Department of Orthopedic Surgery, Soon Chun Hyang University Seoul Hospital, Seoul, South Korea.
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul, South Korea.
Medicine (Baltimore). 2021 Aug 13;100(32):e26894. doi: 10.1097/MD.0000000000026894.
Idiopathic flatfoot is common in infants and children, and patients with this condition are frequently referred to pediatric orthopedic clinics. Flatfoot is a physiologic process, and that the arch of the foot elevates spontaneously in most children during the first decade of life. To achieve a consensus as the rate of spontaneous improvement of flatfoot, the present study aimed to estimate the rate of spontaneous improvement of flatfoot and to analyze correlating factors.We reviewed the records of patients examined between May 2013 and May 2019 so as to identify those factors associated with idiopathic flatfoot below 12 years of age. We included patients with who had been followed for >6 months, and those for whom ≥2 (anteroposterior and lateral) weight-bearing bilateral radiographs of the foot had been obtained. The progression rates of the anteroposterior (AP) talo-first metatarsal angle, talonavicular coverage angle, lateral talo-first metatarsal angle, and calcaneal pitch angle were adjusted by multiple factors using a linear mixed model, with sex, body mass index, and Achilles tendon contracture as the fixed effects and age and each subject as the random effects.We found that 4 of the radiographic measurements improved as patients grew older. The AP talo-first metatarsal angle, talonavicular coverage angle, and the lateral talo-first metatarsal angle decreased, while the calcaneal pitch angle increased. The AP talo-first metatarsal angle (P < .001), talonavicular coverage angle (P < .001), and lateral talo-first metatarsal angle (P < .001) improved significantly; however, the calcaneal pitch angle (P = .367) did not show any significant difference. In general, the flatfeet showed an improving trend; after analyzing the factors, no sex difference was observed (P = .117), while body mass index (P < .001) and Achilles tendon contracture (P < .001) showed a negative correlation.The study demonstrated that children's flatfeet spontaneously improved at the age of 12 years. It would be more beneficial if the clinician shows the predicted appearance of the foot at the completion of growth by calculating the radiographic indices and identifying the correlating factors in addition to explaining that flatfoot may gradually improve. This will prevent unnecessary medical expenses and the psychological adverse effects to the children caused by unnecessary treatment.
特发性扁平足在婴儿和儿童中很常见，患有这种疾病的患者经常被转介到儿科矫形诊所。扁平足是一种生理过程，在大多数儿童的生命的第一个十年中，足弓会自发地升高。为了就扁平足的自发改善率达成共识，本研究旨在估计扁平足的自发改善率，并分析相关因素。我们回顾了 2013 年 5 月至 2019 年 5 月期间检查的患者记录，以确定与 12 岁以下特发性扁平足相关的因素。我们纳入了随访时间超过 6 个月的患者，以及至少拍摄了 2 次（前后位和侧位）负重双侧足部 X 线片的患者。使用线性混合模型，通过性别、体重指数和跟腱挛缩作为固定效应，年龄和每个受试者作为随机效应，对前后位（AP）距骨第一跖骨角、距舟覆盖角、外侧距骨第一跖骨角和跟骨倾斜角的进展率进行了多重因素调整。我们发现，随着患者年龄的增长，有 4 项影像学测量结果得到了改善。AP 距骨第一跖骨角、距舟覆盖角和外侧距骨第一跖骨角减小，而跟骨倾斜角增加。AP 距骨第一跖骨角（P<0.001）、距舟覆盖角（P<0.001）和外侧距骨第一跖骨角（P<0.001）显著改善；然而，跟骨倾斜角（P=0.367）没有显示出任何显著差异。总的来说，扁平足有改善的趋势；在分析了这些因素后，没有发现性别差异（P=0.117），而体重指数（P<0.001）和跟腱挛缩（P<0.001）呈负相关。该研究表明，儿童的扁平足在 12 岁时会自发改善。如果临床医生通过计算影像学指标并确定相关因素，除了解释扁平足可能会逐渐改善外，还能展示生长完成时足部的预期外观，这将更有益。这将防止不必要的医疗费用和不必要的治疗对儿童造成的心理不良影响。
