SLR - September 2020 - Rekha N. Kouri

Factors Affecting Subjective Symptoms in Children with Pes Planovalgus Deformity

Reference: Jae Jung Min, Soon-Sun Kwon, Ki Hyuk Sung, Kyoung Min Lee, Chin Youb Chung, and Moon Seok Park. Factors Affecting Subjective Symptoms in Children with Pes Planovalgus Deformity J Bone Joint Surg Am. 2020 Jun 23; 00:1-7

Scientific Literature Review

Reviewed By: Rekha N. Kouri, DPM 
Residency Program: SSM Health DePaul – Bridgeton, MO 

Podiatric Relevance: One of the most common foot deformities in children and adolescents is idiopathic pes planovalgus. The patients we usually see under this condition present with a wide range in severity of the symptoms beginning from asymptomatic to highly disabling. Previous studies have looked into the relationship between skeletal maturity and radiographic improvement of pes planovalgus, however no studies have investigated the correlation between radiographic severity and symptomatic presentation in patients with idiopathic planovalgus deformity. Therefore, this study looks at the radiographic severity and the factors affecting symptoms of idiopathic planovalgus using the Oxford Ankle Foot Questionnaire (OxAFQ). 

Methods: This was a level IV retrospective study that screened all patients less than or equal to 18 years of age and had a chief symptom of pes planovalgus, and completed the OxAFQ from June to August of 2019 at their clinic. Their exclusion criteria was patients with inadequate radiographs or children with other general conditions affecting the foot. For radiographic indices to be measured, they found anteroposterior talo-first metatarsal, lateral talo-first metatarsal, and hallux valgus angles to have excellent reliability and validity and the most feasible to use for this study. The data were analyzed using a multiple regression model, with age, sex and radiographic indices as explanatory variables.

Results: Overall, 161 patients were screened and 123 patients were selected after the implementation of inclusion and exclusion criteria. The OxAFQ are composed of  four domains: physical, school and play, emotional and footwear. Results showed there to be a significant correlation between physical domain and anteroposterior talo-first angle (p=0.033) as well as female sex (p=0.047). All the other domains (school and play, emotional and footwear) were significantly affected by the age of greater 10 years (p<0.05).  

Conclusions: The study assessed the relationship between radiographic severity and symptomatic presentation in patients with idiopathic planovalgus deformity using the OxAFQ scores. The factors affecting the OxAFQ scores include age greater than or equal to 10 years, female sex and the anteroposterior talo-first metatarsal angle. The anterior talo-first metatarsal angle is a significant influencer of physical demand scores in children and therefore the externally rotated forefoot may lead to dysfunction and may be the most important component causing physical symptoms of planovalgus deformity. Even though the study provided a good correlation, it had some limitations, these include but not limited to the inability of OxAFQ to assess laterality. Therefore, patients with bilateral pes planovalgus  had to assume the analysis was only performed on the more severely affected side. Also, their subject selection was limited to their clinic data and therefore does not reflect the entire population of people with pes planovalgus. Overall, the key takeaways from this study is that the forefoot abduction component of the deformity should be carefully assessed as it is more closely associated with subjective symptoms. Also, female patients with a more severe anteroposterior talo-first metatarsal angle and an aggravation of symptoms with aging should be expected when managing pes planovalgus deformity. 

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