Management of spasmodic flatfoot deformities in children and adolescents using dedicated physical therapy program. A prospective case series and early functional outcomes

Abstract

Objectives

To report our early results (functional outcomes and incidence of relapses) after applying a specified physical therapy program to pediatric and adolescent patients with spasmodic flat foot deformity (SFFD).

Methods

A prospective case series was conducted between January 2021 and December 2022 at a specialized foot and ankle surgery unit in cooperation with a specialized orthopedic physiotherapy unit. Thirty-one patients presenting with SFFD were included. The physical therapy program was formed of three supervised sessions weekly for six weeks and was based on the kinetic chain principle. It included Gastrocnemius-Soleus complex stretching and strengthening, Tibialis posterior strengthening (closed kinetic chain ROM exercises), eccentric dorsiflexors active free exercises, Ankle dorsiflexion combined with inversion ROM exercises, and for proximal stability, open and closed hip abduction exercises.

Results

After a mean follow up of 13.42 ± 5.18 months, 29 patients (39 feet) were available for assessment. Their mean age was 15.26 ± 2.83 (8 to 18) years. 10 (34.5%) had bilateral and 19 (65.5%) unilateral SFFD, and 23 (79.3%) were males. According to AOFAS, the functional outcomes improved significantly from a preintervention score of 43.80 ± 10.2 to a postintervention score of 88.65 ± 9.5, P < 0.005. Relapse occurred in four (10.3%) feet after a mean follow up of 6.2 ± 1.79 months. 25 (86.2%) patients were satisfied with the results and were willing to go through the protocol again.

Conclusion

We achieved acceptable functional and patient satisfaction outcomes after applying a detailed physical therapy program for managing pediatric or adolescent patients presented with SFFD. For the successful application of such a program, proper diagnosis should be reached first, then cooperation between the orthopedic surgeon, physical therapist, and the patient is paramount. The physical therapy program we proposed could help postpone the surgical intervention; however, longer follow up and better-designed studies are mandatory.