Flat feet: which children need surgery?

Research Training Fellowship*: Mr Alpesh Kothari

Estimates suggest nearly one in five children is flat footed.¹ The majority of these children find their feet cause no noticeable problems. However, some develop considerable disability. Mr Alpesh Kothari, of the University of Oxford, is looking for objective ways to predict which children will develop disability. This could help guide surgeons when deciding whether a child would benefit from an operation to recreate the arches of his or her feet.

What is the problem and who does it affect?

The most common reason why children are referred to specialist orthopaedic clinics is that they have flat feet. Essentially, this means the arches of their feet are lost when standing.

While most children with flat feet are fine, others go on to experience on-going pain and disability. "Problems can range from some pain around the foot and ankle when walking long distances, to difficulty even walking short distances," says Mr Kothari. "Children with more severe problems can find it difficult to participate in many recreational activities with their peers, which puts them at risk of feeling left out and isolated. Further down the line flat footedness can lead to other problems like foot and ankle arthritis, bunions and nerve entrapment, and may be linked with knee, hip and back problems."

Surgery to recreate the foot arch can help. However, there are risks, including infections, damage to nerves and blood vessels, problems with metalwork, recurrent deformity and stiffness.

"At the moment, surgeons have no robust way to predict which children are likely to develop disabilities and which children will be fine," says Mr Kothari. "This makes it difficult to decide whether or not a child would benefit from early surgery."

What is the project trying to achieve?

"I am investigating why flat feet lead to disability in some children and not in others," explains Mr Kothari. He is studying 100 children aged between nine and 15. Half of the children have flat feet.

Mr Kothari is assessing several things:

• the structure of the children’s feet – using MRI scans, for example
• how the children’s feet, legs and pelvis move when they are walking
• how forces are exerted through the sole of the children’s feet
• whether the children have any symptoms or disabilities that they think are related to their feet.

"I hope to establish new diagnostic guidelines that can help to predict whether a child with flat feet is likely to develop disabilities," says Mr Kothari. "I also hope to find out whether flat feet lead to problems in the knees, hips and lower back. All this information will help when deciding which children need surgery."

What are the researchers’ credentials?

"I hope to become an academic paediatric orthopaedic surgeon – helping children on a day-to-day basis in my clinical practice and improving future care through research," explains Mr Kothari. "I feel a huge sense of responsibility to use this funding wisely to make a difference to the lives of children and their families."

References

1. Craxford AD et al. Plantar pressures and gait parameters: a study of foot shape and limb rotations in children. J Pediatr Orthop 1984; 4: 477-81.

*Research Training Fellowships:

Each year, Action Medical Research awards these prestigious grants to help the brightest and best doctors and scientists develop their career in medical research.