Kosashvili Yona, Fridman Tali, Backstein David, Safir Oleg, Bar Ziv Yaron
Division of Orthopedics, Assaf Harofeh Medical Center, Israel.
Foot Ankle Int. 2008 Sep;29(9):910-3. doi: 10.3113/FAI.2008.0910.
Anterior knee pain and intermittent low back pain are among the most common orthopedic complaints of adolescents. However, little is known about pes planus and its relative risk for these symptoms. The goal of the study was to track the prevalence of pes planus in adolescents, and examine its associated risk to anterior knee pain and intermittent low back pain, respectively.
A retrospective study of 97,279 military recruits presenting to recruitment centers was conducted. Pes planus was graded by an orthopedist as mild, moderate or severe according to the flattening of the plantar arch and its rigidity to standing on one's toes. Anterior knee pain was diagnosed when symptoms were attributed to the patellofemoral joint. Intermittent low back pain was diagnosed when there was pain but neither abnormal clinical nor radiographic findings.
Pes planus was present in 15,698 (16%) individuals. 11,549 (74%), 3,341 (21%) and 808 (5%) were diagnosed as having mild, moderate and severe pes planus, respectively. The prevalence of intermittent low back pain was 5% in both the control and mild pes planus groups, while it was 10% in the moderate and severe pes planus groups (p < 0.0001). The prevalence of anterior knee pain was 4% in both the control and mild pes planus groups, while it was 7% in the moderate and severe pes planus groups (p < 0.0001).
Moderate and severe pes planus was associated with nearly double the rate of anterior knee pain and intermittent low back pain, while mild pes planus was associated with no higher rate for these problems. Prophylactic measures may be helpful only in those adolescents with moderate and severe pes planus.
膝前疼痛和间歇性下背痛是青少年最常见的骨科病症。然而，对于扁平足及其引发这些症状的相对风险却知之甚少。本研究的目的是追踪青少年扁平足的患病率，并分别研究其与膝前疼痛和间歇性下背痛的相关风险。
对前往征兵中心的97279名新兵进行了一项回顾性研究。骨科医生根据足弓扁平程度及其踮脚尖站立时的僵硬程度将扁平足分为轻度、中度或重度。当症状归因于髌股关节时诊断为膝前疼痛。当存在疼痛但临床及影像学检查均无异常发现时诊断为间歇性下背痛。
15698人（16%）存在扁平足。其中，11549人（74%）、3341人（21%）和808人（5%）分别被诊断为轻度、中度和重度扁平足。对照组和轻度扁平足组中间歇性下背痛的患病率均为5%，而中度和重度扁平足组中该患病率为10%（p<0.0001）。对照组和轻度扁平足组中膝前疼痛的患病率均为4%，而中度和重度扁平足组中该患病率为7%（p<0.0001）。
中度和重度扁平足与膝前疼痛和间歇性下背痛的发生率几乎翻倍相关，而轻度扁平足与这些问题的发生率升高无关。预防措施可能仅对那些患有中度和重度扁平足的青少年有帮助。
