Plantar pressures in symptomatic and asymptomatic flexible flatfeet: how do they differ?

As radiographic and clinical parameters have not been found to consistently correlate with pain and disability in adolescents with flexible flatfoot deformities, there is no consensus as to why some flexible flatfeet become bothersome and others do not. The purpose of this study was to assess pedobarographic differences between adolescents with symptomatic flexible flatfoot (SFF) and those with asymptomatic flatfeet (AFF) deformities. A retrospective review of a Foot and Ankle registry identified 59 adolescents (64 feet) with SFF who underwent plantar pressure analysis. Normalized contact area (CA%), contact time (CT%) and mean force (MF%) were assessed for the medial/lateral hindfoot, midfoot, and forefoot regions. In those with SFF, patient-reported outcomes were evaluated with the Oxford Ankle Foot Measure (OxAFM) questionnaire. From a control group, 13 feet with medial midfoot CA% greater than 1 SD comprised the AFF group. The SFF group differed from controls and the AFF group in all variables across the foot, with an emphasis in the medial midfoot. Ten symptomatic patients went on to surgery and 54 were managed nonoperatively. No pedobarographic differences were found between the operative and nonoperative groups; however, the operative group reported significantly lower OxAFM for school and play (P = 0.030) and emotional wellbeing (P = 0.023). There is a greater medial shift in CA%, MF%, and CT% within the SFF group when compared with the AFF. Pedobarographic differences were not found between symptomatic flatfeet undergoing surgical treatment and those managed conservatively. Level of evidence is therapeutic level 3.