Tag Archive for: International Journal of Paediatric Orthopaedics


Volume 8 | Issue 1 | January-April  2022 | Page: 01 | Jayant  S. Sampat

Authors: Jayant S. Sampath FRCSEd (Tr & Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Dear Friends,
The first issue of IJPO in 2022 features a symposium on current concepts in musculoskeletal infections in children. Our associate editors, Dr Mohan V Belthur and Dr Ashish Ranade were instrumental in producing the symposium, from topic selection to coordinating with individual authors. A wide-ranging array of subjects feature in the symposium including tropical pyomyositis, diagnostic tools in infection, management guidelines for septic arthritis and the role of non-vascularised fibular grafting for post-infection bony defects.
The original article in this issue highlights improvements in the treatment outcomes of lateral condyle fracture of the humerus in children by a simple modification of existing techniques. In addition, there are 3 case reports which will be of interest to readers.
As life returns to normal following the pandemic, orthopaedic surgeons have less spare time to devote to academic pursuits. We appeal to POSI members to maintain the momentum that was created in 2020 by submitting their articles to IJPO on a regular basis. We will provide the necessary editorial assistance so that your ideas and research work can be shared with the global community of orthopaedic surgeons. This will be particularly useful to trainees and first-time authors.
The Editorial Board would like to thank the team of reviewers without whom this journal would not be possible.

Dr Jayanth S Sampath FRCSEd (Tr&Orth)


How to Cite this Article: Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | May-August 2022; 8(1): 01.

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Stop Maligning the Asymptomatic Child’s Flatfoot

Volume 4 | Issue 2 | July-December 2018 | Page: 01-02 | Benjamin Joseph

Authors: Benjamin Joseph [1]

[1] Aster Medcity, Kochi, Kerala, India.

Address for correspondence:
Prof. Benjamin Joseph,
18 H.I.G. Colony, Manipal − 576 104, Karnataka, India
E-mail: bjosephortho@yahoo.co.in

Recently, a lady met me and gave me some very colourful pamphlets about a range of fancy foot wear and shoe inserts for toddlers and young children designed to ’correct’ flatfeet. I asked her why asymptomatic flatfeet need to be treated. I patiently listened to her as she listed several ‘harmful effects of flatfeet’ including a predilection for foot injury, back ache and so on, which, according to her could be avoided by using the shoes and shoe inserts she was promoting. Needless to say, there were no scientific data to support these claims. After she left, I reflected about what the scientific literature had to say about flatfoot and also recollected my personal experience of dealing with flatfeet in young children in my practice.

There has been a long-held notion that flatfeet are bad and that they may interfere with strenuous physical activity. On the basis of this, young men with flatfeet were rejected from recruitment into the armed forces. However, Cowan et al.[1] did a study on army recruits in the USA and could not demonstrate a higher frequency of injuries in those with flatfeet. Esterman and Pilotto[2] did a similar study in Australia and concluded that ’foot shape has little impact on pain, injury and function’. Tudor et al.[3] studied athletic performance in school children with flatfoot and normal arches and documented no difference in performance in 17 different tasks. So it is high time we dispel the erroneous notion that the flatfoot is in some way inferior to feet with a well-formed arch.

Stemming from the belief that flatfoot is undesirable, concerted efforts have been made to ‘treat’ young children with shoe modifications and various types of shoe inserts that elevate the medial longitudinal arch or control the hindfoot valgus. Despite the fact that Wenger et al.,[4] in as early as 1989, demonstrated clearly that shoes and shoe inserts in no way alter the natural history of flatfoot, orthopaedic surgeons continue to prescribe them. This wasteful and meaningless practice needs to stop.

The natural history of asymptomatic flexible flatfoot is that of resolution in the vast majority of children because the arch develops by the age of 6–7 years. This is very evident as at 1 year of age, 95% of children have flatfeet and by the age of 10, the prevalence is as low as 5%. The increase in the tone of muscles that support the arch and spontaneous reduction in joint laxity as the child grows facilitate the arch to develop. Barefoot activity in early childhood also facilitates the arch to develop while shoe-wearing appears to be detrimental to the development of the arch. This was demonstrated in two large cross-sectional surveys, which showed that the prevalence of flatfoot was highest among children who wore closed-toe shoes below the age of 6 years and lowest in the unshod.[5,6] The frequency of flatfoot in children who wore sandals and slippers fell between these two. With this evidence, it seems hardly logical to prescribe shoes for a young child with flatfoot. Instead, we need to spread the message to encourage children to play barefoot outdoors on sand and gravel. We could also encourage school authorities to have sandals rather than shoes as the regulation footwear. These suggestions are perfectly appropriate in the warm climate in India.

In my practice, I have never had parents from the lower socio-economic strata bring a child for the treatment of flatfoot. Every single child brought to me with the complaints of flatfoot has been from an affluent family. Often it has been a paediatrician, or family physician, who referred the child with flatfoot to me. For a long time, I wondered why there was this socio-economic difference in my flatfoot practice. It then dawned on me; the poor child is unshod and in early childhood has played barefoot, and the poor child consequently is unlikely to have flatfoot. Even if the poor child has flatfeet, they cause no pain and the feet function perfectly well. The child’s parents have no access to the internet, so they have never heard anyone maligning their child’s feet. No wonder, I never saw a poor child with flatfoot in my clinic.

Benjamin Joseph
Aster Medcity, Kochi, Kerala, India
Address for correspondence: Prof. Benjamin Joseph, 18 H.I.G. Colony,
Manipal − 576 104, Karnataka, India
E-mail: bjosephortho@yahoo.co.in


1. Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics
and risk of exercise-related injury. Arch Fam Med 1993;2:
2. Esterman A, Pilotto L. Foot shape and its effect on functioning in Royal
Australian Air Force recruits. Part 1: Prospective cohort study. Mil Med
3. Tudor A, Ruzic L, Sestan B, Sirola L, Prpic T. Flat-footedness is not a
disadvantage for athletic performance in children aged 11 to 15 years.
Pediatrics 2009;123:e386-92.
4. Wenger DR, Mauldin D, Speck G, Morgan D, Lieber RL. Corrective
shoes and inserts as treatment for flexible flatfoot in infants and
children. J Bone Joint Surg Am 1989;71:800-10.
5. Rao UB, Joseph B. The influence of footwear on the prevalence of flat
foot. A survey of 2300 children. J Bone Joint Surg Br 1992;74:525-7.
6. Sachithanandam V, Joseph B. The influence of footwear on the
prevalence of flat foot. A survey of 1846 skeletally mature persons. J
Bone Joint Surg Br 1995;77:254-7.

How to Cite this Article:  Joseph B |  Stop Maligning the Asymptomatic Child’s Flatfoot | July-
December 2018; 4(2): 01-02.

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Paediatric orthopaedics and global initiative for children’s surgery

Volume 4 | Issue 1 | January-June 2018 | Page: 01-02 | Vrisha Madhuri

Authors: Vrisha Madhuri [1]

[1] Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.

Address for correspondence:
Dr. Vrisha Madhuri,
Professor and Head, Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College,
Vellore, Tamil Nadu, India
E-mail: madhuriwalter@cmcvellore.ac.in

Global burden of surgical disease and attendant morbidity and mortality has received much attention in the recent past from the World Health Organization and the Lancet Commission on Global Surgery.[1],[2],[3] This has led to several initiatives in the last 2 years by the global surgical community to address the relevant issues. Among them is a coalition of children’s surgery organizations, led by American Paediatric Surgery Association and British Association of Paediatric Surgeons, who are working to bring together the providers and the implementers of surgical services for children in low- and medium-income countries. The coalition consists of health, advocacy and policy experts from the western world. Two meetings of this Global Initiative for Children’s Surgery (GICS) have taken place with the aim of analysing the current state of the surgical care; develop priorities to improve its delivery and identify and bring together needed resources.[4] The dream of GICS is that every child in the world with a surgical need will have access to the resources necessary to optimise his or her individual care.[4]

India has the largest child population in the world. Similar to other developing countries, we have a very wide range of causes including acute, chronic and neglected problems, with many of them being amenable to surgical treatment. The few centres providing high-quality specialised paediatric surgical care are concentrated in the metropolises, and inadequately trained non-paediatric specialists are available to address these problems in the community. Despite the success of a few focussed programs, such as ‘Smile Train’ for cleft lip and palate and the collaborative program between CURE International, India and several state governments for clubfoot conservative treatment and bracing, much of the surgical needs of the children in the community remain unaddressed because of the lack of adequate infrastructure to support children’s surgery, service delivery systems and trained manpower. The supporting services such as paediatric anaesthesia, intensive care, nursing and orthotics also lack infrastructure and trained personnel. Adequate planning at national and regional levels requires paediatric-specific determination of burden of illnesses in different areas such as congenital, neuromuscular disorders, trauma and oncology.

Rashtriya Bal Swasthya Karyakram, a new initiative by the Government of India, envisages the screening of all children and adolescents for key medical and surgical conditions and their referral and treatment by the existing healthcare providers in public and private sectors. However, in the existing system, the lack of paediatric surgical specialists forms a crisis, wherein identified children are unable to access or obtain quality care, and those suffering from complex conditions do not receive comprehensive care. The lack of a triaging system burdens the tertiary care referral centres with routine surgical conditions, which are best handled at secondary levels, causing overcrowding.

The paediatric orthopaedic community is a major stakeholder in the development of surgical services in the country. Our help, along with other paediatric surgical specialists, is required in needs assessment in the area of infrastructure, service delivery and manpower. A specialist organization such as paediatric orthopaedic society can do these in addition to setting up appropriate standards of care for different conditions, triaging systems by level of hospital, standardizing training programs and identifying areas of research. They can also be great advocates for children’s surgery and attract funding and resources. The baseline demographic studies can be used to determine optimal resources such as the number of children’s hospitals required for the population served. The other important areas are the standardization of equipment to be made available for children’s need and integration of infrastructure needs into national children’s surgical plan. They can also promote preventive strategies such as improved prenatal diagnosis and health promotion and rehabilitation.

While GICS is setting up the needs assessment and standards for infrastructure, healthcare delivery and processes and personnel at all levels of care, we can join hands with them and other paediatric surgical colleagues to provide the appropriate inputs and help build up systems and best practices to provide safe affordable surgical care for children.


1. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA,
et al. Global Surgery 2030: Evidence and solutions for achieving health,
welfare, and economic development. Lancet 2015;386:569-624.
2. Available from: http://www.who.int/bulletin/volumes/86/8/07-050435/
en/. [Last accessed on 2017 Jan 23].
3. Available from: http://bulletin.facs.org/2015/04/the-lancet-commissionon-
[Last accessed on 2017 Jan 23].
4. Global Initiative for Children’s Surgery (GICS) Organizing Committee,
GICS I Summary.Available from: http://www.baps.org.uk/announcements/
June 2016. [Last accessed on 2017 Jan 31].

How to Cite this Article:  Madhuri V | Paediatric orthopaedics and global initiative for children’s surger y| International Journal of Paediatric Orthopaedics | January-June 2018; 4(1): 01-02.

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