Molina-García Cristina, Banwell George, Rodríguez-Blanque Raquel, Sánchez-García Juan Carlos, Reinoso-Cobo Andrés, Cortés-Martín Jonathan, Ramos-Petersen Laura
Health Sciences Ph.D. Program, Universidad Católica de Murcia UCAM, Campus de Los Jerónimos n°135, Guadalupe, 30107 Murcia, Spain.
Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
Children (Basel). 2023 Feb 13;10(2):371. doi: 10.3390/children10020371.
Paediatric flexible flatfoot (PFF) is a very common condition and a common concern among parents and various healthcare professionals. There is a multitude of conservative and surgical treatments, with foot orthoses (FO) being the first line of treatment due to their lack of contraindications and because the active participation of the child is not required, although the evidence supporting them is weak. It is not clear what the effect of FO is, nor when it is advisable to recommend them. PFF, if left untreated or uncorrected, could eventually cause problems in the foot itself or adjacent structures. It was necessary to update the existing information on the efficacy of FO as a conservative treatment for the reduction in signs and symptoms in patients with PFF, to know the best type of FO and the minimum time of use and to identify the diagnostic techniques most commonly used for PFF and the definition of PFF. A systematic review was carried out in the databases PubMed, EBSCO, Web of Science, Cochrane, SCOPUS and PEDro using the following strategy: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) on child patients with PFF, compared to those treated with FO or not being treated, assessing the improvement of signs and symptoms of PFF. Studies in which subjects had neurological or systemic disease or had undergone surgery were excluded. Two of the authors independently assessed study quality. PRISMA guidelines were followed, and the systematic review was registered in PROSPERO: CRD42021240163. Of the 237 initial studies considered, 7 RCTs and CCTs published between 2017 and 2022 met the inclusion criteria, representing 679 participants with PFF aged 3-14 years. The interventions of the included studies differed in diagnostic criteria, types of FO and duration of treatment, among others. All articles conclude that FO are beneficial, although the results must be taken with caution due to the risk of bias of the included articles. There is evidence for the efficacy of FO as a treatment for PFF signs and symptoms. There is no treatment algorithm. There is no clear definition for PFF. There is no ideal type of FO, although all have in common the incorporation of a large internal longitudinal arch.
小儿柔性扁平足（PFF）是一种非常常见的病症，也是家长和各类医疗保健专业人员普遍关注的问题。治疗方法有多种，包括保守治疗和手术治疗，足部矫形器（FO）因其没有禁忌证且无需患儿积极配合，成为一线治疗手段，不过支持其疗效的证据并不充分。目前尚不清楚FO的效果如何，也不清楚何时推荐使用FO。PFF若不治疗或不矫正，最终可能会导致足部本身或相邻结构出现问题。有必要更新关于FO作为保守治疗手段减轻PFF患者体征和症状疗效的现有信息，了解最佳的FO类型和最短使用时间，并确定PFF最常用的诊断技术以及PFF的定义。我们采用以下策略在PubMed、EBSCO、Web of Science、Cochrane、SCOPUS和PEDro数据库中进行了系统评价：针对患有PFF的儿童患者开展随机对照试验（RCT）和对照临床试验（CCT），并与接受FO治疗或未接受治疗的患者进行比较，评估PFF体征和症状的改善情况。排除研究对象患有神经或系统性疾病或已接受手术的研究。两位作者独立评估研究质量。遵循PRISMA指南，并在PROSPERO中注册了该系统评价：CRD42021240163。在最初考虑的237项研究中，2017年至2022年发表的7项RCT和CCT符合纳入标准，涉及679名3至14岁的PFF患者。纳入研究的干预措施在诊断标准、FO类型和治疗持续时间等方面存在差异。所有文章均得出FO有益的结论，不过由于纳入文章存在偏倚风险，对结果需谨慎看待。有证据表明FO对治疗PFF的体征和症状有效。目前尚无治疗方案。PFF尚无明确的定义。没有理想的FO类型，不过所有FO的共同特点是都有一个较大的内侧纵弓。
