Flexible flat feet in children: A real problem?

Objectives To estimate the prevalence of flexible flat feet in the provinci al population of 4- to 13-year-old schoolchildren and the incidence of trea tments considered unnecessary. Setting. Province of Malaga, Spain. Methods. We examined and graded by severity a sample of 1181 pupils taken f rom a total population of 198 858 primary schoolchildren (CI: 95%; margin o f error: 5%). The sample group was separated into three a-year age groups: 4 and 5 years, 8 and 9 years, and 12 and 13 years. The plantar footprint wa s classified according to Denis(1) into three grades of flat feet: grade I in which support of the lateral edge of the foot is half that of the metata rsal support; grade 2 in which the support of the central zone and forefoot are equal; and grade 3 in which the support in the central zone of the foo t is greater than the width of the metatarsal support. The statistical analysis for the evaluation of the differences between the groups was performed with Student's t and chi(2) tests as appropriate. Results. The prevalence of flat feet was 2.7%. Of the 1181 children sampled , 168 children (14.2%) were receiving orthopedic treatment, but only 2.7% h ad diagnostic criteria of flat feet. When we inspected the sample, we found that a number of children were being treated for flat feet with boots and arch supports. Most of them did not have a flat plantar footprint according to the criteria that we used for this work. Furthermore, in the group of c hildren that we diagnosed as having flat feet, only 28.1% were being treate d. We found no significant differences between the number of children recei ving orthopedic treatments and the presence or absence of a fiat plantar fo otprint. Children who were overweight in the 4- and 5-year-old group showed an increased prevalence for flat feet as diagnosed by us. Conclusion. The data suggest that an excessive number of orthopedic treatme nts had been prescribed in the province. When extrapolated to the 1997 popu lation of schoolchildren within the age groups studied the figures suggeste d that similar to 28 167 children in Malaga province probably would have be en receiving orthopedic treatments with boots and insoles at the time of ou r study. Consequently, the total expenditure on orthopedic boots and insole s that year could be estimated as 676 008 000 pesetas ($4 447 422 in US cur rency).