Pediatrik Ayak Deformitelerinde Biyomekanik Adaptasyonlar, Tanısal Algoritmalar ve Koruyucu Fizyoterapi ve Prehabilitasyon Yaklaşımları

Bu makalenin ilk hali 30 Haziran 2026 tarihinde yayımlandı. https://dergipark.org.tr/tr/pub/jnlm/article/1962906

Düzeltme Notu

Bazı tabloların metin içine kaydığı ve genel yapıyı bozduğu tespit edilmiştir.

Öz

Giriş: Pediatrik ayak deformiteleri, alt ekstremite kinetik zincirini önemli ölçüde değiştiren kas-iskelet sistemi bozukluklarının önemli bir grubunu oluşturmaktadır. Uzun vadeli fonksiyonel bozuklukları önlemek için, iskeletin gelişimsel plastisite dönemlerinde erken teşhis ile hedefe yönelik koruyucu fizyoterapi ve prehabilitasyon (KFP) hayati öneme sahiptir. Amaç: Bu kapsamlı derlemenin amacı, pediatrik ayak deformitelerinin tedavisinde KFP protokollerinin biyomekanik adaptasyonlarını, çok aşamalı tanı algoritmalarını ve kanıta dayalı etkinliğini değerlendirmektir. Yöntemler: Pediatrik pes planovalgus (PPV), idiyopatik parmak ucunda yürüme (İPY), pes kavovarus ve parmak anomalileri gibi durumlarda üç boyutlu kinematik analizler, pedobarografik testler, konservatif ve cerrahi modülasyon stratejileri üzerinde odaklanılarak mevcut literatürün sistematik bir sentezi yapılmıştır. Sonuçlar: Son prospektif kohort ve kesitsel veriler, kısa ayak egzersizleri, kinetik zincir odaklı nöromüsküler antrenman ve kişiye özel sert ayak ortezleri gibi yapılandırılmış KFP müdahalelerinin subtalar esnekliği önemli ölçüde iyileştirdiğini, medial uzun ark indekslerini stabilize ve plantar basınç dağılımını optimize ettiğini doğrulamaktadır. Ayrıca ayakta duruş endeksi-6 ve 3D yürüyüş analizi gibi gelişmiş tanı araçları, fizyolojik varyantları, rijit patolojilerden ve Otistik Parmak Üzerinde Yürüyüş gibi nörogelişimsel durumlardan başarıyla ayırt etmektedir. Sonuç: Etkili pediatrik ayak yönetimi, izole anatomik değerlendirmelerden kapsamlı kinetik zincir paradigmalarına geçişi gerektirmektedir. Erken aşamadaki KFP, cerrahiye olan ihtiyacı en aza indirir ve uzun vadeli fonksiyonel bağımsızlığı korur.

Anahtar Kelimeler

• Pediatrik ayak gelişimi
• Pes planovalgus
• İdiyopatik parmak üzerinde yürüme
• Ayak bozukluğu
• Pedobarografi
• 3D yürüyüş analizi.

Biomechanical Adaptations, Diagnostic Algorithms, and Preventive Physical Therapy and Prehabilitation Approaches in Pediatric Foot Deformities

Bu makalenin ilk hali 30 Haziran 2026 tarihinde yayımlandı. https://dergipark.org.tr/tr/pub/jnlm/article/1962906

Düzeltme Notu

It was observed that some tables were embedded within the text, disrupting the overall structure.

Öz

Background: Pediatric foot deformities represent a critical spectrum of musculoskeletal disorders that significantly alter the lower extremity kinetic chain. Early identification and targeted preventive physical therapy and prehabilitation (PPT) are paramount during periods of developmental skeletal plasticity to prevent long-term functional impairment. Objective: This comprehensive review evaluates the biomechanical adaptations, multi-step diagnostic algorithms, and evidence-based efficacy of PPT protocols in managing pediatric foot deformities. Methods: A systematic synthesis of current literature was conducted, focusing on three-dimensional kinematic analyses, pedobarographic advancements, and conservative versus surgical modulation strategies in conditions including pediatric pes planovalgus (PPV), idiopathic toe-walking (ITW), pes cavovarus, and digital anomalies. Results: Recent prospective cohort and cross-sectional data confirm that structured PPT interventions—such as short foot exercises (SFE), kinetic chain-focused neuromuscular training, and customized rigid foot orthoses (FO)—significantly improve subtalar flexibility, stabilize medial longitudinal arch (MLA) indices, and optimize plantar pressure distribution. Furthermore, advanced diagnostic tools like the Foot Posture Index-6 (FPI-6) and 3D gait analysis successfully differentiate physiological variants from rigid pathologies and neurodevelopmental conditions like Autistic Toe-Walking (ATW). Conclusion: Effective pediatric foot management mandates transitioning from isolated anatomical assessments to comprehensive kinetic chain paradigms. Early-stage PPT minimizes surgical reliance and preserves long-term functional independence.

Anahtar Kelimeler

• Pediatric foot development
• Pes planovalgus
• Idiopathic toe-walking
• Clubfoot
• Pedobarography

Kaynakça

1. 2012). Ultrasonographic evaluation of Achilles tendons in clubfeet before and after percutaneous tenotomy. Journal of Orthopaedic Surgery (Hong Kong), 20(1), 71-74. https://doi.org/10.1177/230949901202000114 (PMID: 22535815)
2. Alsancak, S., Guner, S., Güven, E., Özgün, A. K., Akkaş, Y., & Alkıs, N. (2021). Paediatric flat foot and foot dimension in Central Anatolia. BMC Pediatrics, 21(1), 200. https://doi.org/10.1186/s12887-021-02645-9.
3. Alvarez, C., De Vera, M., Beauchamp, R., Ward, V., & Black, A. (2007). Classification of idiopathic toe walking based on gait analysis: development and application of the ITW severity classification. Gait & posture, 26(3), 428-435.
4. Arthur Vithran, D. T., Liu, X., He, M., Essien, A. E., Opoku, M., Li, Y., et al. (2024). Current advancements in diagnosing and managing cavovarus foot in paediatric patients. EFORT Open Reviews, 9(1), 69-79. https://doi.org/10.1530/EOR-23-0086.
5. Banwell, H. A., Paris, M. E., Mackintosh, S., & Williams, C. M. (2018). Paediatric flexible flat foot: How are we measuring it and are we getting it right? A systematic review. Journal of Foot and Ankle Research, 11(1), 21. https://doi.org/10.1186/s13047-018-0264-3.
6. Bauer, J. P., Sienko, S., & Davids, J. R. (2022). Idiopathic toe walking: An update on natural history, diagnosis, and treatment. Journal of the American Academy of Orthopaedic Surgeons, 30(22), e1419-e1430. https://doi.org/10.5435/JAAOS-D-22-00419.
7. Beer, A. (2024). Common foot deformities in children. Orthopaedics and Trauma, 38(6), 343-348. https://doi.org/10.1016/j.mporth.2024.10.001.
8. Behrendt, A., Siebert, T., & D'Souza, S. (2025). Impact of body weight and age on plantar pressure in typically developing children: Normative data and methodological considerations. Journal of Children's Orthopaedics, 19(3), 179-188.

9. Böhm, H., Döderlein, L., Fujak, A., & Dussa, C. U. (2020). Is there a correlation between static radiographs and dynamic foot function in pediatric foot deformities? Foot and Ankle Surgery, 26(7), 801-809. https://doi.org/10.1016/j.fas.2019.10.006.
10. Böhm, H., Stebbins, J., Kothari, A., & Dussa, C. U. (2024). Dynamic gait analysis in paediatric flatfeet: Unveiling biomechanical insights for diagnosis and treatment. Children, 11(5), 604. https://doi.org/10.3390/children11050604.
11. Bollepalli, H., White, C. J. K., Kodra, J. D., & Liu, X. C. (2025). An evaluation of orthotics on in-toeing or out-toeing gait. Healthcare, 13(5), 531. https://doi.org/10.3390/healthcare13050531.
12. Bosch, K., Gerss, J., & Rosenbaum, D. (2007). Preliminary normative values for foot loading parameters of the developing child. Gait & Posture, 26(2), 238-247. https://doi.org/10.1016/j.gaitpost.2006.09.014.
13. Bosch, K., Gerß, J., & Rosenbaum, D. (2010). Development of healthy children's feet—Nine-year results of a longitudinal investigation of plantar loading patterns. Gait & Posture, 32(4), 564-571. https://doi.org/10.1016/j.gaitpost.2010.08.003
14. Butterworth, M. L., & Marcoux, J. T. (2020). The pediatric foot and ankle. Springer Nature Switzerland AG. https://doi.org/10.1007/978-3-030-29788-6.
15. Cady, R., Hennessey, T. A., Schwend, R. M., & SECTION ON ORTHOPAEDICS. (2022). Diagnosis and treatment of idiopathic congenital clubfoot. Pediatrics, 149(2), e2021055555. https://doi.org/10.1542/peds.2021-055555.
16. Camathias, C., Valderrabano, V., Rutz, E., & Speth, B. M. (2026). Pediatric pes planovalgus and femoral antetorsion: Understanding a biomechanical unit: A narrative review of the proximal-to-distal kinetic chain in childhood flatfoot. Children, 13(4), 510. https://doi.org/10.3390/children13040510.
17. Caserta, A., Morgan, P., & Williams, C. (2019). Identifying methods for quantifying lower limb changes in children with idiopathic toe walking: A systematic review. Gait & Posture, 67, 181-186. https://doi.org/10.1016/j.gaitpost.2018.10.007.
18. Dars, S., Uden, H., Banwell, H. A., & Kumar, S. (2018). The effectiveness of non-surgical intervention (foot orthoses) for paediatric flexible pes planus: A systematic review: Update. PLoS ONE, 13(2), e0193060. https://doi.org/10.1371/journal.pone.0193060
19. Dave, M., Rankin, J., Pearce, M., & Foster, H. E. (2020). Global prevalence estimates of three chronic musculoskeletal conditions: Club foot, juvenile idiopathic arthritis and juvenile systemic lupus erythematosus. Pediatric Rheumatology, 18(1), 49. https://doi.org/10.1186/s12969-020-00443-8
20. Davies, K., Black, A., Hunt, M., & Holsti, L. (2018). Long-term gait outcomes following conservative management of idiopathic toe walking. Gait & Posture, 62, 214-219. https://doi.org/10.1016/j.gaitpost.2018.02.014.
21. De Angeli, L. R. A., Serafim, B. L. C., & Masquijo, J. J. (2025). The autistic toe walking: A narrative review for interventions and comparison with idiopathic toe walking. Children, 12(9), 1198. https://doi.org/10.3390/children12091198.
22. Di Gennaro, G. L., Trisolino, G., Viotto, M., Todisco, M., Cerasoli, T., & Rocca, G. (2025). Simultaneous correction of juvenile hallux valgus and flexible flatfoot in children: Outcomes of combined first metatarsal hemiepiphysiodesis and calcaneal-stop procedure. Journal of Clinical Medicine, 14(20), 7330. https://doi.org/10.3390/jcm14207330
23. Donne, J. H., Powell, J. A., Fahey, M. C., Beare, R., Kolic, J., & Williams, C. M. (2023). Some children with idiopathic toe walking display sensory processing difficulties but not all: A systematic review. Acta Paediatrica, 112(8), 1620-1632. https://doi.org/10.1111/apa.16821.
24. Fadle, A. A., Ibrahim, M. A., Khalifa, A. A., Zaher, H. A., Osman, A. E., & Said, H. G. (2024). Management of spasmodic flatfoot deformities in children and adolescents using dedicated physical therapy program: A prospective case series and early functional outcomes. Fuß & Sprunggelenk, 22(4), 243-253. https://doi.org/10.1016/j.fuspru.2024.09.001.
25. Ganesan, B., Luximon, A., Al-Jumaily, A., Balasankar, S. K., & Naik, G. R. (2017). Ponseti method in the management of clubfoot under 2 years of age: A systematic review. PLoS ONE, 12(6), e0178299. https://doi.org/10.1371/journal.pone.0178299.
26. Gumuskaya, O., Peterson, B., Donnelly, H., Unver, B., Lafferty, D., & Tehan, P. (2025). Preoperative and postoperative physical and mechanical rehabilitation interventions in hallux valgus: A systematic review. Journal of Foot and Ankle Research, 18(3), e70083. https://doi.org/10.1002/jfa2.70083.
27. Jiang, H., Mei, Q., Wang, Y., He, J., Shao, E., Fernandez, J., et al. (2023). Understanding foot conditions, morphologies and functions in children: A current review. Frontiers in Bioengineering and Biotechnology, 11, 1192524. https://doi.org/10.3389/fbioe.2023.1192524.
28. Liu, W., Xu, L., Wu, H., Wang, Y., Jiang, H., Gao, Z., et al. (2025). Bilateral asymmetries of plantar pressure and foot balance during walking, running, and turning gait in typically developing children. Bioengineering, 12(2), 151. https://doi.org/10.3390/bioengineering12020151.
29. Mahaffey, R., Le Warne, M., Blandford, L., & Morrison, S. C. (2022). Age-related changes in three-dimensional foot motion during barefoot walking in children aged between 7 and 11 years old. Gait & Posture, 95, 38-43. https://doi.org/10.1016/j.gaitpost.2022.04.001. Miralles, M. J. C., Vargas, R. G., Vallés, A. J., Jose, L. C., Benimeli-Fenollar, M., García-Gomariz, C., et al. (2025). A systematic review of digital deformities in pediatric patients and their podiatric treatments. Children, 12(11), 1461. https://doi.org/10.3390/children12111461.
30. Molina-García, C., Banwell, G., Rodríguez-Blanque, R., Sánchez-García, J. C., Reinoso-Cobo, A., Cortés-Martín, J., et al. (2023). Efficacy of plantar orthoses in paediatric flexible flatfoot: A five-year systematic review. Children, 10(2), 371. https://doi.org/10.3390/children10020371.
31. Pardus, K., Stencel-Gabriel, K., Kurdyś, P., Konwant, D., & Nowak, U. (2022). Analysis of selected methods of diagnostics and physiotherapy of pes plano-valgus in children. Journal of Education and Health Sport, 12(11), 18-22. https://doi.org/10.12775/JEHS.2022.12.11.002.
32. Pavone, V., Chisari, E., Vescio, A., Lucenti, L., Sessa, G., & Testa, G. (2018). The etiology of idiopathic congenital talipes equinovarus: A systematic review. Journal of Orthopaedic Surgery and Research, 13(1), 206. https://doi.org/10.1186/s13018-018-0913-z.
33. Puszczalowska-Lizis, E., Krawczyk, K., & Omorczyk, J. (2022). Effect of longitudinal and transverse foot arch on the position of the hallux and fifth toe in preschool children in the light of regression analysis. International Journal of Environmental Research and Public Health, 19(3), 1669. https://doi.org/10.3390/ijerph19031669.
34. Rusu, L., Marin, M. I., Geambesa, M. M., & Rusu, M. R. (2022). Monitoring the role of physical activity in children with flat feet by assessing subtalar flexibility and plantar arch index. Children, 9(3), 427. https://doi.org/10.3390/children9030427.
35. Salinas-Torres, V. M., Salinas-Torres, R. A., Carranza-García, L. E., Herrera-Orozco, J., & Tristán-Rodríguez, J. L. (2023). Prevalence and clinical factors associated with pes planus among children and adults: A population-based synthesis and systematic review. The Journal of Foot and Ankle Surgery, 62(5), 899-903. https://doi.org/10.1053/j.jfas.2023.05.007.
36. Sanpera, I., Villafranca-Solano, S., Muñoz-Lopez, C., & Sanpera-Iglesias, J. (2021). How to manage pes cavus in children and adolescents? EFORT Open Reviews, 6(6), 510-517. https://doi.org/10.1302/2058-5241.6.210021.
37. Smith, C., Zaidi, R., Bhamra, J., Bridgens, A., Wek, C., & Kokkinakis, M. (2021). Subtalar arthroereisis for the treatment of the symptomatic paediatric flexible pes planus: A systematic review. EFORT Open Reviews, 6(2), 118-129. https://doi.org/10.1302/2058-5241.6.200076.
38. Soangra, R., Wen, Y., Yang, H., & Grant-Beuttler, M. (2022). Classifying toe walking gait patterns among children diagnosed with idiopathic toe walking using wearable sensors and machine learning algorithms. IEEE Access, 10, 77054-77067. https://doi.org/10.1109/ACCESS.2022.3192136.
39. Turner, C., Gardiner, M. D., Midgley, A., & Stefanis, A. (2020). A guide to the management of paediatric pes planus. Australian Journal of General Practice, 49(5), 245-249. https://doi.org/10.31128/AJGP-09-19-5089.
40. Uden, H., Scharfbillig, R., & Causby, R. (2017). The typically developing paediatric foot: How flat should it be? A systematic review. Journal of Foot and Ankle Research, 10(1), 37. https://doi.org/10.1186/s13047-017-0218-1.
41. Urukalo, J., Banwell, H., Williams, C., Morrison, S. C., & Kumar, S. (2025). The F-words relating to symptomatic flexible flat feet: A scoping review. PLoS One, 20(5), e0320310. https://doi.org/10.1371/journal.pone.0320310.
42. Vergillos Luna, M., Khal, A. A., Milliken, K. A., Solla, F., & Rampal, V. (2023). Pediatric flatfoot: Is there a need for surgical referral? Journal of Clinical Medicine, 12(11), 3809. https://doi.org/10.3390/jcm12113809.
43. Vykhliaiev, Y. M., & Ardasheva, O. E. (2014). Physical rehabilitation of functional violations and deformations of children foot. Pedagogics, Psychology, Medical-Biological Problems of Physical Training and Sports, (5), 3-9.
44. Winfeld, M. J., & Winfeld, B. E. (2019). Management of pediatric foot deformities: An imaging review. Pediatric Radiology, 49(12), 1678-1690. https://doi.org/10.1007/s00247-019-04503-4.
45. Xu, L., Gu, H., Zhang, Y., Sun, T., & Yu, J. (2022). Risk factors of flatfoot in children: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(14), 8247. https://doi.org/10.3390/ijerph19148247.
46. Yang, L., Liu, X., Liu, Y., Zheng, W., Wang, W., & Yan, S. (2024). Altered gait patterns during arch important development period in children with persistent obesity: An experimental longitudinal study. Gait & Posture, 111, 143-149. https://doi.org/10.1016/j.gaitpost.2024.04.026.
47. Zhao, Y., Yan, S., Zhang, L., Shi, B., & Yang, L. (2025). Do gait patterns normalize concurrently with the recovery of foot arches in children with flatfoot? A prospective cohort study. Journal of Biomechanics, 187, 112758.