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== Search Strategy  ==
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Revision as of 15:59, 14 June 2013

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

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Search Strategy[edit | edit source]

1. SEARCH STRATEGY ARTICLES


Keywords:

  • Pes valgus physiotherapy (10 results and 3 free full texts): Most successful search
  • Pes valgus (75 results and 4 free full texts) (Elsevier Sciencedirect)
  • Pes planovalgus (23 results and 2 free full texts) (ADB Vubis)
  • Flatfeet children (2 results and 1 free full text) (Elsevier Sciencedirect)


Search engines : Pubmed / Web of knowledge


2. SEARCH STRATEGY BOOKS


Keywords:
• Examination peadiatric foot posture


Via Google Books: Clinical Pediatric Orthopedics

Introduction[edit | edit source]

This text describes pes valgus in children. It is a problem commonly encountered in pediatric orthopedics and is generally considered as caused by the collapse of the medial longitudinal arch in the foot. It was found that 42% of children between 3 and 6 years witch normal weight develop pes valgus. Age, gender, obesity, cerebral palsy, syndrome of Down, … are known risk factors for the development of growth and musculoskeletal changes. Almost 20% of the adult population has pes valgus.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Cause[edit | edit source]

The medial longitudinal arch of the foot normally develops by the age of 5 or 6 as the fat pad in babies is gradually absorbed and balance improves as skilled movements are acquired. In some children however, the arch fails to develop which may be a result of tightness in the calf muscles, laxity in the Achilles tendon or poor core stability in other areas such as around the hips. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title  Over time it may lead to an altered walking pattern, clumsiness, limping after long walks, and pain in the foot, knees or hips. Beside the aforementioned causes for pes valgus, tarsal coalitions, peroneal spasm and vertical talus are common aetiologies during the childhood. It is therefore important that appropriate treatment starts at an early age. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Classification [edit | edit source]

The classification of the pes valgus is based on three aspects.
• Arch height[1], [2]
The best parameter to characterize medial longitudinal arch structure was found to be a ratio of navicular height to foot length. It is accepted that the flatness of normal children’s feet and their age are inversely proportioned.
• Heel eversion angle [3], [4]
Heel eversion or hindfoot valgus is generally accepted as a normal finding in young, newly walking children and is expected to reduce with age. The eversion of the heel has been repeatedly used for determining the posture of the child’s foot.
Resting calcaneal stance position is a more recent method. It has guided clinicians in assessment of the child’s foot posture and calcaneal eversion has been suggested to reduce by a degree every 12 months to a vertical position by age 7 years. A vertical heel is optimal for foot function. The average rear foot angle for children from 6 to16 years is 4° (raging from 0 to 9° valgus).
• Whether the flat foot structure is rigid or flexible (cf. Jack’s test [5])
Rigid pes valgus, also called congenital pes planovalgus (convex) [6], is often a result of tarsal coalition, which is typically characterized as a painful unilateral or bilateral deformity.
In flexible pas valgus, also called congenital pes cancaneovalgus [7], the foot lies against the lower leg, or can be extended without resistance until it impinges against the leg. In contrast to the congenital pes planovalgus, the foot can be restored to a normal position without great resistance. Plantar flexion is occasionally is reduced.


Observation and the development of clinical measures [edit | edit source]

• Footprints  [8]
It is still controversial if footprints reflect the real morphology of the medial longitudinal arch. Recent development found an initial correlation between dynamic pressure patterns and static foot-prints.
• X-rays [9] ,  [10]
X-rays are used to categorize the feet as having normal, slightly flat and moderate arches.
• Foot-posture index (FPI-6)  [11]
It is based on six specific criteria:
1. Talar head palpation
2. Curves above and below lateral malleolus
3. Inversion/eversion of the calcaneus
4. Bulge in the region of the talonavicular joint (TNJ)
5. Congruence of medial longitudinal arch
6. Abduction/adduction of the forefoot en rear foot

• Supination resistance test [12], [13]
This test is used to estimate the magnitude of pronatory moments. The foot is manually supinated. The higher the force required, the greater the supination resistance and the stronger the pronatory forces. This test is subjective.
• Jack’s test and Feiss angle (are related)[14]
Performing the Jack’s test. The hallux is manually dorsiflexed while the child is standing. If the medial longitudinal arch rises due to dorsiflexion of the hallux, the foot is considered a flexible flat foot. If the medial longitudinal arch remains unchanged, the test designates a rigid flat foot. The pupose of this test is to check the foot flexibility and the onset of the windlass mechanism by tensioning the plantar fascia trough the extension of the first metatarsophalangeal joint. The Feiss line is the line interconnecting malleolus medialis, navicular and first metatarsal head. The inclination of this line with the ground increases when the first metatarsophalangeal joint is dorsiflexed (Jack’s test). This dorsiflexion activates forefoot supination and raises the arch height (140°± 6°).
• Ankle range [15], [16]
Children’s ankle range assessment is generally an unreliable measure, as typically assessed when the child is non-weight-bearing.
So it is suggested that therapists look at a child’s ability to squat, heel walk and increase stride length.[17]



Considerations and treatment[edit | edit source]

In some rare cases of pes planovalgus deformity, surgical intervention (arthrodesis) is necessary.[18], [19]
But generally the physiotherapeutic options for the very flat child’s foot may include:
• Advice on appropriate footwear Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, [20]
• Advice on appropriate insoles to improve foot position and referral to an podiatrist and an orthotist: in-shoe wedging, foot splints, night stretch splints and cast orthoses. The primary action splint therapy is aimed at stabilizing the rear foot and midfoot but not blocking the forefoot. Age-expected foot position, stance and gait are dynamic considerations and need to be well understood.[21]
• Reducing pain and risk of secondary joint problems [22] , [23], [24]
• Providing advice on exercise to help stretch tight muscles and strengthen weak areas to aid development of correct foot posture. [25]


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References[edit | edit source]

see adding references tutorial.

  1. ↑ 1. K.C. Chen, C.J. Yeh, Li-Chen Tung, J.F. Yang, S.F. Yang, C.H. Wang – Relevant factors influencing flatfoot in preschool-aged children - Springer – 2010  A2
  2. ↑ 5. H. Wetzenstein – The significance of congenital pes calcaneo-valgus in the origin of pes planovolgus in childhood – Orthopaedic department in Jönköping  B
  3. ↑ 3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010  A1
  4. ↑ 8. G.K. Rose, E.A. Welton, T. Marshall – The diagnosis of flat foot in the child – Britih Editorial Society of Bone and Joint Surgery – 1985  A2
  5. ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010  A1
  6. ↑ 4. H. Wetzenstein – Pes plano-valgus in childhood – Orthopaedic department in Jönköping  B
  7. ↑ 5. H. Wetzenstein – The significance of congenital pes calcaneo-valgus in the origin of pes planovolgus in childhood – Orthopaedic department in Jönköping  B
  8. ↑ 3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010  A1
  9. ↑ 3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010  A1
  10. ↑ 8. G.K. Rose, E.A. Welton, T. Marshall – The diagnosis of flat foot in the child – Britih Editorial Society of Bone and Joint Surgery – 1985  A2
  11. ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010  A1
  12. ↑ 3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010  A1
  13. ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010  A1
  14. ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010  A1
  15. ↑ 3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010  A1
  16. ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010  A1
  17. ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010  A1
  18. ↑ 2. C.A. Turriago, M. F. Arbela´ez, L.C. Becerra - Talonavicular joint arthrodesis for the treatment of pes planus valgus in older children and adolescents with cerebral palsy – Epos – 2009  A2
  19. ↑ 3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010  A1
  20. ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010  A1
  21. ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010  A1
  22. ↑ 1. K.C. Chen, C.J. Yeh, Li-Chen Tung, J.F. Yang, S.F. Yang, C.H. Wang – Relevant factors influencing flatfoot in preschool-aged children - Springer – 2010  A2
  23. ↑ 3. A. D. Cass, C.A. Camasta - Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning – The Journal of Foot and Ankle Surgery – 2010  A1
  24. ↑ 6. D.J. Oeffinger, R. W. Pectol Jr., C. M. Tylkowski - Foot pressure and radiographic outcome measures of lateral column lengthening for pes planovalgus deformity – Springer – 2009  A2
  25. ↑ 7. Pediatrics – Angela Evans and Ian Mathieson – Elsevier – 2010  A1


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