Hameed Nadira, Baseer Najma, Huma Zilli, Javed Sumaira, Raza Tauseef, Sadaf Aisha
Department of Anatomy, Fazaia Ruth Pfau Medical College Faisal Base Karachi, Pakistan.
*Institute of Basic Medical Sciences Khyber Medical University Peshawar, Pakistan.
J Ayub Med Coll Abbottabad. 2020 Jul-Sep;32(3):359-367.
Flat-foot involves total collapse of medial longitudinal arch, which becomes distressful when children begin to stand on their feet. Flat foot is usually diagnosed on clinical examination, however due to lack of a standardized protocol, there are conflicting views regarding its management. The objective of this study is to determine the accuracy of radiographic and podometric measurements in diagnosing paediatric flat foot.
It was a cross sectional diagnostic accuracy study. Eighty-four children of preschool and school going age were recruited equally into control and flat foot groups. Each child was examined clinically and was further classified into having flexible or rigid flat foot. For radiographic assessment, lateral and anteroposterior foot radiographs were taken while footprints were captured using podoscope and analysed with FREESTEP software. The diagnostic accuracy and correlation among different parameters were also computed.
Clinically, of the 42 children in the flat foot group, 26 had flexible while 16 had rigid flat foot. Of these, 40 children were flat footed on one or more radiographic parameters, while 36 had podometric measurements within the flat foot range. Radiography had the sensitivity and specificity of 95% and 69%, respectively, while podometry was 86% sensitive and 47% specific. Clark's angle had highest sensitivity of 90%, with AUC of 0.952. A strong positive correlation was found between arch index and talocalcaneal angle (r=.805).
The diagnostic accuracy of radiography was more than podometry. More specific and sensitive parameters in combination with clinical assessment may prove to be useful in the management of paediatric flat foot.
扁平足涉及内侧纵弓完全塌陷，当儿童开始站立时会感到不适。扁平足通常通过临床检查进行诊断，然而，由于缺乏标准化方案，对于其治疗存在相互矛盾的观点。本研究的目的是确定X线摄影和足印测量在诊断儿童扁平足中的准确性。
这是一项横断面诊断准确性研究。84名学龄前和学龄儿童被平均招募到对照组和扁平足组。对每个儿童进行临床检查，并进一步分为柔韧性扁平足或僵硬性扁平足。对于X线摄影评估，拍摄足部的侧位和前后位X线片，同时使用足印仪采集足印并使用FREESTEP软件进行分析。还计算了不同参数之间的诊断准确性和相关性。
临床上，扁平足组的42名儿童中，26名患有柔韧性扁平足，16名患有僵硬性扁平足。其中，40名儿童在一个或多个X线摄影参数上表现为扁平足，而36名儿童的足印测量值在扁平足范围内。X线摄影的敏感性和特异性分别为95%和69%，而足印测量的敏感性为86%，特异性为47%。克拉克角的敏感性最高，为90%，曲线下面积为0.952。足弓指数与距跟角之间存在强正相关（r = 0.805）。
X线摄影的诊断准确性高于足印测量。结合临床评估，更具特异性和敏感性的参数可能对儿童扁平足的治疗有用。
