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. 2009 Aug 19:2:25.
doi: 10.1186/1757-1146-2-25.

The paediatric flat foot proforma (p-FFP): improved and abridged following a reproducibility study

Angela Margaret Evans  1 , Hollie Nicholson, Noami Zakarias
Affiliations

The paediatric flat foot proforma (p-FFP): improved and abridged following a reproducibility study

Angela Margaret Evans et al. J Foot Ankle Res. .

Abstract

Background: Concern about a child's flat foot posture is a common reason for frequent clinical consultations for an array of health care and medical professionals. The recently developed paediatric flatfoot clinical-care pathway (FFP) has provided an evidence based approach to diagnosis and management. The intra and inter-rater/measurer reliability of the FFP has been investigated in this study.

Methods: From a study population of 140 children aged seven to 10 years, a sample with flat feet was identified by screening with the Foot posture index (FPI-6). Subjects who scored >/= 6 on the FPI-6 for both feet became the study's flat foot sample. A same subject, repeated measure research design was used for this study which examined the reliability of the FFP in 31 children aged seven to 10 years, as rated by three examiners.

Results: Approximately half of the items of the FFP showed less-than-desirable inter-rater reliability, arbitrarily set at the conventional 0.7 level (intra-class correlations). Removal of the unreliable items has produced a shorter; more relevant instrument designated the paediatric flat foot proforma (p-FFP).

Conclusion: The p-FFP is a reliable instrument for the assessment and resulting treatment actions for children with flat feet. Findings indicate that the simplified p-FFP is a reproducible instrument for the clinical assessment of flat foot in mid-childhood.

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Figures

Figure 1
Figure 1
The paediatric flatfoot clinical-care pathway (FFP), as used in this reliability study.
Figure 2
Figure 2
Foot posture histograms. The FPI-6 total scores for both left and right feet of the study population (N = 140), children aged seven to 10 years. For both feet the total FPI-6 scores approximated 4, indicative of a 'pronated' status as a regular finding for foot posture in this age cohort.
Figure 3
Figure 3
The paediatric flat foot proforma (p-FFP). The new p-FFP has an item reliability mean of 0.71 (ICC 1,1). Treatment is directed for the typical flexible flat foot according to sub-type assessment ie type A1, symptomatic/'red light', treat; type A2, asymptomatic-non-developmental/'orange light', monitor; type A3, asymptomatic-developmental/'green light', leave alone.
See this image and copyright information in PMC

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