Orthotics for Treatment of Symptomatic Flat Feet in Children

NCT ID: NCT04104555

Last Updated: 2023-11-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

134 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-04-21

Study Completion Date

2023-08-31

Brief Summary

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Update 13.12.2021 To mitigate the effects the COVID-19 pandemic, and due to difficulties in sites setting up the custom orthoses arm of the protocol an amendment was approved to change the design of the study from a 3 to a 2 arm trial. The amendment drops the custom orthoses arm and was implemented prior to the start of recruitment.

As a child grows the shape of their foot changes and most develop an arch in their foot. For some, however, the arch does not fully form or it might be flat against the ground. This is known as having flat feet and it can cause pain in the feet, legs, or back. At the moment, we are not sure what the best treatment for flat feet is, so the purpose of this research is to conduct a trial to compare two of the most common treatments. The first is exercise and advice about things like which types of shoes might help. The second of the treatment is a type of insole, which is put inside the shoe.

Participants will receive their treatment as part of their normal National Health System care. We would like 478 children and young people aged between 6 and 14 years old to take part in the study. Everyone will receive advice about the type of shoes to wear, ankle exercises and things to look out for when children have painful flat feet. In addition to this, half of the participants will receive a pre-made insole that is the right size. We will ask for their help for 12 months. During this time, we will track their progress by sending them 3 questionnaires in the post to fill in and weekly text messages to find out how painful their feet are during the first few months. We also want to learn more about the problems that flat feet cause, and children's experiences of the treatments delivered as part of this clinical trial. We will explore this through in-depth conversations with children and their parent(s) or the person who looks after them. Once we have finished the trial, we will work with the people who took part in the trial, and clinicians, to make sure that our results can be used by as many people as possible.

We will run 3 additional studies. The first will find out if having information about the study in the form of a video in addition to information in a paper booklet will increase recruitment rates. The second will find out if sending participants a birthday card will increase the response rates to postal questionnaires. The third study will take a 3D impression of the participant's foot and see if it changes over the course of the study.

Detailed Description

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The aim of the study is to undertake a large, pragmatic, multi-armed, randomised controlled trial to assess the clinical and cost-effectiveness of prefabricated orthoses in addition to exercises and advice compared with exercises and advice alone on the physical functioning of children with symptomatic flat feet. We will aim to recruit 478 children with flat feet. They will be allocated to one of two groups, in a 1:1 ratio to either (a) prefabricated orthoses plus exercises and footwear advice or (b) exercises and footwear advice only. We will follow the participants up for 12 months after randomisation to assess their physical functioning, levels of pain and quality of life. We will undertake qualitative interviews with approximately 30 children and their parents, to find out about their experiences of having flat feet, and of being in the trial.

In addition to the main OSTRICH study we will undertake two additional trial methodological Studies within a Trial (SWAT) and a sub-study.

The multimedia trial information SWAT: This SWAT will evaluate the effectiveness of including signposting to multimedia trial information in the patient information sheet, which is sent to participants in their recruitment pack.

The birthday card SWAT: This SWAT will evaluate the effectiveness of sending a birthday card to participants on response rates to postal questionnaires.

Foot scan sub-study: This embedded observational sub-study will assess the capability of a 3D scanning approach to identify and stratify severity of pes planus and to assess change in foot shape over the duration of the trial. We will investigate the associations between aspects of foot shape and score on the physical domain scale of the OxAFQ-C.

Conditions

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Pes Planus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Usual supportive care - exercises and footwear advice

OSTRICH main trial:

Participants will be offered an exercise programme and advice regarding footwear. The treating clinician will be able to prescribe appropriate exercises from a menu of exercises.

Group Type ACTIVE_COMPARATOR

Usual supportive care - exercises and footwear advice (the comparator)

Intervention Type OTHER

Active comparator

Prefabricated, off-the-shelf orthoses

OSTRICH main trial:

A pair of prefabricated, off-the-shelf orthoses (i.e. mass produced to a generic shape but can be adapted by a clinician) plus an exercise programme and advice regarding footwear. The treating clinician will be able to prescribe appropriate exercises from a menu of exercises.

Group Type EXPERIMENTAL

Prefabricated orthoses

Intervention Type DEVICE

Prefabricated insole

Signposting to multimedia

OSTRICH 'signposting to multimedia' Study within a trial (SWAT) Participants will be given signposting information to the multimedia trial information resources in the participant information sheet which is included in the OSTRICH recruitment pack.

Group Type EXPERIMENTAL

Signposting to multimedia

Intervention Type OTHER

Signposting to multimedia information in the patient information sheet which is sent to participants in the post as part of the OSTRICH recruitment pack.

Standard written information only

OSTRICH signposting to multimedia' Study within a trial (SWAT) Participants will receive the standard written information sheet only. This will not include signposting to the multimedia trial information resources, in the OSTRICH recruitment pack.

Group Type NO_INTERVENTION

No interventions assigned to this group

Birthday card

OSTRICH Birthday card study within a trial (SWAT) Participants will be sent a birthday card on or shortly before their birthday from the OSTRICH study team to encourage completion of questionnaires.

Group Type EXPERIMENTAL

Birthday card

Intervention Type OTHER

Birthday card sent to participants in the post

No birthday card

OSTRICH Birthday card study within a trial (SWAT) Participants will not be sent a birthday card during the trial.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Birthday card

Birthday card sent to participants in the post

Intervention Type OTHER

Prefabricated orthoses

Prefabricated insole

Intervention Type DEVICE

Signposting to multimedia

Signposting to multimedia information in the patient information sheet which is sent to participants in the post as part of the OSTRICH recruitment pack.

Intervention Type OTHER

Usual supportive care - exercises and footwear advice (the comparator)

Active comparator

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Potential participants will be included in the trial if they fulfil all of the following criteria:

* Are aged between six and 14 years, inclusive
* Have one or both symptomatic pes planus\*
* The child and/or parent/legal guardian is able to speak, write and understand English
* The parent/legal guardian is able to give informed consent \*Symptomatic pes planus is described as the manifestation of foot and lower limb symptoms, secondary to altered foot alignment (reduced medial longitudinal arch, everted rearfoot and abducted forefoot). The diagnosis will be made pragmatically, by treating clinicians in line with current practice

Exclusion Criteria

Potential participants will be excluded from the study if they fulfil any of the following criteria:

* Have a history of major trauma or fracture of the lower leg (below knee)
* Have pes planus secondary to any systematic condition/syndrome\*\* /malignancy
* Have a history of foot and/or ankle surgery
* Require an ankle-foot orthoses or other lower limb device or have received treatment previously for their flat feet

* This does not exclude children with hypermobility spectrum disorder (HSD) where the manifestation is non-syndromic and isolated (L-HSD), peripheral (P-HSD) or generalised hypermobility (G-HSD)(14).
Minimum Eligible Age

6 Years

Maximum Eligible Age

14 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Leeds

OTHER

Sponsor Role collaborator

University of Salford

OTHER

Sponsor Role collaborator

University of Oxford

OTHER

Sponsor Role collaborator

King's College London

OTHER

Sponsor Role collaborator

University of Warwick

OTHER

Sponsor Role collaborator

University of York

OTHER

Sponsor Role lead

Responsible Party

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Sarah Cockayne

Research Fellow

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David Torgerson, PhD

Role: PRINCIPAL_INVESTIGATOR

University of York

Locations

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East Cheshire NHS Trust

Macclesfield, Cheshire, United Kingdom

Site Status

Birmingham Community Healthcare NHS Foundation Trust

Birmingham, , United Kingdom

Site Status

Bolton NHS Foundation Trust

Bolton, , United Kingdom

Site Status

Cardiff and Vale University Local Health Board

Cardiff, , United Kingdom

Site Status

Medway Community Healthcare

Gillingham, , United Kingdom

Site Status

North Lincolnshire & Goole NHS Foundation Trust

Goole, , United Kingdom

Site Status

Harrogate and District Foundation Trust

Harrogate, , United Kingdom

Site Status

Leeds Community Healthcare NHS Trust

Leeds, , United Kingdom

Site Status

Leeds Teaching Hospitals NHS Trust

Leeds, , United Kingdom

Site Status

Kent Community Health NHS Foundation Trust

Maidstone, , United Kingdom

Site Status

South Tees Hospitals NHS Foundation Trust

Middlesbrough, , United Kingdom

Site Status

Lancashire & South Cumbria Nhs Foundation Trust

Preston, , United Kingdom

Site Status

University Hospital Southampton NHS Foundation Trust

Southampton, , United Kingdom

Site Status

Solent NHS Trust

Southampton, , United Kingdom

Site Status

Royal National Orthopaedic Hospital NHS Trust

Stanmore, , United Kingdom

Site Status

Walsall Healthcare NHS Trust

Walsall, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Evans AM, Rome K, Carroll M, Hawke F. Foot orthoses for treating paediatric flat feet. Cochrane Database Syst Rev. 2022 Jan 26;1(1):CD006311. doi: 10.1002/14651858.CD006311.pub4.

Reference Type DERIVED
PMID: 35080267 (View on PubMed)

Evans AM, Rome K, Carroll M, Hawke F. Foot orthoses for treating paediatric flat feet. Cochrane Database Syst Rev. 2022 Jan 14;1(1):CD006311. doi: 10.1002/14651858.CD006311.pub3.

Reference Type DERIVED
PMID: 35029841 (View on PubMed)

Other Identifiers

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265719

Identifier Type: -

Identifier Source: org_study_id