Table 3. Statements receiving agreement of >70% from Round Two and Three of Delphi.
| Category | Statement | Agreement |
|---|---|---|
| Flexible pes planus determination; | Visual assessment of dynamic foot in gait | 85.7% |
| Dynamic WB and non-WB foot motion and/or measures | 85.7% | |
| Static foot posture measures; | Foot Posture Index 6 (FPI-6) | 100% |
| Foot function determination in paediatric flexible pes planus; | Neurological assessments (Reflexes, sensation, tone and strength) | 78.5% |
| Single Limb Balance | 71.4% | |
| The Balance tests to assess foot function; | Hopping (n = dominant and non-dominant leg) | 78.5% |
| Timed balance, standing on one leg (eyes open & closed) | 85.7% | |
| All balance tests for comprehensive assessment of functional impact rather than pes planus presence | 100% | |
| Walk along straight line/marching/heel-toe gait (forwards and backwards) | 78.5% | |
| Running | 78.5% | |
| Jumping | 71.4% | |
| Likeliness of FOs prescription for paediatric flexible pes; | If dynamic foot function affected (instability in single leg stance, walking, running, turning, etc.) | 85.7% |
| In presence of symptoms (pain, reduced function, strength and structure per WHO-ICD) | 100% | |
| In presence of structural changes (hallux abducto valgus, hallux limitus, etc.) | 71.4% | |
| With foot posture related delayed milestones | 78.5% | |
| With parental concern, accompanied by affected function | 78.5% | |
| With gross pronation (apropulsive gait and low tone) | 100% | |
| With hereditary lower limb disorder/s changing function and causing pain | 92.8% | |
| If improvement in ICF (The International Classification of Functioning, Disability and Health) outcomes | 71.4% | |
| Symptoms (e.g., pain, general discomfort, reduced walking, poor endurance and balance) | 100% | |
| Plantar arch/fascia pain | 92.8% | |
| Heel pain | 78.5% | |
| Tibialis Posterior tendon pain | 100% | |
| Medial Tibial Stress Syndrome (MTSS) type symptoms | 100% | |
| Activity related pain | 92.8% | |
| Regarding child’s age, decision of FOs use is influenced by: | Other factors than age as extent/degree of deformity, type and frequency of activity, and function | 92.8% |
| Acquisition of motor skills rather than age | 71.4% | |
| FOs preferred, in: | Presence of symptoms (foot and leg pain, affected function and gross motor skill development) | 92.8% |
| The aim of prescribing FOs is to: | Reduce symptoms | 92.8% |
| Reduce fatigue | 85.7% | |
| Improve gross motor skill | 85.7% | |
| Improve balance, stability, comfort, coordination, stamina and endurance | 92.8% | |
| Improve overall wellbeing and health outcomes per WHO-ICF, thus improved quality of life | 71.4% | |
| When comparing pre-fabricated FOs to custom-made FOs; | Pre-fabricated FOs are easily modifiable | 78.5% |
| Pre-fabricated FOs are cost effective | 71.4% | |
| Pre-fabricated FOs should be used when they offer enough control | 71.4% | |
| Customised FOs should be used if pre-fabricated FOs do not provide adequate support for the child’s foot | 100% | |
| Pre-fabricated FOs can be quickly dispensed i.e., as soon as the parents decide to use them | 78.5% | |
| The features that guide the choice of prefabricated FOs specific may include: | Easy fit in a shoe | 71.4% |
| Smooth contours (low irritation and increased comfort) | 71.4% | |
| Material easily customised | 71.4% | |
| Appropriate material strength to provide needed control | 85.7% | |
| Financial limitation of parents/cost | 71.4% | |
| Size availability | 78.5% | |
| For Custom FOs, a Medial (Kirby) heel skive may be used: | To provide additional/better rearfoot control | 78.5% |
| To help reduce STJ pronation | 85.7% | |
| In severe pes planus in the frontal plane | 71.4% | |
| For custom FOs, a UCBL (i.e., Medial and Lateral flange) device may be used: | In grossly pronated feet with hypotonia | 71.4% |
| When extra mid foot control is required in transverse plane | 92.8% | |
| For custom FOs, a medial flange device may be used: | When extra midfoot control is required | 92.8% |
| To limit MTJ pronation and prevent foot rolling over device | 78.5% | |
| In very flexible pes planus where medial edge of device is not tolerated | 71.4% | |
| Shell materials for Custom FOs; | Three-dimensional printing materials | 71.4% |
| Alternative devices for flexible pes planus; | Rearfoot or heel wedges/lifts | 71.4% |
| Exercise therapy | 85.7% | |
| For custom FOs, consider; | Adequate accommodation of talo-navicular region to prevent blistering by wider midfoot area in device | 71.4% |
Notes.
- WB
- Wight bearing
- WHO-ICD
- World Health Organisation-International Classification of Diseases
- STJ
- Subtalar joint
- MTJ
- Midtarsal joint
- UCBL
- University of California Biomechanics Laboratory