Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2023; 14(10): 755-762
Published online Oct 18, 2023. doi: 10.5312/wjo.v14.i10.755
Catania flatfoot score: A diagnostic-therapeutic evaluation tool in children
Andrea Vescio, Gianluca Testa, Alessia Caldaci, Marco Sapienza, Vito Pavone
Andrea Vescio, Gianluca Testa, Alessia Caldaci, Marco Sapienza, Vito Pavone, Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
Author contributions: Vescio A and Testa G contributed equally to this work; Vescio A, Testa G and Pavone V designed the research study; Caldaci A and Sapienza M performed the research; Vescio A contributed new reagents and analytic tools; Vescio A and Testa G analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: No ethical committee approval is needed because of the retrospective nature of the study.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data are available on request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gianluca Testa, MD, Professor, Research Assistant Professor, Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy. gianpavel@hotmail.com
Received: January 3, 2023
Peer-review started: January 3, 2023
First decision: April 13, 2023
Revised: April 26, 2023
Accepted: June 9, 2023
Article in press: June 9, 2023
Published online: October 18, 2023
ARTICLE HIGHLIGHTS
Research background

Flexible flatfoot (FFF) is a very common condition in children, but no evidence-based guidelines or assessment tools exist. Yet, surgical indication is left to the surgeon’s experience and preferences.

Research motivation

The lack of common diagnostic criteria for FFF.

Research objectives

To develop a functional clinical score for FFF [Catania flatfoot (CTF) score] and a measure of internal consistency; to evaluate interobserver and intra-observer reliability of the CTF Score; to provide a strong tool for proper FFF surgical indication.

Research methods

CTF is a medically compiled score of four main domains for a total of twelve items: Patient features, Pain, Clinical Parameters, and Functionality. Each item refers to a specific rate. Five experienced observers answered 10 case reports according to the CTF. To assess inter- and intra-observer reliability of the CTF score, the intra-class correlation coefficients’ (ICCs) statistics test was performed, as well as to gauge the correlation between the CTF score and the surgical or conservative treatment indication. Values of 75% were chosen as the score cut-off for surgical indication. Sensitivity, specificity, positive likelihood ratio (PLHR), negative likelihood ratio (NLHR), positive predictive value (PPV), and negative predictive value (NPV).

Research results

Overall interobserver reliability ICC was 0.87 (95%CI: 0.846-0.892; P < 0.001). Overall intra-observer reliability ICC was 0.883 (95%CI: 0.854-0.909; P < 0.001). A direct correlation between the CTF score and surgical treatment indication [Pearson correlation coefficient = 0.94 (P < 0.001)] was found. According to the 75% cut-off, the sensitivity was 100% (95%CI: 83.43%-100%), specificity was 85.71% (95%CI: 75.29%-92.93%), PLHR was 7 (95%CI: 3.94-12.43), NLHR was 0 (95%CI: 0-0), PPV was 75% (95%CI: 62.83%-84.19%) and NPV was 100% (95%CI: 100%-100%).

Research conclusions

CTF represents a useful tool for orthopedic surgeons in the FFF evaluation. The CTF score is a quality questionnaire to reproduce suitable clinical research, survey studies, and clinical practice. Moreover, the 75% cut-off is an important threshold for surgical indication and helps in the decision-making process.

Research perspectives

CTF needs further multicentric studies to increase its validity for diagnostic and surgical indications in FFF.