March 2013

FLAT FOOT: Arch structure in children with talipes planovalgus improves with shoe inserts

By Jordana Bieze Foster

Orthotic management of pediatric talipes planovalgus starting at an early age is associated with significant improvement in weightbearing arch structure, according to research from Saga University in Japan.

Investigators analyzed 102 children treated for talipes planovalgus starting from a mean age of 2 years 9 months. Children were given shoe inserts with arch supports, metatarsal pads, and lateral wedges ranging in height from 3 mm to 7 mm depending on the degree of valgus deformity. Parents were advised to have children wear the inserts with shoes with hard heel counters that could be firmly tied or otherwise fastened. The children were also prescribed exercises, including walking barefoot on unstable surfaces and walking on their tiptoes.

Children wore the inserts for a mean of three years, seven months. More than half (57.8%) of patients achieved a weightbearing longitudinal arch by the end of the treatment, compared to 2.9% at baseline. A similar improvement was seen with regard to the weightbearing transverse arch, improving from 2% of patients at baseline to 22.5% of patients after treatment.

Toyoko Asami, PhD, clinical professor in the department of rehabilitation medicine at Saga University who presented the group’s findings at the ISPO World Congress in Hyderabad, noted that there is still room for more improvement.

“After the orthotic treatment had been provided, more than 40% of children at an average age of six and a half still have talipes planovalgus, indicating the need for further management,” Asami said.


Asami T, Kodama K, Akiyama N, et al. Orthotic treatment using shoe inserts for talipes planovalgus in children. Presented at International Society of Prosthetics and Orthotics 2013 World Congress, Hyderabad, India, February 2013.

2 Responses to FLAT FOOT: Arch structure in children with talipes planovalgus improves with shoe inserts

  1. Klaas Postema says:

    Probably these children might have gotten the same development without any orthosis! It seems to be the normal development flatfeet in children. Based on this research the authors should not draw this conclusion.

  2. Lucy Best says:

    Yes, totally agree – it is normal for children at a young age to be flat footed and to develop an arch later.
    Why were they given lateral wedges? Normally it would be a medial wedge to correct valgus deformity.

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