[Original Article] Pes planovalgus associated with down syndrome, its symptoms, and the effect of brace therapy

[ABSTRACT]【Introduction】Pes planovalgus (PP) is the most common orthopedic complication of Down syndrome (DS). The frequency of PP in DS ranges from 19.9–51.4%, but there is no consensus on follow-up or therapeutic intervention. In this study, we investigated PP associated with DS, its symptoms, and the effects of orthotic therapy.【Methods】The subjects were 52 children with DS (2–19 years old, mean 7.7 years old) who visited our department from July 2021 to June 2022. The parameters examined were the presence or absence of PP with visual inspection of the too-many-toes sign, symptoms such as foot pain, the presence or absence of orthotic therapy, and the presence or absence of arch formation. DS patients were followed-up annually. If the child had flat feet when they commenced walking, the family was instructed to create an arch support with felt on the insole of the shoe and to provide high-cut shoes. Patients would receive insoles made by the physician if they developed callouses, ingrown toenails, and/or hallux valgus, or if there was no change or worsening of their flat feet after reaching school age.【Results】Observations of note were PP in 48 patients (92.3%), hallux valgus in 1 patient (2.9%), callouses in 2 patients (5.7%), ingrown toenails in 4 patients (11.4%), and foot pain in 2 patients (5.7%). Orthotic therapy was performed in 45 of 48 patients (93.8%). Arch formation was observed in 9 patients (18.8%), which included 8 of the 45 patients (mean age7.8 years) who underwent treatment. Arch formation was confirmed in children who were 5–10years old (mean 7.1 years old). There was no significant difference in arch formation between the treated and untreated groups ( p=0.5). 【Conclusion】Many patients with DS have foot symptoms. Aggressive orthotic therapy for PP with DS may be useful.