The following guidelines should prove useful in determining when a child with a flatfoot/pes plano valgus should undergo treatment.
• Symptoms (frequent changes in activity level and function before pain develops) of any kind that are attributable to abnormal foot posture
• A non-physiologic flatfoot at any age
• Abnormal weightbearing position of the foot based on the child’s age with associated signs of abnormal foot posture such as midfoot abduction, talar deviation and frontal plane hallux deviation
• The presence of comorbidities linked to pedal compensations
• Changes in dynamic function in gait associated with flatfoot
Following these guidelines should enable clinicians to recognize the at-risk pediatric foot and offer management recommendations to parents who are often eager to improve their child’s quality of life. Parents are also eager to embrace preventative measures that will increase the likelihood of their children growing ever more active and reaching maturity with feet prepared to serve an ever increasing average life expectancy. By following the principles outlined in this article, you can help them achieve these goals.
Dr. Volpe is a Professor in the Department of Orthopedics and Pediatrics at the New York College of Podiatric Medicine. He is in private practice in New York City and Farmingdale, N.Y.