The Paediatric Foot
Edited by: Dr Angela Evans, Dr Stewart Morrison, Dr Cylie Williams, Guest editors: Angela M. Evans, Cylie M. Williams, Stewart C. Morrison
Making sense of the clinical challenges that manifest in the paediatric foot and lower limb is an evolving area of practice. In many areas of medicine and health care, evidence-based practice has grown in the last century, and continues to shape clinician’s understanding of paediatric lower limb conditions. In some instances, the contemporary evidence has presented contrary recommendations for practice. A crucial shift has been the management of the congenital paediatric clubfoot (talipes equino varus). Longitudinal observation and investigation has seen the non-surgical Ponseti method now adopted globally as ‘best practice’, largely relegating the surgical posterior medial release (PMR). How extraordinary that the inexpensive Ponseti method also provides the best clinical outcomes! Without observation, query, and the use of good scientific method, many children of the world with a clubfoot would remain either untreated, or surgically managed, often deleteriously.
The medical literature has a story to tell, but must be interpreted carefully, systematically, and fairly, if we are to make sense of it. Literature reviews make an, often unheralded, contribution to our body of knowledge and provide the platform from which further inquiry can begin. This special collection from selected articles published within Journal of Foot and Ankle Research, both exemplifies the emerging body of evidence and illustrates the current gaps in the evidence for common clinical presentations viz. calcaneal apophysitis (Sever’s disease), growing pains, flatfoot, and the impact of obesity.
Where to from here? The next decade requires more robust, systematic investigation of the paediatric foot and lower limb. We need: research designs for the collection of longitudinal data; query driven by public health initiatives; to utilise appropriate, well-designed methods; and outcome measures which are child-specific. Using evidence-based practice will ensure that children receive only those interventions that are demonstrably beneficial and necessary.