Pes Planus (flat feet) is one of the most commonly recognised foot pathologies affecting people with Down syndrome (DS), attributed to the almost universally reported hypotonia and ligamentous laxity. Unlike many children, pes planus that occurs in DS is unlikely to correct itself as the child grows and can result in an increased risk of a variety of musculoskeletal disorders, structural and postural changes of the foot, skeletal dysplasias, delayed ambulation and gait instability. As a result this can be associated with delayed acquisition of motor milestones, which can result in low levels of physical activity. Despite its high prevalence, pes planus appears to be either not rated as a problem or under recognised, possibly due to having a non-standardised approach to screening, assessment or classification of its severity linked to DS specifically.
This current ongoing PhD study ultimately aims to develop a clinical screening tool specific for the lower limb and foot and establish clear clinical surveillance guidelines for pes planus in paediatric DS, which has the potentially to influence clinical care pathways for effective management of pes planus in paediatric DS.
The overall PhD study will utilise a phased approach, including mixed methodologies. Phase 1 utilised qualitative methods primarily and recruited n=10 parents/ guardians of children with Down syndrome to participate in focus group interviews to explore their knowledge and awareness of flat feet and gain an understanding of their insights of the impact of flat feet and any associated experiences of health care management of the condition.
A total of n=10 participants took part in three organised focus group interviews across two sites in Ireland. The total sample included n=9 female and n=1 male, the age ranging from 39 56 years. The age of their children with DS ranged from 5 16 years. The majority of the children (n=5) started to walk at 24-35 months. All parents identified their child as having flat feet and n=9 of the children had received treatment for the condition in the form of specialist footwear and/or orthotics, who provided that treatment varied. Initial coding of the data highlights prominent outcomes in the areas of: knowledge and impact of pes planus, orthotics and footwear, access to services, provision of information, health professionals roles, improvements required to screening and care of the foot.
Incorrect or mistimed management of pes planus can lead to children being at risk of gait abnormalities, callus formation, repetitive ligamentous injury and risks of structural damage. There is a need to have early multi-disciplinary intervention and musculoskeletal examination, early consideration of orthotics and supportive footwear in order to effectively manage pes planus in paediatric DS. With no standardised care pathways with the inclusion of foot screening and a lack of a standardised approach to treating the condition, this long term study hopes to generate a new lower limb and foot screening tool that may help guide suitable treatment and ultimately help to standardise the management of pes planus for children with Down syndrome.