Rationale and Objectives Bleomycin electrosclerotherapy (BEST) is a promising treatment for slow-flow vascular malformations (SFVMs). Due to limited paediatric data, this study aimed to assess the safety, effectiveness, and patient-reported outcomes of BEST in children with SFVMs. Material and Methods This monocenter cohort study included patients <18 years with symptomatic SFVMs treated by BEST. Patient records were analysed for procedural details and complications. Symptom severity was objectively classified before and after BEST. A treatment-specific, patient-reported questionnaire assessed mobility, aesthetic concerns, swelling, social participation, pain using a visual analogue scale (VAS), and post-procedural skin discoloration. Outcomes were compared between simple and infiltrative lesions. Results Overall, 68 BEST sessions were performed in 45 children. Total complication rate was 10/68 (14.7%), most commonly pes equinus deformities (5/68, 7.4%) after treating SFVMs in calf muscles. Physician-rated overall symptom severity improved significantly (p<0.001). Treatment-specific, patient-reported questionnaire revealed improved mobility in 14/41 (34.1%) and symptom-free patients in 10/41 (24.4%). Outcome in both aesthetic measure and social participation was mostly rated as improved or perfect (33/41, 80.5%; 35/41, 85.4%). Median VAS pain scale improved significantly (2.0 vs. 0.0, p<0.001). Postprocedural swelling occurred in all children, in 26/41 cases (64.4%) persisting for 2-4 weeks. Postprocedural skin discoloration (41/41, 100%) was mostly (25/41, 61.0%) reported to fade over time. No differences between simple and infiltrative lesions were revealed in all outcome parameters. Conclusion BEST is effective for paediatric SFVMs by objective and subjective measures while maintaining low complication rates. Notably, BEST achieves therapeutic success even in infiltrative SFVMs expanding the range of available treatment options.

Background: Flatfeet in children are common, causing concern for parents due to potential symptoms. Technological advances, like 3D foot kinematic analysis, have revolutionized assessment. This review examined 3D assessments in paediatric idiopathic flexible flat feet (FFF). Methods: Searches focused on paediatric idiopathic FFF in PubMed, Web of Science, and SCOPUS. Inclusion criteria required 3D kinematic and/or kinetic analysis during posture or locomotion, excluding non-idiopathic cases, adult feet, and studies solely on pedobarography or radiographs. Results: Twenty-four studies met the criteria. Kinematic and kinetic differences between FFF and typical feet during gait were outlined, with frontal plane deviations like hindfoot eversion and forefoot supination, alongside decreased second peak vertical GRF. Dynamic foot classification surpassed static assessments, revealing varied movement patterns within FFF. Associations between gait characteristics and clinical measures like pain symptoms and quality of life were explored. Interventions varied, with orthoses reducing ankle eversion and knee and hip abductor moments during gait, while arthroereisis normalized calcaneal alignment and hindfoot eversion. Conclusions: This review synthesises research on 3D kinematics and kinetics in paediatric idiopathic FFF, offering insights for intervention strategies and further research.