![]() To ensure a standardised approach to the construction of this review, the PRISMA protocol was used. This systematic review, to the best of our knowledge, will be the first complete compilation of children’s foot posture data to date. Given the lack of consensus on what constitutes typical development of the paediatric foot the objective of this systematic review is to define the postural characteristics of the paediatric foot across the ages, and define the measures used to report the foot posture data. Currently, there is no gold standard assessment method for measuring foot posture in a clinical setting, with a broad array of measurements used. Indeed, to correctly identify abnormal foot posture and therefore manage appropriately, characteristics of “typical” foot posture must be clearly defined. This controversy may be due, in part, to concerns in identifying when a flatfoot is ‘outside of typical’ development. It is therefore understandable that the decision “to treat or not to treat” remains controversial. However, as a result of paucity in consensus, “the experienced clinician’s discretion” currently guides the decision on whether intervention into paediatric flat foot is required. ![]() A long held clinical opinion is that mature foot posture is reached between 7 and 10 years of age. In fact, no consensus could be found on what age foot postures should cease to change any further. Furthermore, whilst feet are observed to decrease in flatness with increasing age, it is not known how flat they should be at each advancing year. Whilst the child’s foot is expected to be flat, there is currently no consensus as to how flat the foot should be. The question of the paediatric flat foot markedly divides clinical opinion. It has been established that adults with flexible flat feet have a significantly increased likelihood of reporting back or lower limb pain, foot pain hallux abducto-valgus, callus, hammertoes and degenerative joint disease. Despite flat feet being a typical developmental occurrence, it is still a frequent reason for which parents seek paediatric medical opinion Parents are frequently concerned by the appearance of children’s feet and worried that their child’s future will be impacted by deformity and pain. This trend of reducing flat foot with increasing age is consistently noted within the literature. Thirdly, no firm conclusion could be reached as to which age the foot posture of children ceases to develop further, as no two foot measures are comparable, therefore future research needs to consider the development of consensus recommendations as to the measurement of the paediatric foot, using valid and reliable assessment tools.Īll typically developing children are born with flexible flat feet, progressively developing a medial longitudinal arch during the first decade of life. Secondly, the foot posture of the developing child is indeed age dependent and has been shown to change over time. ![]() Conclusionįirstly, the use of the term normal in relation to foot posture is misleading in the categorisation of the paediatric foot, as indeed a flat foot posture is a normal finding at specific ages. Sixteen different foot posture assessments were identified of which footprint based measures were the most reported outcome. Thirty four epidemiological papers pertaining to the development of the paediatric foot were graphically compared. The Epidemiological Appraisal Instrument (EAI) was used to assess the risk of bias of the included studies. The PRISMA protocol was applied to compare all data currently published describing the typical development of the paediatric foot. The objective of this systematic review is to define the postural characteristics of the ‘typically’ developing paediatric foot. Furthermore, whilst feet are observed to decrease in flatness with increasing age, it is not known how flat they should be at each age increment. Whilst the child’s foot is expected to be flat, there is currently no consensus as to how flat this foot should be. All typically developing children are born with flexible flat feet, progressively developing a medial longitudinal arch during the first decade of their lives. ![]()
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