Non-surgical interventions for paediatric pes planu [Intervention Review]
Rome, K; Ashford, RL; Evans, A
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BACKGROUND: Paediatric pes planus ('flat feet') is a common childhood condition with a reported prevalence of 14%. Flat feet can result in pain and altered gait. No optimal strategy for non-surgical management of paediatric flat feet has been identified. OBJECTIVES: To assess the effectiveness of non-surgical interventions for treatment of paediatric pes planus (flat feet). SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, Index to Theses, and Dissertation Abstracts (up to June 2009). SELECTION CRITERIA: All randomised and quasi-randomised trials of non-surgical interventions for paediatric pes planus were identified. The primary outcomes were pain reduction and adverse events; secondary outcomes included disability involving the foot, goniometric measurements, quality of life and patient comfort. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed the risk of bias of included trials. MAIN RESULTS: Three trials involving 305 children were included in this review. Due to clinical heterogeneity, data were not pooled. All trials had potential for bias. Data from one trial (40 children with juvenile arthritis and foot pain) indicated that use of custom-made orthoses compared with supportive shoes alone resulted in significantly greater reduction in pain intensity (mean difference (MD) -1.5 points on a 10-point visual analogue scale (VAS), 95% CI -2.8 to -0.2; number need to treat to benefit (NNTB) 3, 95% CI 2 to 23), and reduction in disability (measured using the disability subscale of the Foot Function Index on a 100mm scale (MD -18.65mm, 95% CI -34.42 to -2.68mm). The second trial of seven to 11 year old children with bilateral flat feet (n = 178) found no difference in the number of participants with foot pain between custom-made orthoses, prefabricated orthoses and the control group who received no treatment. A third trial of one to five year olds with bilateral flat feet (n=129) did not report pain at baseline but reported the subjective impression of pain reduction after wearing shoes. No adverse effects were reported in the three trials. AUTHORS' CONCLUSIONS: The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of non-surgical interventions for paediatric pes planus. Future high quality trials are warranted in this field. Only limited interventions commonly used in practice have been studied and there is much debate over the treatment of symptomatic and asymptomatic pes planus NON-SURGICAL INTERVENTIONS FOR FLAT FEET IN CHILDREN: This summary of a Cochrane review presents what we know from research about the effect of non-surgical treatments for pes planus (flat feet) in children.The review shows that in children with flat feet and juvenile idiopathic arthritis, custom foot orthoses:-may improve pain and function slightly-harms and side effects were not measuredWe often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. What are flat feet and what are non-surgical treatments?Children with flat feet, also called pes planus, do not have a normal arch. It means that when the child is standing, the whole foot touches the ground. Sometimes, this condition can cause pain, or change the way a child walks.There are many types of non-surgical treatments for the pain and disability caused by flat feet such as foot orthoses (shoe inserts), stretching, footwear selection and modifications, activity modifications, manipulation, applying a series of casts, losing weight (if appropriate) and medication for pain and inflammation.This review found information mainly on custom foot orthoses or shoe inserts. A custom foot orthosis is a medical device that is made from a custom mould of the child's foot, prescribed by a qualified health-care professional and which is designed by that professional to allow more normal foot and leg function and to decrease the pressure on parts of the foot that might be causing pain.Best estimate of what happens to children with flat feet: Pain:-children who used a custom-made foot orthoses in their shoes rated their pain to be 1.5 on a scale of 0-10;-children who wore their shoes only rated their pain to be 3 on a scale of 0-100;-children who used a custom-made foot orthoses in their shoes rated their pain to be 1.5 points better (Absolute improvement: 15%).Physical Function:-children who used a custom-made foot orthoses in their shoes rated their disability level to be 15 on a scale of 0-100;-children who wore their shoes rated their disability to be 34 on a scale of 0-100;-children who used a custom-made foot orthoses in their shoes rated their disability to be 19 points better (Absolute improvement: 19%).