Normative reference data for paediatric foot posture
Normative reference data is helpful for clinicians, as it allows comparison of an individual with a relevant group or population.
Paediatric reference values are perhaps more challenging for clinicians, as these change with growth, such that a normal finding at one age, may be abnormal at a different age.
A good example of this is encountered with coronal plane knee alignment in children, eg
Genu varum at age 18 months – normal
Genu varum at age 4 years – abnormal
Genu valgum at age 18 months – abnormal
Genu valgum at age 4 years – normal.
Paediatric foot posture has been a confused clinical encounter for too long. The recent publication of International normative data for paediatric foot posture assessment, has collated the foot posture (Foot Posture Index: FPI-6) from over 3000 healthy children (https://bmjopen.bmj.com/content/9/4/e023341).
This large study found the average FPI score across childhood to be +4, with standard deviation of +3. This means that approximately 2/3 children can be expected to have an FPI within a normal range of +1 to +7.
Further, this study refuted the relationship between heavier children and ‘flatter’ feet.
Below is a paediatric foot posture ‘Ready Reckoner’, developed from this study in effort to aid clinicians in discussions with parents, children and other medical and health professionals.
As you can see, the ‘bottom line’ from the ‘Ready Reckoner’ suggests clinicians appreciate that:
* Normal FPI across childhood = 4 (Range 1 – 7)
* Triage using ‘Three Quick Questions’ – 3QQ – pain/asymmetry/age (https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.13761)
* Consider wider diagnoses for ALERT values
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Dr Angela Evans AM PhD, FFPM RCPS(Glasg)