Adults with flexible pes planus and the approach to the prescription of customised foot orthoses in clinical practice: A clinical records audit

• 77% of adults with flexible pes planus reported back or lower limb pain.
• An inverted (heel) cast pour and the use of a medial heel (Kirby) skive were frequently used variations from a standardised modified Root-style device.
• There was a statistically significant difference between frequently used variations from a standardised modified Root-style device and recorded rearfoot morphology.

A clinical records audit of the University of South Australia's podiatry clinic clients attending in 2010 was undertaken to determine prevalence of symptomatic flexible pes planus, presenting reasons and treatment options most frequently used. Analysis of rearfoot measures (resting calcaneal stance position, subtalar joint range of motion) between those prescribed a vertical (heel) or inverted (heel) cast pour and a medial heel (Kirby) skive was undertaken. Of 223 clinical records audited, 50% (111/223) of clients were assessed with flexible pes planus, 77% (86/111) of clients with pes planus presented with back or lower limb pain and 58% (64/111) were prescribed customised foot orthoses. Of 42 prescriptions for customised foot orthoses audited; 64% (27/42) were prescribed a vertical (heel) cast pour, 36% (15/42) an inverted (heel) cast pour and 19% (8/42) received a medial heel (Kirby) skive. Those prescribed a medial heel (Kirby) skive had a more everted resting calcaneal stance position than those that were not (mean −8.6 ± 2.8° vs. −5.5 ± 3.4°, p = 0.02). Those prescribed an inverted (heel) cast pour had a greater range of subtalar joint motion than those prescribed a vertical (heel) cast pour (median 36.0 ± 10.0° vs. 29.0 ± 5.0°, p = 0.01).