Advancing Functional Assessment of Pediatric Flatfoot Using Weightbearing CT - Project Summary The foot is a complex structure and severe deformities such as flatfeet are common among children, particularly those with neurologic disorders. Treatment of pediatric foot deformities is currently limited by the inadequate visualization provided by standard of care 2D radiographs. These radiographic images are limited to a single point of view and flatten irregularly shaped, 3D foot bones into 2D objects. Weightbearing computed tomography (WBCT) is an emerging technology that allows for full volumetric assessment of the foot in weightbearing with equivalent or less radiation exposure than a current standard of care foot & ankle radiograph series. International experts have called WBCT a “game-changer” due to its ability to observe pathologies in the adult foot previously not able to be seen including subtalar joint alignment, impingement, and subluxation which have important clinical implications. WBCT has advanced knowledge of foot and ankle morphology with a consensus for its use in adult symptomatic pes planus/flatfeet. Despite the successes and changes in clinical paradigms resulting from the technological advances of WBCT, its applications have been limited to adult foot deformity and have not been translated to pediatric populations, creating a large knowledge gap in our understanding of foot pathologies throughout growth and development. Planus deformity, with reported incidence as high as 44% of children, is of particular interest due to lack of understanding in structural changes that may cause pain and dysfunction later in young adulthood. Our overall objective for the current multisite project is to complete a comprehensive study of the 3D structure and function of pediatric planus feet. To accomplish this goal, we propose two specific aims. Specific Aim 1 to complete a cross sectional evaluation of children with planus foot deformity using current standard-of-care 2D radiographic analysis and equivalent metrics obtained from 3D WBCT. We will also explore relationships between joint form and function. Specific Aim 2 is to complete a longitudinal evaluation of children with planus foot deformity to determine radiographic and functional metrics that are predictive of worsening symptoms and arch collapse. The long-term focus of this project is to provide a more comprehensive assessment of the 3D structure and function of planus foot structure in children. This will allow for accurate clinical assessment and targeted treatment planning through improved radiographic measurements and the ability to diagnose these complex foot disorders in developing children.
