J Korean Foot Ankle Soc.  2020 Sep;24(3):113-119. 10.14193/jkfas.2020.24.3.113.

Effect of Pressure Based Customized 3-Dimensional Printing Insole in Pediatric Flexible Flat Foot Patients

• Lee SW
• Choi JH
• Kwon HJ
• Song KS

• KMID: 2506528
• DOI: http://doi.org/10.14193/jkfas.2020.24.3.113

Abstract

Purpose
A flatfoot that fails to form a longitudinal foot arch is a common lower limb deformity in children. This study evaluated the structural and functional effects of the insole for pediatric flexible flat foot (PFFF).
Materials and Methods
Twenty-nine PFFF patients (20 boys and 9 girls, 58 feet) with bilateral symptomatic flatfoot deformities between February 2017 and May 2019 were included in this study. Sixteen patients (32 cases, study group) were treated with a pressured based 3-dimensional printing insole, and 13 patients (26 cases, control group) were followed up regularly without any treatment. Flatfoot was diagnosed by a lateral talo-first metatarsal angle of more than 4° in convex downward and talocalcaneal angles of more than 30° and a calcaneal pitch of less than 20°. The foot pressures, including the midfoot pressure, total foot pressure, and the ratio of the midfoot pressure to the total foot pressure, were evaluated by pedobarography. The clinical scores were assessed using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Pediatrics Outcomes Data Collection Instrument (PODCI) scores.
Results
The mean age of the study group was 9.16 years, and the mean age of the control group was 7.73 years. The mean follow-up period was 16 months. The change in the lateral talocalcaneal angle was –4.664°±1.239° in the study group and –0.484°±1.513° in the control group. A significant difference in the amount of change of the lateral talocalcaneal angle was observed between the two groups (p=0.034). The midfoot pressures were similar in the two groups.
Conclusion
Pressure based customized 3-dimensional printing insole in PFFF may have some effect on the hindfoot bony alignment, but it does not affect the changes in midfoot pressure.

Keyword

Flexible flatfoot; Foot orthoses; 3-dimensional printing

Figure

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  Figure. 1 Radiographic parameters are shown on weight-bearing lateral radiograph. a: talo-first metatarsal angle, b: talocalcaneal angle, c: calcaneal pitch angle.

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  Figure. 2 Pedobarographic result. (A) Ten anatomical zones. (B) Graph shows the ten anatomical zones analysis of the dynamic recording.

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  Figure. 3 Three-dimensional printing insole.

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  Figure. 4 Initial (A) and last follow-up (B) radiograph. Radiographic parameters were improved in last follow-up radiograph. But all values were still within the abnormal range.

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