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Title: The evaluation of flexible flat feet in children aged eight to fifteen years old
Author: Kothari, Alpesh
ISNI:       0000 0004 6346 3985
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2015
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Paediatric flexible flat feet (PFF) are a very common presentation, but considerable debate continues about its aetiology, diagnosis and management. In this thesis a cohort of children with PFF (n=48) and neutral feet (NF)(n=47) have been investigated to test the theory that flat foot posture is related to the presence of symptoms and biomechanical dysfunction. Aetiological and clinical factors that may result in functional impairments have also been investigated. The ultimate aim of this thesis was to better define treatment indications for PFF. Firstly the question of what defines PFF was addressed and appropriate categorical and continuous measures of foot posture were proposed. Subsequently the clinical importance of foot posture was contextualized by demonstrating that children with PFF had significant impairment of health-related quality of life (HRQOL) compared to NF children. Investigation into the aetiology of PFF demonstrated that an absent anterior articulation of the subtalar joint, increased lower limb flexibility and knee valgus were factors associated with this condition. Inabilities to perform a single heel raise and to attain plantigrade were found to be sensitive tests to identify children with more symptomatic PFF. Differences in navicular motion of PFF compared to NF children were noted, hinting at midfoot dysfunction, and formal gait analysis demonstrated a number of deviations in gait parameters associated with a flat foot posture. Of these, walking speed and increased forefoot supination were related to impaired HRQOL. There was also evidence of potential instability in the PFF children, and foot ankle joint moments in this group were suggestive of impaired transition of the foot from a supple compliant structure to a rigid lever during stance. Whilst children with PFF were more likely to have proximal joint symptoms, kinematic and kinetic analysis did not identify the mechanism by which this could occur. The findings of this thesis have been utilized to define an evidence-based algorithm for the treatment of PFF.
Supervisor: Theologis, Tim ; Zavatsky, Amy Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available