Saratov JOURNAL of Medical and Scientific Research

Significance of estimation criteria in pediatric flatfoot

Year: 2020, volume 16 Issue: №4 Pages: 905-911
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Sertakova A.V., Rubashkin S.A., Timaev M.Kh., Dokhov M.M., Korshunova G.A., Zvereva K.P., Agafonova N.Yu.
Organization: Saratov State Medical University

Objective: to analyze a set of versatile criteria for assessing flatfoot in children and identify the most significant for flatfoot diagnosis. Material and Methods. We conducted a cross sectional study that involved 150 patients with flatfoot diagnosis (mean age 9.5 ±0.8 у. o.) and 50 patients with neutral feet (mean age 10.1 ±1.3 у. o.). The examination of the children suggested a set of methods including the clinical one, quality-of-life questionnaire survey, X-ray and computed tomography, biomechanical and electroneuromyography (ENMG) methods. The findings of the conventional diagnostic tests underwent clustering and mathematical simulation. Results. The statistically significant X-ray indicators for flatfoot diagnosis are: astragalus horizontal angle (p<0.001), longitudinal arch angle (p=0.038), arch height (p=0.053). The valid biomechanical indicators are the foot transfer time (p=0.044) and the support time (p=0.042) as the temporal characteristics of the gait. Electroneuromyography detected significant changes in the M-response and F-waves as well as F/M ratio with the calf muscle. In most cases, high-amplitude M-responses (13.4±1.6 mV, 7.7±0.8 mV in health) and F-waves (1603±235.4 mV, 360±115 mV in health) were registered from the calf muscles, exceeding the data in healthy children 5 times. 8 statistically significant indicators of 18 X-ray and 13 biomechanical criteria were assigned; they provide 77.3% of the correct diagnosis when used for the mathematical model. Conclusion. We established the most sensitive and statistically significant criteria for the flatfoot diagnosis in children. They enable the assessment of the changes severity in flatfoot and designing the medical decision making support system for choosing the proper treatment method when these criteria are used for the data base and the artificial intelligence predicative model.

1. Costa FP, Costa G, Carvalho MS, et al. Long-term outcomes of the calcaneo-stop procedure in the treatment of flexible flatfoot in children: a retrospective study. Acta Med Port 2017; 30 (7-8): 541-5. DOI: 10.20344/amp. 8137.
2. Fyodorov MA. The current state of surgical treatment of planovalgus feet deformity in children. Issues of Reconstructive and Plastic Surgery 2016; 3 (58): 26-35.
3. Sheikh AM, Feldman DS. Painful Flexible Flatfoot. Foot Ankle Clin 2015; 20 (4): 693-704. DOI: 10.1016/j. fcl. 2015.07.011.
4. Dare DM, Dodwell ER. Pediatric flatfoot: cause, epidemiology, assessment, and treatment. Current Opinion in Pediatrics 2014; 26 (1): 93-100. DOI: 10.1097/MOP 0000000000000039.
5. Timaev MKh, Sertakova AV, Kurkin SA, et al. The flatfoot of children age: actual state of problem. Russian Medical Journal 2017; 23 (3): 165-8.
6. Hosl М, Bohm Н, Multerer С, et al. Does excessive flatfoot deformity affect function? A comparison between symptomatic and asymptomatic flatfeet using the oxford foot model. Gait Posture 2014; 39 (1): 23-8. DOI: 10.1016/j. gaitpost. 2013.05.017.
7. Mosca VS. Flexible flatfoot in children and adolescents. J Child Orthop 2010; 4 (2): 107-21. DOI: 10.1007/sl 1832-010-0239-9.
8. Atik A, Ozyurek S. Flexible flatfoot. North Clin Istanbul 2014; 1 (1): 57-64. DOI: 10.14744/nci. 2014.2929.
9. Kerr CM, Zavatsky AB, Theologis T, et al. Kinematic differences between neutral and flat feet with and without symptoms as measured by the Oxford foot model. Gait & Posture 2019; (67): 213-8. DOI: 10.1016/j. gaitpost. 2018.10.015.
10. Twomey DM, Mclntosh AS. The effects of low arched feet on lower limb gait kinematics in children. Foot 2012; 22 (2): 60-5. DOI: 10.1016/j. foot. 2011.11.005.
11. Kerr CM, Stebbins J, Theologis T, et al. Static postural differences between neutral and flat feet in children with and without symptoms. Clin. Biomech 2015; 30 (3): 314-7. DOI: 10.1016/j. clinbiomech. 2015.02.007.
12. Kothari A, Dixon PC, Stebbins J, et al. The relationship between quality of life and foot function in children with flexible flatfeet. Gait Posture 2015; 41 (3): 786-90. DOI: 10.1016/j. gaitpost. 2015.02.012.
13. Damayanti Y, Hadisoemarto PF, Defi IR. Flatfoot decreases school functioning among children < 11 years of age. Univ Med 2018; 37 (1): 50-6. DOI: 10.18051/UnivMed. 2018. V37.50-56.
14. Kothari A, Stebbins J, Zavatsky AB, et al. Health-related quality of life in children with flexible flatfeet: A cross-sectional study. J Child Orthop 2014; (8): 489-96.
15. Wilson JMM. Synopsis of causation: pes planus. UK: Ministry of Defence, 2008; 14 p.
16. Gonzalez-Martin C, Pita-Fernandez S, Pertega-Diaz S. Quality of life and functionality in patients with flatfoot. In: Badekas Th., ed. Update in Management of Foot and Ankle Disorders. London: Intech Open, 2018; 73-90.
17. Kuslik Ml. To the accurate method of flat feet degree determining. New surgery 1925; (2): 66-7.
18. Bourdet С, Seringe R, Adamsbaum С, et al. Flatfoot in children and adolescents Analysis of imaging findings and therapeutic implications. Orthop Traumatol Surg Res 2013; 99 (1): 80-7. DOI: 10.1016/j. otsr. 2012.10.008.
19. Butterworth ML, Marcoux JT (Eds). The Pediatric Foot and Ankle. Cham ZG: Springer Nature Switzerland AG, 2020; 289 p.
20. Vanderwilde R, Staheli LT, ChewDE,etal. Measurements on radiographs of the foot in normal infants and children. J Bone Joint Surg (Am) 1988; 70 (3): 407-15.

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