CLINICAL BOTTOM LINE Commentary on “Foot Orthoses for Pediatric Flexible Flatfoot: Evidence and Current Practices Among Canadian Physical Therapists”
“How should I apply this information?” Physical therapists (PTs) contribute to decisions about flatfoot management as part of the child’s health care team. Children with more complex impairments related to flatfoot are often referred to PTs, heightening the need for best practice information and evidence to guide decision making about when to use foot orthoses (FOs). An evidence-informed understanding can assist clinicians in identifying those who may benefit from FOs, to avoid inappropriate intervention. Flatfoot classification is important to judge whether the foot posture is following a trajectory of an asymptomatic developmental (physiological) or of a symptomatic (painful) nondevelopmental (pathological) flatfoot. By surveying 34 PTs in Canada and discussing their responses in the context of the research literature, the authors found that objective physical examination and differentiation between developmental and pathological flatfoot can help clinicians identify suitable candidates for FOs, monitor foot posture over time, and evaluate treatment effectiveness. An evidence-informed approach to assessment and intervention is important to improve management in children with pediatric flatfoot. “What should I be mindful about when applying this information?” Physical therapists have a clear role on the health care team with respect to flatfoot assessment, determining appropriate physical therapy intervention and monitoring for changes in foot posture, function, and symptoms. Despite the lack of high-quality evidence available to guide these decisions, the variation in constructing the FOs by an orthotist or a PT, or ordering them commercially, illustrates a lack of clear consensus regarding the clinical application of FOs, also reflecting a lack of best practice information in the literature. Use of currently available best evidence-based tools to guide decisions about whether the foot is flexible or rigid, and whether it is symptomatic or asymptomatic, is recommended.
˚ Bartonek, PT, PhD Asa Karolinska Institutet Stockholm, Sweden The author declares no conflicts of interest. DOI: 10.1097/PEP.0000000000000116
60
Kane
Pediatric Physical Therapy
Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
“How should I apply this information?” Physical therapists (PTs) contribute to decisions about flatfoot management as part of the child’s health care team. Children with more complex impairments related to flatfoot are often referred to PTs, heightening the need for best practice information and evidence to guide decision making about when to use foot orthoses (FOs). An evidence-informed understanding can assist clinicians in identifying those who may benefit from FOs, to avoid inappropriate intervention. Flatfoot classification is important to judge whether the foot posture is following a trajectory of an asymptomatic developmental (physiological) or of a symptomatic (painful) nondevelopmental (pathological) flatfoot. By surveying 34 PTs in Canada and discussing their responses in the context of the research literature, the authors found that objective physical examination and differentiation between developmental and pathological flatfoot can help clinicians identify suitable candidates for FOs, monitor foot posture over time, and evaluate treatment effectiveness. An evidence-informed approach to assessment and intervention is important to improve management in children with pediatric flatfoot. “What should I be mindful about when applying this information?” Physical therapists have a clear role on the health care team with respect to flatfoot assessment, determining appropriate physical therapy intervention and monitoring for changes in foot posture, function, and symptoms. Despite the lack of high-quality evidence available to guide these decisions, the variation in constructing the FOs by an orthotist or a PT, or ordering them commercially, illustrates a lack of clear consensus regarding the clinical application of FOs, also reflecting a lack of best practice information in the literature. Use of currently available best evidence-based tools to guide decisions about whether the foot is flexible or rigid, and whether it is symptomatic or asymptomatic, is recommended.
˚ Bartonek, PT, PhD Asa Karolinska Institutet Stockholm, Sweden The author declares no conflicts of interest. DOI: 10.1097/PEP.0000000000000116
60
Kane
Pediatric Physical Therapy
Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
