992).
Arthroereisis procedures are widely accepted in patients who are young. This method involves placing absorbable or metallic implant into the back of the foot sandwiched between the calcaneus and talus. It maintains some space between the two bones reducing the instances of undesirable pronation or sometimes the collapse of the curve as a spacer that limits and prevents collapse of the curve or excessive pronation (Harris, Vanore and Thomas 2004).
The process of implanting obviously involves a surgery. It is perhaps the slightest invasive procedure done as an intervention against flatfoot, as no bone cutting or other procedures involving tendons are done. Furthermore, some specialists consider that this procedure is reversible, in case there is a need in the future to remove the implants (Root, Orien and Weed 1971). This type of procedure is highly recommended for adolescents and children. In addition, there are theories that suggest that the support provided by this implant can help to normalize the bone development and attain a normal bone anatomy at maturation. Moreover, arthroeresis procedures can be combined with various measures shown below, for instance, tibial-tendon augmentation, as well as midfoot fusions. These other processes are useful in treating other foot parts, while arthroereisis treats the rear part of the foot (Lin, Lai, and Kuan 2001).
Augmentation of the Rear Tibial-Tendon Joint
Rebuilding of the rear tibial-tendon joint is the foundation of flexible flatfoot rebuilding. It is frequently combined with some additional measures for various degrees of flatfoot deformity (Wenger, Mauldin, and Speck, 1989). Some people view the tibial-tendon of the foot as an approach that is physically developed in terms of ‘tightening’ up the tendon, while reclaiming its physical properties and act as an arch-sustaining strength. If an accessory bone that is symptomatic is placed at the insertion, it is transferred, and the tibial-tendon joint of the foot is attached again to the navicular tuberosity using anchors made of a bone. When the tibial-tendon has been damaged, a tendon may be transferred. During this procedure, the flexor digitorum longus tendon is utilised (Park, Song and Shin 2004).
Medializing Calcaneal Osteotomy
The middle calcaneal osteotomy refers to a brace procedure for the reconstruction of flexible flatfoot. Flatfoot is visible, when the heel is in a valgus position (Valmassy 1999). This involves cutting the bone in the area where calcaneus is the widest. The posterior part of the heel is well-reconstructed and tightened together using screws (Stately 1999). The procedure is safe to perform on teenagers, since their skeletons are not mature. In order to reduce the incidents as well as the intensity of the disturbance of the bone, pins are sometimes utilised to replace screws. The majority of experienced specialists recommend that heel valgus that is larger than 8° to 10° is more effectively addressed using rear foot fusions. However, many other factors influence the choice of whether to use this method or not (Notari 1988).
Bone Grafting Osteotomy
The Evans calcaneal osteotomy has been widely accepted for adolescents, since it offers flatfoot rectification through increasing the length of the lateral foot fraction, in other words through the calcaneus, while trying to avoid various growth plates such as calcaneal. The above is achieved through the use of a bone graft, which is sometimes fixed with wires, plates or even screws. One specific type of this (cotton medial cuneiform osteotomy) is recommended for adolescents and children, as their skeletons are not yet mature. It entails putting a structural bone graft carefully into the inner bones of the foot in an attempt to rectify the arch (Mickle, Steele and Munro 2006).
This is perhaps the most common procedure for treating flatfoot. The reconstruction is done when the foot is flat because of the arch collapsing (Franco 1987). This procedure is effective alone and can be utilised as a stand-alone procedure; it can be also combined with other procedures and still show excellent results. The common procedure that is combined with this one involves the transfer of the tendon to fix the foot. The two types of medial column procedures are navicular cuneiform arthrodesis and the Lapidus arthrodesis (or Lapidus bunionectomy). These two procedures correct the instability that causes the collapse of the foot. This is achieved through the fusion of various joints of the bones, which increases stability (Kuhn et al. 1999).
This type of procedures is set aside for being applied in very severe situations of flexible flatfoot malformation, as an intervention procedure. It is only applied when other procedures have not been effective, or in combination with arthroesis as a remedy for the collapse of arch (Wetton 1992). This procedure is avoided in young children, as it involves the interference in essential joints. If these joints are adversely interfered in, the results can be malformation or degeneration of the circumflex joints, for example the midfoot or the ankle. When performed, this procedure sometimes involves a subtalar joint arthrodesis and the calcaneocuboid joint arthrodesis among others. These several processes involved lead to joining together all the three rear foot joins referred to as a triple arthrodesis.
In addition, different non-surgical interventions can be used to rectify flexible flat foot. However, operative intervention is used when other methods have not been effective.
Among various treatment procedures that are used by Cypriot podiatrists is Orthotics. Orthotics has caused a lot of controversy, especially when it should be applied to children. There is a common concern about the effectiveness of the procedure, its necessity, and applicability to children. This chapter will attempt to highlight some of the views that have been expressed by Cypriot podiatrists on Orthotics therapy for children.
Orthotics can be considered to be custom-made shoe inserts which are designed in such a manner that they align to the plaster cast of the foot. They are designed in different formats in order to perform a particular function as the condition may dictate. They are made in a way that they control the mechanics of the feet to an accurate angle as the condition may require. They are classified into three broad categories: soft, semi-rigid, and rigid. The rigid type is made in such a way that shoe inserts control the function and are usually made of a firm material such as graphite or even plastic. A soft orthotic eases the shock and relieves the pressure from the sore spots. A semi-rigid orthotic gives the body a dynamic balance, especially while one is in motion. Orthotics help the body to maintain the proper functionality by allowing the tendons and the muscle to be effective in their performance.
There is a consensus among podiatrists that the majority of foot imbalances and defects have their roots in the childhood of the patients. They aggravate in the course of time. Moreover, the defects may be magnified by some factors such as wearing shoes. These deformities can be recognized from the age of four. They are mainly characterized with the flattening of the feet, and there are chances that the symptoms will result in serious problems later in life. It is during this tender age that the alignment and the structure can be repositioned to grow in the proper direction.
In most cases, patients may experience discomfort in the feet, ankles, callus formation, heel pain, and other symptoms. In this case, it is necessary to consult a medical practitioner so that appropriate orthotics can be prescribed. Due to the fact that orthotics are often taken as a preventive measure that cautions against future foot problems, they may be prescribed even in situations when no pain is being experienced (Evans 2009).
There have been several study attempts by various researchers and Cypriot podiatrists. In a study, 50 young patients who had idiopathic flat foot were involved. Gait analysis was carried out. The analysis is used to indicate the position of the anatomical landmarks while the subject is in motion. A referencing platform was obtained for the comparison with the system. Six un-scaled speed barefoot walk on both the left and the right side were evaluated. From the results that were obtained, a clinical examination was carried out in the calculation of the heel valgus, as well as the footprint was graded. There was also an x-ray measurement in the evaluation of the talocalcaneal angle and the costa-Bertani angle.
The experiment was aimed at proving the fact that flat foot is a symptom of a common disease among young people. The experiment therefore aimed to put emphasis on the fact that the diagnosis of the condition should be based on the proper examination and evaluation of the symptoms. The objective of the work was to ascertain the presence of an irregular gait pattern, especially in children and correlate that with the clinical evaluations, and also the data from the X-ray measurement.
The data that were then obtained were compared by means of the statistical analysis. The preliminary results indicated that there existed differences among the samples that were obtained. However, some parameters were observed to be dependent on the speed as the flat feet were observed at higher speed as compared to the rest.
This analysis was very important, as it helped in the development of procedures that can be used in the evaluation of a case. Thus, it can be used to distinguish the actual impaired with a mere simple morphological flat foot condition. The study helped in overcoming the notion that children’s feet are usually flat by providing a platform that will differentiate between the normal flat and the one that needs to be diagnosed (Catani 1996).
Another research was carried out using the Oxford Foot Model which has been assessed and proclaimed a validated method of detecting the deformities in the feet. Five OFM angles were found to be different from the others. The results were analysed, and symptomatic differences were detected. Thus, it made possible the detection of a diagnosable condition, even in infants who have their feet flat (Kerr & Stebbins 2012).
The use of orthotics in children is still a controversial issue among various medical specialists. The common belief that is against the use of orthotics in children is based on the fact that children are young and they have the potential to outgrow any disorder that their parents might be having. In New Zealand, there is a general consensus that the therapy should only be applied to children in some serious cases. However, there are common concerns when a child, for instance, starts tripping or walking in a funny manner. This calls for the intervention of a podiatrist who can probably treat the condition.
Flat feet, though common among infants, mainly trouble their parents. If the condition is not accompanied with any pain, then common monitoring of any new development is sufficient before taking any further action. However, if there is pain that accompanies the condition, then junior formthotics, which are specifically designed for the condition, should be prescribed by a medical professional. There are several other kinds of pain that are associated with the growth of children, and thus proper evaluation of the condition needs to be undertaken before prescribing any orthotics (Orthotics for children).
From the analysis provided above, there seems to be a common belief in the effectiveness of the use of orthotics in children. Most medical professionals seem to agree on the necessity of the procedures; thus, the focus turns to the proper use of the device to ensure the maximum effectiveness. Alona Kashanian, one of the experts in the field of Cypriot podiatrists, puts emphasis on the need for continuous use of the therapy. He warns that one should not give high hopes for the recovery, as it may result in discouragement. Richard Jay, who is another expert in the same field, explains the need for continuous change of orthotics, as the treatment progresses (Feit 2012).
The use of orthotics in children is favoured by most Cypriot podiatrists. However, the emphasis is placed on the proper evaluation of the condition before the prescription. Thus, buying orthotics over the counter is discouraged, as thorough investigation of the condition needs to be undertaken.
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