Exploration of Flexible Pes Planus as a Potential Risk Factor for Cardiac Pathologies in Pediatric Cases

Yavuz Selim Karatekin; Harun Altinayak; Şeyma Karatekin; Hüseyin Karadağ; Emre Usta; Bedri Karaismailoğlu; Ali Seker

doi:10.7759/cureus.46139

Exploration of Flexible Pes Planus as a Potential Risk Factor for Cardiac Pathologies in Pediatric Cases

Cureus. 2023 Sep 28;15(9):e46139. doi: 10.7759/cureus.46139. eCollection 2023 Sep.

Authors

Yavuz Selim Karatekin¹, Harun Altinayak², Şeyma Karatekin³, Hüseyin Karadağ⁴, Emre Usta⁵, Bedri Karaismailoğlu⁶, Ali Seker⁷

Affiliations

¹ Orthopedics and Traumatology, Samsun Training and Research Hospital, Samsun, TUR.
² Orthopaedics and Traumatology, Samsun Training and Research Hospital, Samsun, TUR.
³ Pediatrics, Faculty of Medicine, Samsun University, Samsun, TUR.
⁴ Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, TUR.
⁵ Pediatric Cardiology, Faculty of Medicine, Samsun University, Samsun, TUR.
⁶ Orthopaedics and Traumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, TUR.
⁷ Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, TUR.

Abstract

Objective: The aim of this study is to investigate the relationship between flexible pes planus (FPP) and cardiac pathologies in pediatric patients, with a particular emphasis on hypermobility status.

Methods: Between January and June 2022, a retrospective screening was conducted on a total of 68 patients aged between 6 and 18 years who had been diagnosed with FPP. Eight patients were excluded from the study due to suspicion of connective tissue or neuromuscular diseases following systemic examinations conducted by a pediatric specialist. The included 60 patients underwent comprehensive cardiac examinations conducted by pediatric cardiology specialists and were evaluated through echocardiography (ECHO) as part of the study. Simultaneously, a control group of healthy individuals aged 6 to 18, without a diagnosis of pes planus (PP), was selected from those who applied for health reports for the purpose of obtaining sports licenses. Patients diagnosed with FPP were compared to a control group in terms of the presence of cardiac pathology. Furthermore, the Beighton Hypermobility Scores (BHSs) of patients diagnosed with FPP were compared based on the presence of cardiac pathology.

Results: A total of 60 patients (40 males, 20 females) diagnosed with FPP were included in the study, and a control group consisting of 453 healthy individuals (287 males, 166 females) was selected. The incidence of cardiac pathology in patients diagnosed with FPP (23.3%) was found to be significantly higher compared to the control group (7%) (p <0.01). The risk of cardiac pathology in patients diagnosed with FPP was determined to be four times higher compared to the control group (Odds ratio: 4 (1.993-8.046), p<0.01). Among patients with FPP, individuals who were found to have cardiac pathology had statistically significantly higher average BHSs compared to those without cardiac pathology (p: 0.043).

Conclusions: Our study suggested that there may be a significant relationship between FPP and high cardiac pathology risk in pediatric patients. We observed a significant increase in the incidence of cardiac pathologies among patients diagnosed with FPP. Additionally, the presence of higher hypermobility scores among patients diagnosed with FPP suggests a potential connection between the two. In the evaluation of FPP in the pediatric population, it should be considered as a potential risk factor for cardiac pathologies and its potential association with hypermobility.

Keywords: cardiac pathology; echocardiography; flat foot; heart failure; hypermobility; mitral valve prolapse; pes planus; valvular heart disease.