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  • Open Access

Biomechanical assessment of the paediatric foot: using the current evidence

Journal of Foot and Ankle Research20125 (Suppl 1) :P7

  • Published:


  • Assessment Score
  • Critical Literature
  • Relevant Item
  • Universal Method
  • Joint Hypermobility


The paediatric flat foot is a frequent presentation in clinical practice, a common concern to parents and continues to be debated. As an entity, it is confused by varied classifications, the notion of well-intended prevention and unsubstantiated, if common, treatment [1]. The paediatric flat foot proforma (p-FFP) is a standardized framework from which to evaluate the paediatric flat foot [2].

Materials and methods

An algorithm, extending the p-FFP, has been developed to direct assessment and management of the paediatric flatfoot. Based upon best available evidence, this model includes joint hypermobility, body weight and gender as relevant items to assess [3]. The normative data sets using the foot posture index are included and recent reliability studies [4] have identified the value of the ankle lunge test, Beighton scale and the lower limb assessment score in evaluation joint range, hypermobility and quality of life (Table 1).
Table 1

Inter-rater reliability: mean inter-rater ICC’s (95% CI’s) and SEM in children aged seven to 15 years (n=30)


ICC (95% CI)

Mean (SD)


Foot Posture Index

0.79 (0.38-0.94)

4.3 (2.7)


Lunge Test

0.83 (0.56-0.94)

43.7 (5.0)

2.9 deg

Beighton Scale

0.73 (0.42-0.88)

2.4 (1.2)


Lower Limb Assessment Score

0.78 (0.41-0.93)

9.7 (3.3)



A recent critical literature review has identified that the resting calcaneal stance position (RCSP), navicular height and Foot Posture Index (FPI-6) are the only three reliable measures of static foot posture [5].


Further research is required to establish a universal method of assessment of paediatric foot posture. The relevance of static foot posture to pain and shod gait function remains largely unsubstantiated in children, and warrants further investigation.

Authors’ Affiliations

Health & Rehabilitation Research Institute, AUT University, Auckland, 92006, New Zealand
University of South Australia, Adelaide, 5000, Australia


  1. Rome K, Ashford RL, Evans AM: Non-surgical interventions for paediatric pes planus (Review). Cochrane Database Syst Rev. 2010, 7: DOI:10.1002 /14651858.CD006311.pub2Google Scholar
  2. Evans AM, Nicholson H, Zakaris N: The paediatric flat foot proforma (p-FFP): improved and abridged following a reproducibility study. J Foot Ankle Res. 2009, 2: 25-10.1186/1757-1146-2-25.PubMed CentralView ArticlePubMedGoogle Scholar
  3. Evans AM, Rome K: A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. Eur J Phys Rehabil Med. 2011, 47: 69-89.PubMedGoogle Scholar
  4. Evans AM, Rome K, Peet L: The Foot posture index, Ankle lunge test, Beighton scale and the Lower Limb Assessment Score in healthy children: a reliability study. 2011, Under reviewGoogle Scholar
  5. Kneebone KA, Scutter SD, Evans AM: Clinical measures of paediatric foot posture: a critical review. 2011, Under reviewGoogle Scholar


© Evans and Rome; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.