Screening for foot problems in children: is this practice justifiable?

Abstract

Podiatry screening of children is a common practice, which occurs largely without adequate data to support the need for such activity. Such programs may be either formalised, or more ad hoc in nature, depending upon the use of guidelines or existing models. Although often not used, the well-established criteria for assessing the merits of screening programs can greatly increase the understanding as to whether such practices are actually worthwhile. This review examines the purpose of community health screening in the Australian context, as occurs for tuberculosis, breast, cervical and prostate cancers, and then examines podiatry screening practices for children with reference to the criteria of the World Health Organisation (WHO). Topically, the issue of paediatric foot posture forms the focus of this review, as it presents with great frequency to a range of clinicians. Comparison is made with developmental dysplasia of the hip, in which instance the WHO criteria are well met. Considering that the burden of the condition being screened for must be demonstrable, and that early identification must be found to be beneficial, in order to justify a screening program, there is no sound support for either continuing or establishing podiatry screenings for children.

Figure 1

The framework used for population based screening programs in Australia. Reproduced from: Population Based Screening Framework, Australian Health Ministerial Advisory Council (AHMAC), 2008.

Figure 2

This algorithm displays the best available evidence for assessing and managing flatfoot in children is derived from the paediatric flatfoot proforma (p-FFP). Reproduced from: A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet, Evans AM, Rome K (2011) European Journal of Physical Rehabilitation Medicine 47(1): 69–89.

Figure 3

The statistical definition of ‘normal’ is the area under the curve, which is two standard deviations either side of the population mean. This represents 95% of any normally distributed sample, such that only 2.5% are above and below these values. Reproduced from:http://michaelsrickert.wordpress.com/2012/02/06/what-is-your-emr-bell-curve/

Figure 4

The Scatter plot of FPI scores according to age, hence illustrate the normal presence of a flat foot posture in childhood, and reduction of the same with increasing age. Reproduced from: Normative values for the Foot Posture Index, Redmond AC, Crane Y, Menz HB (2008), Journal of Foot and Ankle Research 1(6).