1
|
Özhan A, Günaydın F. Impact of static foot disorders on the conservative treatment success in chronic venous disease patients without wounds. J Vasc Surg Venous Lymphat Disord 2024; 12:101849. [PMID: 38350496 DOI: 10.1016/j.jvsv.2024.101849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE Chronic venous disease (CVD) and static foot disorders (SFDs) are prevalent conditions that commonly cause lower extremity pain. These conditions share common factors such as age and weight in their etiology. This study aimed to investigate the impact of SFDs on the treatment response of patients undergoing conservative treatment for CVD without wounds. MATERIALS AND METHODS A retrospective evaluation was conducted on 328 patients (60 males, 268 females) with CVD. Parameters including age, gender, affected side, body mass index, Visual Analog Scale (VAS), Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, and revised Venous Clinical Severity Score (rVCSS) were considered for evaluation. Radiological measurements of calcaneal pitch angle (CPA) were analyzed as a determinant of SFDs. RESULTS VAS and rVCSS of the patients were evaluated before and after conservative treatment of CVD without concomitant treatment of SFDs. The presence of SFDs was associated with decreased treatment success (P < .001). Among different types of SFDs, the pes cavus group exhibited the lowest change in VAS and rVCSS scores before and after conservative CVD treatment. In contrast, the normal group demonstrated the highest improvement. Patients with a normal foot medial arch consistently achieved the best treatment outcomes compared with patients with other SFDs. CONCLUSIONS In conclusion, SFDs affect outcomes of conservative treatment of CVD in CEAP 0 to 3 patients, with the efficacy of treatment dependent upon the severity of SFDs.
Collapse
Affiliation(s)
- Abdulkerim Özhan
- Department of Cardiovascular Surgery, Göztepe Prof Dr Süleyman Yalçın State Hospital, İstanbul, Turkey
| | - Fatih Günaydın
- Department of Orthopaedic Surgery, Mersin Training and Research State Hospital, Mersin, Turkey.
| |
Collapse
|
2
|
Pasapula CS, Choudkhuri MR, Monzó ERG, Dhukaram V, Shariff S, Pasterse V, Richie D, Kobezda T, Solomou G, Cutts S. Review of Classification Systems for Adult Acquired Flatfoot Deformity/Progressive Collapsing Foot Deformity and the Novel Development of the Triple Classification Delinking Instability/Deformity/Reactivity and Foot Type. J Clin Med 2024; 13:942. [PMID: 38398256 PMCID: PMC10889573 DOI: 10.3390/jcm13040942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Classifications of AAFD/PCFD have evolved with an increased understanding of the pathology involved. A review of classification systems helps identify deficiencies and respective contributions to the evolution in understanding the classification of AAFD/PCFD. Methods: Using multiple electronic database searches (Medline, PubMed) and Google search, original papers classifying AAFD/PCFD were identified. Nine original papers were identified that met the inclusion criteria. Results: Johnson's original classification and multiple variants provided a significant leap in understanding and communicating the pathology but remained tibialis posterior tendon-focused. Drawbacks of these classifications include the implication of causality, linearity of progression through stages, an oversimplification of stage 2 deformity, and a failure to understand that multiple tendons react, not just tibialis posterior. Later classifications, such as the PCFD classification, are deformity-centric. Early ligament laxity/instability in normal attitude feet and all stages of cavus feet can present with pain and instability with minor/no deformity. These may not be captured in deformity-based classifications. The authors developed the 'Triple Classification' (TC) understanding that primary pathology is a progressive ligament failure/laxity that presents as tendon reactivity, deformity, and painful impingement, variably manifested depending on starting foot morphology. In this classification, starting foot morphology is typed, ligament laxities are staged, and deformity is zoned. Conclusions: This review has used identified deficiencies within classification systems for AAFD/PCFD to delink ligament laxity, deformity, and foot type and develop the 'Triple classification'. Advantages of the TC may include representing foot types with no deformity, defining complex secondary instabilities, delinking foot types, tendon reactivity/ligament instability, and deformity to represent these independently in a new classification system. Level of Evidence: Level V.
Collapse
Affiliation(s)
- Chandra Seker Pasapula
- The Queen Elizabeth Hospital Kings Lynn, NHS Foundation Trust, King’s Lynn PE30 4ET, UK; (C.S.P.); (M.R.C.); (T.K.)
| | - Makhib Rashid Choudkhuri
- The Queen Elizabeth Hospital Kings Lynn, NHS Foundation Trust, King’s Lynn PE30 4ET, UK; (C.S.P.); (M.R.C.); (T.K.)
| | | | - Vivek Dhukaram
- University Hospitals Coventry & Warwickshire, Coventry CV2 2DX, UK;
| | - Sajid Shariff
- Medway Maritime Hospital, NHS Foundation Trust, Kent ME7 5NY, UK;
| | | | - Douglas Richie
- California School of Podiatric Medicine, Samuel Merritt University, Oakland, CA 94609, USA;
| | - Tamas Kobezda
- The Queen Elizabeth Hospital Kings Lynn, NHS Foundation Trust, King’s Lynn PE30 4ET, UK; (C.S.P.); (M.R.C.); (T.K.)
| | - Georgios Solomou
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 2EL, UK
| | - Steven Cutts
- James Paget University Hospitals, NHS Foundation Trust, Great Yarmouth NR31 6LA, UK;
| |
Collapse
|
3
|
Subasi O, Sharma S, Karaismailoglu B, Hresko A, Waryasz G, Ashkani-Esfahani S, Bejarano-Pineda L. In silico comparative biomechanical analysis of oblique and chevron medial displacement calcaneal osteotomies for pes planus deformity. Comput Biol Med 2024; 169:107945. [PMID: 38199207 DOI: 10.1016/j.compbiomed.2024.107945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/04/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Medializing displacement calcaneal osteotomy is commonly performed as part of reconstructive surgery for patients with valgus hindfoot and progressive pes planus deformity. Among several types of calcaneal osteotomies, the oblique and Chevron osteotomy patterns have been commonly described in the literature and gained popularity as they are easily reproducible through percutaneous techniques. Currently, there is scarce evidence in the literature on which cut pattern is superior in terms of stability. To investigate the impact of cut pattern and posterior fragment medialization level on foot biomechanics, computational methods are employed. METHODS Ankle weightbearing computer tomography (CT) scans of seven patients diagnosed with stage II pes planus deformity are segmented and converted into 3D computational models. Oblique and Chevron osteotomy patterns are modeled independently for each patient. The posterior fragments are medially translated by 8-, 10- and 12-mm and subsequently fixated to the anterior calcaneus with two screws. A total of 42 models are exported to finite element software for biomechanical simulations. Among the investigated parameters, the higher stiffness and lower von Mises stress at the osteotomy interface and the screw site are assumed to be precursors of better stability. RESULTS It is recorded that as the medialization level increases, the stiffness decreases, and overall stresses increase. Also, it is observed that the Chevron cut produces a stiffer construct while the overall stresses are lower, indicating better stability when compared to the oblique cut. The statistical comparisons of the relevant groups that support these trends are found to be significant (p < 0.05). CONCLUSION Chevron osteotomy showed superior stability compared to the oblique osteotomy while underscoring the negative impact of increased medialization of the posterior fragment. CLINICAL RELEVANCE Opting for a lower medialization level and implementing the Chevron technique may facilitate union and earlier weightbearing.
Collapse
Affiliation(s)
- Omer Subasi
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA.
| | - Siddartha Sharma
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA; Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bedri Karaismailoglu
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA; CAST (Cerrahpasa Research Simulation and Design) Laboratory, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Andrew Hresko
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA; Harvard Combined Orthopaedic Residency Program (HCORP), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA
| | - Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02493, USA
| |
Collapse
|
4
|
Chen C, Li Z, Zhang Y, Zhou H, Li Y, He W, Ye T, Yang Y. What's the clinical significance of VAS, AOFAS, and SF-36 in progressive collapsing foot deformity. Foot Ankle Surg 2024; 30:103-109. [PMID: 37858492 DOI: 10.1016/j.fas.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/15/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This study aimed to ascertain the minimal clinically important difference (MCID), and substantial clinical benefit (SCB) of the American Orthopedic Foot and Ankle Society (AOFAS) scale, visual analog scale (VAS) for pain, and Short Form-36 Health Survey (SF-36) in progressive collapsing foot deformity (PCFD) surgery. METHODS In this retrospective cohort study, a total of 84 patients with PCFD (84 feet) who underwent surgery between July 2015 and April 2021 were included. The study assessed the patients' subjective perception, as well as their VAS, AOFAS, and SF-36 scores at a minimum two-year follow-up, and these data were subjected to statistical analysis. The study utilized Spearman correlation analysis to determine the degree of correlation between patients' subjective perception and their VAS, AOFAS, and SF-36 scores. The minimal detectable change (MDC), MCID, and SCB for VAS, AOFAS, and SF-36 were calculated using both distribution- and anchor-based methods. The classification outcomes obtained from the distribution- and anchor-based methods were assessed using Cohen's kappa. RESULTS Based on the subjective perception of the patients, a total of 84 individuals were categorized into three groups, with 7 in the no improvement group, 14 in the minimum improvement group, and 63 in the substantial improvement group. Spearman's correlation analysis indicated that the patients' subjective perception exhibited a moderate to strong association with VAS, AOFAS, SF-36 PCS, and SF-36 MCS, with all coefficients exceeding 0.4. The MCID of VAS, AOFAS, SF-36 PCS, and SF-36 MCS in PCFD surgery were determined to be 0.93, 5.84, 4.15, and 4.10 points using the distribution-based method and 1.50, 10.50, 8.34, and 3.03 points using the anchor-based method. The SCB of VAS, AOFAS, SF-36 PCS, and SF-36 MCS in PCFD surgery were 2.50, 18.50, 11.88, and 6.34 points, respectively. Moreover, the preliminary internal validation efforts have demonstrated the practical application and clinical utility of these findings. With the exception of the distribution-based MCID of SF-36 PCS, which showed fair agreement, all other measures demonstrated moderate to almost perfect agreement. CONCLUSIONS The MDC, MCID, and SCB intuitively enhance the interpretation of VAS, AOFAS, and SF-36 in PCFD surgery, assisting all stakeholders to better understand the therapeutic benefits and limitations of clinical care, and thus to make a more rational decision. Each of these parameters has its own emphasis and complements the others. These parameters are recommended for evaluating the clinical relevance of the results, and their promotion should extend to other areas of foot and ankle surgery.
Collapse
Affiliation(s)
- Cheng Chen
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - ZhenDong Li
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yi Zhang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - HaiChao Zhou
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - YongQi Li
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - WenBao He
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - TianBao Ye
- Department of Cardiology, Shanghai JiaoTong University Affiliated Sixth Peoples Hospital, Shanghai 200233, China.
| | - YunFeng Yang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
| |
Collapse
|
5
|
Schmidt E, Lalevée M, Kim KC, Carvalho KAMD, Dibbern K, Lintz F, Barbachan Mansur NS, de Cesar Netto C. The Role of the Transverse Arch in Progressive Collapsing Foot Deformity. Foot Ankle Int 2024; 45:44-51. [PMID: 37902231 DOI: 10.1177/10711007231205298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND The transverse arch (TA) has recently been shown to significantly increase the intrinsic stiffness of the midfoot when coupled with the medial longitudinal arch (MLA). Progressive collapsing foot deformity (PCFD) is a complex deformity that ultimately results in a loss of stiffness and collapse of the MLA. The role of the TA has not been investigated in patients diagnosed with this disorder using weightbearing CT (WBCT). Therefore, this study aims to answer the following questions: (1) Is the curvature of the TA decreased in PCFD? (2) Where within the midfoot does TA curvature flattening happen in PCFD? METHODS A retrospective review of weightbearing CT images was conducted for 32 PCFD and 32 control feet. The TA curvature was assessed both indirectly using previously described methods and directly using a novel measurement termed the transverse arch plantar (TAP) angle that assesses the angle formed between the first, second, and fifth metatarsals in the coronal plane. Location of TA collapse was also assessed in the coronal plane. RESULTS The TAP angle was significantly higher in PCFD (mean 115.2 degrees, SD 10.7) than in the control group (mean 100.8 degrees, SD 7.9) (P < .001). No difference was found using the calculated normalized TA curvature between PCFD (mean 17.1, SD 4.8) and controls (mean 18.3, SD 4.0) (P = .266). Location of collapse along the TA in PCFD was most significant at the second metatarsal and medial cuneiform. CONCLUSION The TA is more collapsed in PCFD compared to controls. This collapse was most substantial between the plantar medial cuneiform and the plantar second metatarsal. This may represent a location of uncoupling of the TA and MLA. LEVEL OF EVIDENCE Level III, retrospective case control.
Collapse
Affiliation(s)
- Eli Schmidt
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Ki Chun Kim
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea
| | | | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Francois Lintz
- Department of Foot and Ankle Surgery, Ramsay Healthcare, Clinique de L'Union, Saint-Jean, France
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Federal University of Sao Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, Sau Paulo, Brazil
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
6
|
Gowda P, Kohli A, Chhabra A. Two-Dimensional and 3-Dimensional MRI Assessment of Progressive Collapsing Foot Deformity-Adult Acquired Flat Foot Deformity. Foot Ankle Clin 2023; 28:551-566. [PMID: 37536818 DOI: 10.1016/j.fcl.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
This article is meant to serve as a reference for radiologists, orthopedic surgeons, and other physicians to enhance their understanding of progressive collapsing foot deformity, also known as adult acquired flat foot deformity. Pathophysiology, imaging findings, especially on MRI and 3-dimensional MRI are discussed with relevant illustrations so that the readers can apply these principles in their practice for better patient managements.
Collapse
Affiliation(s)
- Prajwal Gowda
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ajit Kohli
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
7
|
Saraiva D, Knupp M, Rodrigues AS, Tulha J, Gomes TM, Oliva XM, Diaz T. Outcomes of Combined Posterior Tibial Tendon Tendoscopy and Medializing Calcaneal Osteotomy for Stage IA Progressive Collapsing Foot Deformity. Foot Ankle Int 2023; 44:629-636. [PMID: 37209035 DOI: 10.1177/10711007231167364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Posterior tibial tendon (PTT) tendoscopy and medializing calcaneal osteotomy (MCO) are among the available techniques for patients presenting with symptomatic flexible hindfoot valgus (stage IA) progressive collapsing foot deformity (PCFD). The aim of this study was to determine clinical and radiographic outcomes of combined PTT tendoscopy and MCO for patients presenting with symptomatic stage IA PCFD. METHODS A retrospective cohort study was performed in order to determine clinical and radiographic outcomes of 30 combined PTT tendoscopies and MCO on 27 patients presenting with symptomatic stage IA PCFD, with a minimum follow-up of 24 months. Patient satisfaction was assessed at last available follow-up as very satisfied, satisfied, and unsatisfied. Clinical assessment was performed evaluating preoperative and last available follow-up visual analog scale for pain (VAS-P), Foot and Ankle Outcome Score (FAOS), and the 36-Item Short Form Health Survey (SF-36). Magnetic resonance imaging (MRI) was performed preoperatively on all patients. Standard weightbearing anteroposterior, lateral, and long axial view radiographs of the foot and ankle were taken preoperatively, immediate postoperatively, at 6 weeks, 3 months, 6 months, 1 year postoperatively, and last follow-up evaluation available for each patient. RESULTS The mean follow-up was 38.6 (range, 26-62) months. We registered 27 very satisfied, 1 satisfied, and 2 unsatisfied patients. There was statistically significant improvement on all clinical scores (VAS-P, FAOS and SF-36), as well as on lateral talo-first metatarsal and hindfoot alignment angles. We found low-grade PTT tears in 5 patients (16.67%) in whom preoperative MRI documented PTT tenosynovitis alone. CONCLUSION We found that combined PTT tendoscopy and MCO provide significant clinical and radiographic improvement for patients presenting with symptomatic stage IAB PCFD. PTT tendoscopy should be considered in the treatment of all surgically addressed flexible valgus feet as it detects tendon tears which are frequently missed on an MRI. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Daniel Saraiva
- Hospital da Prelada, Porto, Portugal
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Markus Knupp
- Mein Fusszentrum, Basel, Switzerland
- Faculty of Medicine, University of Basel, Switzerland
| | | | | | - Tiago Mota Gomes
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Xavier Martín Oliva
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Tania Diaz
- Molecular Oncology and Embryology Laboratory, Department of Anatomy and Human Embryology, Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| |
Collapse
|
8
|
Boivin J, Traynor C, Stehlik K, Jastifer J. Radiographic Measurements of the Foot and Ankle After Ankle Arthrodesis. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231187888. [PMID: 37502710 PMCID: PMC10369094 DOI: 10.1177/24730114231187888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Background Ankle arthrodesis is an established treatment for ankle arthritis. For patients with ankle arthritis, the position of the talus during ankle arthrodesis may affect the radiographic parameters of the foot. The purpose of this study is to assess the radiographic relationship between talar alignment and the longitudinal arch of the foot before and after ankle arthrodesis. Methods We retrospectively reviewed a single-surgeon series of 30 patients who had undergone ankle arthrodesis. Measured parameters included the lateral tibiotalar angle (LTTA), lateral talometatarsal angle (LTMA), lateral talocalcaneal angle (LTCA), cuneiform height (CH), and calcaneal pitch (CP). Additional data collected included demographics, fusion construct type, and visual analog scale (VAS) measurements. Results LTTA was increased from 68.2 ± 7.4 degrees preoperatively to 75.0 ± 6.4 degrees postoperatively (P = .001), LTMA increased from -2.0 ± 10.7 degrees to 4.0 ± 10.1 degrees (P < .001), CH increased from 20.1 ± 7.5 mm to 26.1 ± 8.4 mm (P < .001), LTCA and CP had no statistically significant change. VAS score decreased from 5.7 ± 2.7 to 1.3 ± 1.9 (P < .001). Conclusion Correcting the talar alignment in the sagittal plane during ankle arthrodesis improved the radiographic parameters of the foot, contributing to restoration of the longitudinal arch. The clinical significance of these findings is that in patients undergoing ankle arthrodesis, the surgeon should be aware that the alignment of the foot will be altered at the time of ankle arthrodesis and should be considered in preoperative planning. Further research is needed to determine the effect of ankle arthrodesis in patients determined to have pes planus preoperatively. Level of Evidence Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Jordan Boivin
- Western Michigan Homer Stryker School of Medicine, Kalamazoo, MI, USA
| | | | - Kevin Stehlik
- Western Michigan Homer Stryker School of Medicine, Kalamazoo, MI, USA
| | - James Jastifer
- Western Michigan Homer Stryker School of Medicine, Kalamazoo, MI, USA
| |
Collapse
|
9
|
Badawy MA, Kholeif AM, Radwan YA, EL Sersawy AM. Comparative study between medial displacement calcaneal osteotomy using modified step plate and arthroereisis for management of planovalgus feet. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2023. [DOI: 10.1177/22104917221136283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Flexible flatfoot is a common condition that is characterized by hindfoot valgus with longitudinal medial-arch collapse. Many strategies for treatment have been reported but according to the current literature, controversy remains. Objectives: To compare the clinical and radiological outcomes of medializing calcaneal osteotomy utilizing modified step plate and subtalar arthroereisis utilizing conical subtalar implant for patients with symptomatic flexible pes planus. Methods: A prospective, randomized, double center study was conducted between May 2017 and May 2019 at the Foot and Ankle Department of Cairo University Hospital and El Sahel Teaching Hospital on 26 patients (37 feet) with flexible flat feet to compare between medial displacement calcaneal osteotomy using modified locked step plate (group A) compromising 17 feet and arthroereisis using subtalar implant (group B) compromising 20 feet. Results: By the end period of the study, 25 males and 12 females were available for our analysis of results with a mean follow-up period of 10.14 months (range 7–14 months), clinical scoring (American Orthopaedic Foot and Ankle Society score, Foot Functional Index) with radiological analysis revealed a non-significant difference between both groups, the overall complication rate was 16.2%. Conclusion: Both medial displacement calcaneal osteotomy and subtalar arthroereisis significantly improved radiographic and subjective clinical outcome measures in the surgical treatment of painful flexible planovalgus feet. The less-invasive nature and lower potential morbidity suggest that judicious use of arthroereisis implants is an appropriate alternative.
Collapse
Affiliation(s)
| | - Ahmed M Kholeif
- Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser A Radwan
- Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | |
Collapse
|
10
|
Mateen S, Van JC. Ligament Insufficiency with Flatfoot: Spring Ligament and Deltoid Ligament. Clin Podiatr Med Surg 2023; 40:307-314. [PMID: 36841581 DOI: 10.1016/j.cpm.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The objective of this article was to review the deltoid ligament and spring ligament specifically as they pertain to ligament insufficiency and adult-acquired flatfoot deformity. Discussion includes the normal and abnormal biomechanical forces that extend through these ligaments in normal and flatfoot deformity. Current literature related to spring ligament repair as part of the flatfoot deformity reconstruction is also reviewed.
Collapse
Affiliation(s)
- Sara Mateen
- Foot and Ankle Deformity and Orthoplastics, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jennifer C Van
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
| |
Collapse
|
11
|
Approach to the Ankle in Adult Acquired Flatfoot Deformity. Clin Podiatr Med Surg 2023; 40:341-349. [PMID: 36841584 DOI: 10.1016/j.cpm.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Adult acquired flatfoot is a progressive deformity of the foot and ankle, which frequently becomes increasingly symptomatic. The posterior tibial tendon is most commonly associated with the deformity. A targeted physical examination with plain film radiographs is the recommended initial assessment, which will further guide a physician toward procuring more advanced imaging or toward surgical intervention. In this chapter the authors review the current literature of their approach to the treatment of the ankle in end stage of adult acquired flatfoot deformity.
Collapse
|
12
|
Schleunes S, Catanzariti A. Addressing Medial Column Instability in Flatfoot Deformity. Clin Podiatr Med Surg 2023; 40:271-291. [PMID: 36841579 DOI: 10.1016/j.cpm.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A stable medial column is important to the normal function of the foot and ankle. Medial column instability and forefoot varus can result in compensatory hindfoot motion leading to stress along the medial soft-tissue structures. Medial column stabilization should therefore be considered when (1) forefoot varus deformity is identified following hindfoot realignment; (2) pronounced medial column instability is present, even in the absence of forefoot varus; and (3) when degenerative changes are present within the medial column articulations. Common surgical procedures include arthrodesis of the talonavicular joint, naviculocuneiform joint, and first tarsometatarsal joint, as well as osteotomy of the medial cuneiform (Cotton osteotomy).
Collapse
Affiliation(s)
- Scott Schleunes
- Department of Orthopedics, Division of Foot & Ankle Surgery, West Penn Hospital, Pittsburgh, PA, USA
| | - Alan Catanzariti
- Department of Orthopedic, Allegheny Health Network, West Penn Hospital, Foot and Ankle Institute, 4800 Friendship Avenue N1, Pittsburgh, PA 15224, USA.
| |
Collapse
|
13
|
Theodoulou MH, Ravine M. Anatomic and Biomechanical Considerations of Flatfoot Deformity. Clin Podiatr Med Surg 2023; 40:239-246. [PMID: 36841576 DOI: 10.1016/j.cpm.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this article, the authors present essential anatomy in the presence of the postural flat foot. There is a recognition of static versus dynamic stabilizers of the foot. In the continuum of the collapsed foot, there is an exploration of anatomic and pathologic changes. Providing this fundamental knowledge will allow the reader to appreciate the disease process to establish a prognosis and consider treatment alternatives.
Collapse
Affiliation(s)
- Michael H Theodoulou
- Cambridge Health Alliance, Harvard Medical School, 1493 Cambride Street, Cambridge, MA 02139, USA
| | - Madison Ravine
- Cambridge Health Alliance, Harvard Medical School, 1493 Cambride Street, Cambridge, MA 02139, USA.
| |
Collapse
|
14
|
Dibbern K, Vivtcharenko V, Salomao Barbachan Mansur N, Lalevée M, Alencar Mendes de Carvalho K, Lintz F, Barg A, Goldberg AJ, de Cesar Netto C. Distance mapping and volumetric assessment of the ankle and syndesmotic joints in progressive collapsing foot deformity. Sci Rep 2023; 13:4801. [PMID: 36959355 PMCID: PMC10036322 DOI: 10.1038/s41598-023-31810-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023] Open
Abstract
The early effects of progressive collapsing foot deformity (PCFD) on the ankle and syndesmotic joints have not been three-dimensionally quantified. This case-control study focused on using weight bearing CT (WBCT) distance (DM) and coverage maps (CM) and volumetric measurements as 3D radiological markers to objectively characterize early effects of PCFD on the ankle and syndesmotic joints. Seventeen consecutive patients with symptomatic stage I flexible PCFD and 20 matched controls that underwent foot/ankle WBCT were included. Three-dimensional DM and CM of the ankle and syndesmotic joints, as well volumetric assessment of the distal tibiofibular syndesmosis was performed as possible WBCT markers of early PCFD. Measurements were compared between PCFD and controls. Significant overall reductions in syndesmotic incisura distances were observed in PCFD patients when compared to controls, with no difference in the overall syndesmotic incisura volume at 1, 3, 5 and 10 cm proximally to the ankle joint. CMs showed significantly decreased articular coverage of the anterior regions of the tibiotalar joint as well as medial/lateral ankle joint gutters in PCFD patients. This study showed syndesmotic narrowing and decreased articular coverage of the anterior aspect of the ankle gutters and talar dome in stage I PCFD patients when compared to controls. These findings are consistent with early plantarflexion of the talus within the ankle Mortise, and absence of true syndesmotic overload in early PCFD, and support DM and CM as early 3D PCFD radiological markers.
Collapse
Affiliation(s)
- Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Victoria Vivtcharenko
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Service d'orthopédie Traumatologie, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany
| | | | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| |
Collapse
|
15
|
Osbeck I, Cöster M, Montgomery F, Atroshi I. Surgically treated adult acquired flatfoot deformity: Register-based study of patient characteristics, health-related quality of life and type of surgery according to severity. Foot Ankle Surg 2023; 29:367-372. [PMID: 36948921 DOI: 10.1016/j.fas.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/20/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Population-level data describing patient characteristics and interventions used in surgical treatment of adult acquired flatfoot deformity (AAFD) is lacking. METHODS We analyzed baseline patient-reported data including PROMs and surgical interventions for patients with AAFD reported to the Swedish Quality Register for Foot and Ankle Surgery (Swefoot) 2014-2021. RESULTS 625 feet with primary AAFD surgery were registered. Median age was 60 (range 16-83) years and 64% were women. Mean preoperative EQ-5D index and Self-Reported Foot and Ankle Score (SEFAS) were low. In stage IIa (n = 319) 78% had medial displacement calcaneal osteotomy and 59% had flexor digitorium longus transfer, with some regional variations. Spring ligament reconstruction was less common. In stage IIb (n = 225), 52% had lateral column lengthening, and in stage III (n = 66), 83% had hind-foot arthrodesis. CONCLUSIONS Patients with AAFD have low health-related quality of life before surgery. Treatment in Sweden follows best-available evidence but regional variations exist. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Ida Osbeck
- Department of Clinical Sciences Lund - Orthopedics, Lund University, Lund, Sweden.
| | - Maria Cöster
- Department of Clinical Sciences Malmö - Orthopedics, Lund University, Lund, Sweden; Department of Surgical sciences - Uppsala University, Uppsala, Sweden
| | - Fredrik Montgomery
- Department of Clinical Sciences Malmö - Orthopedics, Lund University, Lund, Sweden
| | - Isam Atroshi
- Department of Clinical Sciences Lund - Orthopedics, Lund University, Lund, Sweden; Department of Orthopedics, Hässleholm Hospital, Hässleholm, Sweden
| |
Collapse
|
16
|
Masaragian HJ, Rega L, Ameriso N, Perin F, Fabrego C, Veizaga J. The Potential of Endoscopic Spring Ligament Repair in Flatfoot Reconstruction. Foot Ankle Int 2023; 44:200-209. [PMID: 36825594 DOI: 10.1177/10711007231152874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Spring ligament fulfills 2 main important functions: one, supporting the head of the talus and stabilizing the talonavicular joint, and the other, maintaining the longitudinal arch by acting as a static support. In this preliminary report, we describe an endoscopic repair for spring ligament injuries with modified portals. METHODS We performed a retrospective case series study from February 2019 to January 2022. Posterior tibial tendon and/or associated bone deformities were assessed at the same surgical procedure. All patients were ≥18 years old and they had more than 6 months of follow-up. The procedure was performed in 11 patients. Mean age was 46 years (range 18-63). Ten had concomitant bony realignment surgery, and 8 had posterior tibial tendon surgery. RESULTS In all patients, endoscopic spring ligament repair could be technically done. The modified portals were used in all procedures as described in the surgical technique. Three patients had a superficial lesion, 1 had a rupture <5 mm, 7 had a rupture >5 mm but not a complete rupture through the entire spring ligament. Most of the patients had good clinical results from the surgery that included endoscopic spring ligament debridement and/or repair at 2 years follow up. CONCLUSION In this small series we found that endoscopy may be an effective technique to diagnose and treat incomplete spring ligament injuries. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
| | - Leonel Rega
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
| | - Nicolas Ameriso
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
| | - Fernando Perin
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
| | - Cesar Fabrego
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
| | - Johann Veizaga
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
| |
Collapse
|
17
|
Lalevée M, Barbachan Mansur NS, Lee HY, Ehret A, Tazegul T, de Carvalho KAM, Bluman E, de Cesar Netto C. A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment. Arch Orthop Trauma Surg 2023; 143:1331-1339. [PMID: 34859296 DOI: 10.1007/s00402-021-04279-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Bluman et al., flatfoot classification is based on posterior tibial tendon (PTT) dysfunction leading to a chronological appearance of several foot deformities. An expert consensus recently proposed a new classification named Progressive Collapsing Foot Deformity (PCFD) in which the focus was shifted to five different independent foot and ankle deformities and their flexibility or rigidity. The aim of this study was to compare Bluman and PCFD classifications. We hypothesize that both classifications will be reliable and that the PCFD classification will allow a larger distribution of the different types of foot deformity. MATERIALS AND METHODS We performed a retrospective IRB-approved study including 92 flatfeet. Three foot and ankle surgeons reviewed patient files and radiographs to classify each foot using both classifications. Bluman classification was performed one time as initially described and a second time after removing the Angle of Gissane sclerosis sign. Interobserver reliabilities were determined with Fleiss' kappa values. RESULTS Interobserver reliabilities of Bluman and PCFD classifications were, respectively, substantial 0.67 and moderate 0.55. PCFD Class C and D reliabilities were, respectively, slight 0.07 and fair 0.28. The 276 readings were spread into 10 substages in Bluman and 65 subclasses in PCFD. The progressivity of the Bluman classification prevented the combination of flexible hindfoot valgus (II Bluman, 1A PCFD), midfoot abduction (IIB, 1B) and medial column instability (IIC, 1C) which was frequent in our study (112/276 readings, 40.6%). By removing the Angle of Gissane sclerosis sign from the Bluman classification, the prevalence of stage III decreased from 44.2 to 10.1%. CONCLUSIONS Bluman and PCFD classifications were reliable. The PCFD classification showed a larger distribution of different types of flatfeet but Classes C and D need better definition. The progressivity of Bluman classification causes inconsistencies and Gissane angle sclerosis sign is inappropriately used and might lead to incorrect surgical indications.
Collapse
Affiliation(s)
- Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA.,Department of Orthopedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA.,Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil
| | - Hee Young Lee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA
| | - Amanda Ehret
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA
| | - Tutku Tazegul
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA
| | - Eric Bluman
- Orthopedic Surgery, Brigham Health, 75 Francis Street, Boston, MA, 02115, USA.,Brigham and Women's Faulkner Hospital, Orthopaedic Center, 1153 Centre Street, Suite 5 South, Boston, MA, 02130, USA
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA, 52242, USA.
| |
Collapse
|
18
|
Villena DS, Sotelano P, Santini Araujo MG, Conti L, Parise AC, Carrasco M. Osteotomía de Evans sin injerto óseo en el pie plano estadio IIB del adulto. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2023. [DOI: 10.15417/issn.1852-7434.2023.88.1.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Objetivo: Evaluar los resultados radiográficos y funcionales al año de la cirugía, en una serie consecutiva de pacientes con diagnóstico de pie plano valgo estadio IIB, sometidos a una osteotomía de Evans sin injerto óseo.
Materiales y Métodos: Se evaluó, en forma retrospectiva, a dos grupos de pacientes: grupo 1 (placa con espaciador, n = 12) y grupo 2 (celdas de PEEK, n = 14). La edad promedio era de 47 años (DE 18) en el grupo 1 y de 54 años (DE 12) en el grupo 2.
Resultados: Se evaluó a 26 pacientes (28 pies operados); 20 (77%) eran mujeres. Las mediciones radiográficas: ángulo de inclinación del calcáneo, ángulo astrágalo-calcáneo (perfil), ángulo astrágalo-calcáneo (frente), cobertura astragalonavicular, altura de la columna medial, longitud de la columna externa, arrojaron diferencias estadísticamente significativas entre las determinaciones preoperatorias y al año dela cirugía. El puntaje promedio de la escala de la AOFAS al año fue de 96 (DE 4,70) en el grupo 1 y de 95 (DE 4,98) en el grupo 2. El puntaje en la escala analógica visual para dolor fue de 1,2 (DE 0,42) en el grupo 1 y 1,16 (DE 0,46) en el grupo 2.
Conclusiones: De acuerdo con los resultados obtenidos, concluimos en que la osteotomía de Evans sin el uso de injerto óseo logra preservar las correcciones obtenidas en el mediano plazo utilizando placas con espaciador o celdas de PEEK.
Collapse
|
19
|
Rhim HC, Dhawan R, Gureck AE, Lieberman DE, Nolan DC, Elshafey R, Tenforde AS. Characteristics and Future Direction of Tibialis Posterior Tendinopathy Research: A Scoping Review. Medicina (B Aires) 2022; 58:medicina58121858. [PMID: 36557060 PMCID: PMC9781788 DOI: 10.3390/medicina58121858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives: Tibialis posterior tendon pathologies have been traditionally categorized into different stages of posterior tibial tendon dysfunction (PTTD), or adult acquired flatfoot deformity (AAFD), and more recently to progressive collapsing foot deformity (PCFD). The purpose of this scoping review is to synthesize and characterize literature on early stages of PTTD (previously known as Stage I and II), which we will describe as tibialis posterior tendinopathy (TPT). We aim to identify what is known about TPT, identify gaps in knowledge on the topics of TPT, and propose future research direction. Materials and Methods: We included 44 studies and categorized them into epidemiology, diagnosis, evaluation, biomechanics outcome measure, imaging, and nonsurgical treatment. Results: A majority of studies (86.4%, 38 of 44 studies) recruited patients with mean or median ages greater than 40. For studies that reported body mass index (BMI) of the patients, 81.5% had mean or median BMI meeting criteria for being overweight. All but two papers described study populations as predominantly or entirely female gender. Biomechanical studies characterized findings associated with TPT to include increased forefoot abduction and rearfoot eversion during gait cycle, weak hip and ankle performance, and poor balance. Research on non-surgical treatment focused on orthotics with evidence mostly limited to observational studies. The optimal exercise regimen for the management of TPT remains unclear due to the limited number of high-quality studies. Conclusions: More epidemiological studies from diverse patient populations are necessary to better understand prevalence, incidence, and risk factors for TPT. The lack of high-quality studies investigating nonsurgical treatment options is concerning because, regardless of coexisting foot deformity, the initial treatment for TPT is typically conservative. Additional studies comparing various exercise programs may help identify optimal exercise therapy, and investigation into further nonsurgical treatments is needed to optimize the management for TPT.
Collapse
Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA
| | - Ravi Dhawan
- Department of Epidemiology and Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Ashley E. Gureck
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel E. Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - David C. Nolan
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, MA 02115, USA
| | - Ramy Elshafey
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Adam S. Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| |
Collapse
|
20
|
Lendrum JA, Hunt KJ. Medial Column Fusions in Flatfoot Deformities: Naviculocuneiform and Talonavicular. Foot Ankle Clin 2022; 27:769-786. [PMID: 36368796 DOI: 10.1016/j.fcl.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Progressive collapsing foot deformity (PCFD; commonly referred to as flatfoot deformity) is a complex condition classically characterized by hindfoot valgus, midfoot abduction, and forefoot varus. Medial column arthrodesis can be used to reliably correct severe, arthritic, and unstable PCFD involving the medial column. Although both naviculocuneiform arthrodesis and talonavicular arthrodesis have their own indications, patient selection and careful radiographic and clinical assessment are crucial for any medial column arthrodesis. Herein, the authors discuss the indications for medial column arthrodesis procedures, outcomes as reported in the literature, and several case examples using medial column arthrodesis in deformity correction.
Collapse
Affiliation(s)
- James A Lendrum
- Department of Orthopedics, University of Colorado, 12631 East 17th Avenue, Mail Stop B202, Aurora, CO 80045, USA
| | - Kenneth J Hunt
- Department of Orthopedics, University of Colorado, 12631 East 17th Avenue, Mail Stop B202, Aurora, CO 80045, USA.
| |
Collapse
|
21
|
Histologic grading correlates with inflammatory biomarkers in tibialis posterior tendon dysfunction. Foot Ankle Surg 2022; 28:1266-1271. [PMID: 35667952 DOI: 10.1016/j.fas.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/17/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND It has been theorized that tibialis posterior tendon dysfunction (TPTD) is a degenerative process unrelated to inflammation. The purpose of this study was to determine if inflammatory cytokines, matrix metalloproteases (MMPs), and glutamate were elevated in diseased tibialis posterior tendons (TPTs). METHODS Matched diseased TPT, TPT insertion, and flexor digitorum longus (FDL) samples were collected from 21 patients. The samples were individually incubated in media, which was analyzed for inflammatory cytokines, MMPs, and glutamate. Histology and statistical analyses were performed. RESULTS Diseased TPT and TPT insertion were significantly elevated compared to transferred FDL in eight inflammatory markers (p < 0.005). Only the diseased TPT was significantly elevated compared to the transferred FDL tendons for glutamate (p < 0.01). Histologic grading correlated with inflammatory cytokine levels. CONCLUSION Diseased TPT and TPT insertion demonstrated significantly elevated levels of inflammatory markers compared to the transferred tendons used as controls, suggesting a role for inflammation in the disease process. The amount of inflammation correlated with increased tendon degradation. LEVEL OF EVIDENCE Level III.
Collapse
|
22
|
Deng Z, Cai Z, Chen S, Liu Y, Chen F, Deng Z, Li Y, Xu J. Comparison of in vivo hindfoot joints motion changes during stance phase between non-flatfoot and stage II adult acquired flatfoot. J Foot Ankle Res 2022; 15:74. [PMID: 36229819 PMCID: PMC9559000 DOI: 10.1186/s13047-022-00577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the kinematic characteristics of hindfoot joints in stage II adult acquired flatfoot deformity (AAFD) with those of non-flatfoot through the 3D-to-2D registration technology and single fluoroscopic imaging system. METHODS Eight volunteers with stage II AAFD and seven volunteers without stage II AAFD were recruited and CT scans were performed bilateral for both groups in neutral positions. Their lateral dynamic X-ray data during the stance phase, including 14 non-flatfeet and 10 flatfeet, was collected. A computer-aided simulated light source for 3D CT model was applied to obtain the virtual images, which were matched with the dynamic X-ray images to register in the "Fluo" software, so that the spatial changes during the stance phase could be calculated. RESULTS During the early-stance phase, the calcaneous was more dorsiflexed, everted, and externally-rotated relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05). During the mid-stance phase, the calcaneous was more dorsiflexed and everted relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05); however, the rotation did not differ significantly between the two groups (p > 0.05). During the late-stance phase, the calcaneous was more plantarflexed, but less inverted and internally-rotated, relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05). During the early- and mid-stance phase, the navicular was more dorsiflexed, everted, and externally-rotated relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05). During the late-stance phase, the navicular was more plantarflexed, but less inverted and internally-rotated, relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05). There was no difference in the motion of cuboid between the two groups during the whole stance phase (p > 0.05). CONCLUSIONS During the early- and mid-stance phase, excessive motion was observed in the subtalar and talonavicular joints in stage II AAFD. During the late-stance phase, the motion of subtalar and talonavicular joints appeared to be in the dysfunction state. The current study helps better understanding the biomechanics of the hindfoot during non-flatfoot and flatfoot condition which is critical to the intervention to the AAFD using conservative treatment such as insole or surgical treatment for joint hypermotion.
Collapse
Affiliation(s)
- Zhenhan Deng
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Zijun Cai
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Siyu Chen
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yan Liu
- Department of Critical Care Medicine and Infection Prevention and Control, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China
| | - Fanglin Chen
- Department of Orthopedics, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Liuzhou, 545000, Guangxi, China
| | - Zhiqin Deng
- Hand and Foot Surgery Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Xu
- Department of Orthopedics, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Liuzhou, 545000, Guangxi, China. .,Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
| |
Collapse
|
23
|
Does tibialis posterior dysfunction correlate with a worse radiographic overall alignment in progressive collapsing foot deformity? A retrospective study. Foot Ankle Surg 2022; 28:995-1001. [PMID: 35177330 DOI: 10.1016/j.fas.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Posterior Tibial Tendon (PTT) dysfunction is considered to have an important role in Progressive Collapsing Foot Deformity (PCFD). The objective of our study was to assess the relationship between PTT status and three-dimensional foot deformity in PCFD. METHODS Records from 25 patients with PCFD were included for analysis. The PTT was considered deficient in patients with a positive single heel rise test or a deficit in inversion strength. Three-dimensional foot deformity was assessed using the Foot and Ankle Offset (FAO) from Weight-Bearing-CT imaging. Hindfoot valgus, midfoot abduction and medial longitudinal arch collapse were assessed on X-Rays using hindfoot moment arm, talonavicular coverage angle and Meary's angle respectively. Deland and Rosenberg MRI classifications were used to classify PTT degeneration. RESULTS PCFD with PTT deficit (13/25) had a mean FAO of 7.75 + /- 3.8% whereas PCFD without PTT deficit had a mean FAO of 6.68 + /- 3.9% (p = 0.49). No significant difference was found between these groups on the hindfoot moment arm and the talonavicular coverage angle (respectively p = 0.54 and 0.32), whereas the Meary's angle was significantly higher in case of PCFD with PTT deficit (p = 0.037). No significant association was found between PTT degeneration on MRI and FAO. CONCLUSION PCFD associated three-dimensional deformity, hindfoot valgus and midfoot abduction were not associated with PTT dysfunction. PTT dysfunction was only associated with a worse medial longitudinal arch collapse in our study. Considering our results, it does not appear that PTT is the main contributor to PCFD. LEVEL OF EVIDENCE Level III, Retrospective Comparative Study.
Collapse
|
24
|
Wuite S, Deschamps K, Eerdekens M, Scheys L, Loomans L, A Matricali G. Posterior tibial tendon dysfunction alters the midfoot mechanics and energetics during gait. J Orthop Res 2022; 40:2196-2208. [PMID: 34910323 DOI: 10.1002/jor.25241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/19/2021] [Accepted: 12/11/2021] [Indexed: 02/04/2023]
Abstract
A comprehensive insight into the in vivo foot kinetics of patients with posterior tibial tendon dysfunction (PTTD) is lacking to support clinical decision making. Our goal was to study how PTTD alters the kinetic and kinematic characteristics of the foot and ankle with a special focus on the midfoot joints. Multisegment foot joint kinetics and kinematics were compared based on the Rizzoli Foot Model and inversed dynamics between a control group (n = 25), patients with PTTD Stage II (n = 21) and PTTD Stage III (n = 4) over the entire stance phase. Compared to controls, a mean decrease in power generation of 1.3 W/kg was found in the Ankle joint in PTTD II patients (p < 0.001) and PTTD III patients of 1.5 W/kg (p < 0.001). In the Chopart joint, there was a mean increase in power absorption of 0.4 W/kg in the PTTD III patients (p = 0.014) and a mean decrease in power generation of 0.6 W/kg (p < 0.001) in the PTTD II patients. The distribution of total negative work showed a shift from the Ankle and first metatarsal phalangeal joint towards the Chopart joint in both PTTD compared with the control subjects. A significant reduction in range of motion was observed among both PTTD groups. The outcome of this study will enable the possibility to customize the conservative and surgical treatment of each patient with PTTD, to improve or even restore the kinetic features. This will prevent the natural deterioration of function seen in this pathology.
Collapse
Affiliation(s)
- Sander Wuite
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven and Division of Orthopaedics, Institute for Orthopaedic Research and Training, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kevin Deschamps
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Campus Brugge, Belgium.,Institut D'Enseignement Supérieur Parnasse Deux-Alice, Brussel, Belgium.,Department of Podiatry, Artevelde University College, Gent, Belgium
| | - Maarten Eerdekens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, KU Leuven and Division of Orthopaedics, Institute for Orthopaedic Research and Training, University Hospitals Leuven, Leuven, Belgium
| | - Laura Loomans
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni A Matricali
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven and Division of Orthopaedics, Institute for Orthopaedic Research and Training, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|
25
|
Femino JE, Kern A, Schumer R, Anthony C, Kruse AJ, Goetz J. The Effect of Progressive Lateral Column Lengthening in a Novel Stage II-B Flatfoot Cadaveric Model Evaluated Using Software-Guided Radiographic Measurements of Foot Alignment. Foot Ankle Int 2022; 43:1099-1109. [PMID: 35611474 DOI: 10.1177/10711007221091817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This work used software-guided radiographic measurement to assess the effects of progressive lateral column lengthening (LCL) on restoring alignment in a novel cadaveric model of stage II-B flatfoot deformity. METHODS A stage II-B flatfoot was created in 8 cadaveric specimens by transecting the spring ligament complex, anterior deltoid, and interosseous talocalcaneal and cervical ligaments. Weightbearing computed tomographic (WBCT) scans were performed with specimens under 450 N of compressive load in the intact, flat, and 6-, 8-, and 10-mm lateral column-lengthening conditions. Custom software-guided radiographic measurements of the lateral talo-first metatarsal (Meary) angle, anteroposterior talo-first metatarsal angle, naviculocuneiform overlap, and 2 new measures (plantar fascia [PF] distance and angle) were recorded on digitally reconstructed radiographs. Four anonymized analysts performed measurements twice. Intra- and interobserver agreement was assessed using intraclass correlation coefficients (ICCs). RESULTS Six-millimeter LCL restored alignment closest to the intact foot in this new cadaveric model, whereas 10-mm lengthening tended toward overcorrection. The PF line displaced laterally in the flatfoot condition, and LCL restored the PF line to a location beneath the talonavicular joint. Interobserver agreement was excellent for PF distance (ICC = 0.99) and naviculocuboid overlap (ICC = 0.91), good for Meary angle (ICC = 0.81) and PF angle (ICC = 0.69), and acceptable for the talonavicular coverage angle (ICC = 0.65). CONCLUSION In this stage II-B cadaveric flatfoot model, cervical ligament transection was essential to create deformity after the medial hindfoot ligaments were transected. Software-guided radiographic measurement proved reliable; standardized implementation should improve comparability between studies of flatfoot deformity. The novel PF distance performed most consistently (ICC = 0.99) and warrants further study. With this model, we found that a 6-mm LCL restored alignment closest to the intact foot, whereas 10-mm lengthening tended toward overcorrection. CLINICAL RELEVANCE Future joint-sparing flatfoot corrections may consider using a relatively small LCL combined with other bony and/or anatomic ligament/tendon reconstructions.
Collapse
Affiliation(s)
| | | | | | | | - Adam J Kruse
- Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | | |
Collapse
|
26
|
Haraguchi N, Asano K, Arimoto T, Niki H, Ota K, Ozeki T, Gibu M, Kanetake Y, Tsutaya A. Supramalleolar Lateral Opening-Wedge Osteotomy in Conjunction With Progressive Collapsing Foot Deformity Reconstruction for PCFD With Ankle Instability. Foot Ankle Int 2022; 43:1070-1083. [PMID: 35642666 DOI: 10.1177/10711007221093344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reconstruction of progressive collapsing foot deformity (PCFD) with ankle instability (PCFD class E) remains a substantial challenge to orthopaedic surgeons. We report the outcomes of PCFD class E treated by means of a relatively standard PCFD foot reconstruction approach with the addition of a supramalleolar lateral opening-wedge osteotomy. METHODS We conducted a retrospective study of 13 patients (15 ankles) who underwent this procedure for PCFD class E between 2010 and 2021. Mean follow-up time was 3.8 (range, 2-6.3) years. Clinical assessment was based on the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale as well as a Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Radiographic assessments, including identification of the mechanical ankle joint axis point and a modified valgus Takakura-Tanaka osteoarthritis grade, were recorded. RESULTS The mean JSSF score improved significantly from 45.2 preoperatively to 83.9 postoperatively (P < .001). SAFE-Q scores at the final follow-up were 70.1 for the pain and pain-related subscale, 75.4 for the physical functioning and daily living subscale, 83.0 for the social functioning subscale, 74.4 for the shoe-related subscale, and 78.1 for the general health and well-being subscale. Radiographic measurements showed improvement in the tibiotalar tilt angle (average improvement: 5.4 degrees); orientation of the talus joint line relative to the ground (average improvement: 14.0 degrees); anteroposterior talus-first metatarsal angle (average improvement: 11.2 degrees), talonavicular coverage angle (average improvement: 21.6 degrees), and lateral talus-first metatarsal angle (average improvement: 17.0 degrees). Postoperatively, the mechanical ankle joint axis point moved medially for all patients and into the medial half of the ankle joint for 7 patients. The modified osteoarthritis stage improved postoperatively in most cases. CONCLUSION In this select and relatively small group of patients who had a supramalleolar lateral opening-wedge osteotomy combined with PCFD reconstruction, we measured general improvement in JSSF scores and radiographic variables. Long-term durability of the procedure remains unknown. This procedure may be an option for preserving the ankle joint in treatment of PCFD class E with osteoarthritis of the ankle. LEVEL OF EVIDENCE Level IV, therapeutic.
Collapse
Affiliation(s)
- Naoki Haraguchi
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Kota Asano
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Tatsuya Arimoto
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Koki Ota
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
| | - Takuma Ozeki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
| | - Masaki Gibu
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
| | - Yoshihiko Kanetake
- Department of Radiology, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
| | - Atsushi Tsutaya
- Department of Radiology, Tokyo Metropolitan Police Hospital, Nakano-ku, Tokyo, Japan
| |
Collapse
|
27
|
Jones J, Catanzariti A. Operative Management: Spring Ligament. Clin Podiatr Med Surg 2022; 39:503-519. [PMID: 35717066 DOI: 10.1016/j.cpm.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pes planovalgus is a multiplanar deformity consisting of a combination of hindfoot valgus, collapse of the medial longitudinal arch, forefoot varus, and forefoot abduction. This deformity is often associated with posterior tibial tendon dysfunction. Collapse of the medial longitudinal arch increases stress to the static stabilizers of the medial column including the deltoid ligament, spring ligament, plantar fascia, plantar and talocalcaneal interosseous ligaments, as well as the talonavicular and naviculocuneiform capsules. There is a higher incidence of concomitant spring ligament pathology in pes planovalgus deformity and posterior tibial tendon dysfunction based on magnetic resonance imaging and intraoperative observation than in other static stabilizers.
Collapse
Affiliation(s)
- Jacob Jones
- Resident Physician, Department of Orthopedics, Division of Foot & Ankle Surgery, West Penn Hospital, Foot & Ankle Institute, 4800 Friendship Avenue N1, Pittsburgh, PA 15224, USA
| | - Alan Catanzariti
- West Penn Hospital Foot & Ankle Surgery, Section Chief of Podiatry, Department of Orthopedic Surgery, Allegheny Health Network, 4800 Friendship Avenue N1, Pittsburgh, PA 15224, USA.
| |
Collapse
|
28
|
Li S, Zhu M, Gu W, Hamati M, Hunt KJ, de Cesar Netto C, Simonson TS, Myerson MS. Diagnostic Accuracy of the Progressive Collapsing Foot Deformity (PCFD) Classification. Foot Ankle Int 2022; 43:800-809. [PMID: 35301895 DOI: 10.1177/10711007221078000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A consensus group recently proposed the term progressive collapsing foot deformity (PCFD) and a new classification with 2 stages plus 5 classes to describe the complex array of flatfoot deformities. This study aimed to validate different diagnostic accuracy rates of the PCFD classification. METHODS This was a survey-based study distributed among 13 foot and ankle fellowship programs for 3 groups of participants with varied experience in practice (group 1: fellows in training, group 2: surgeons in practice for 1-4 years, and group 3: surgeons in practice for ≥5 years). Each participant was asked to assign 20 different cases of flatfoot deformity to the appropriate classes and stages using the PCFD classification. The overall diagnostic accuracy, class, and stage diagnostic accuracy rates for the 20 cases were calculated first for the entire cohort and then compared among the 3 groups. The misdiagnosis rate for each class of deformity (the sum of overdiagnosis and underdiagnosis rates) of the entire cohort was calculated and compared with the other classes. Mean and standard evidence were used to describe numerical data. One-way analysis of variance was used to compare values among the 3 groups and the 5 classes. P <.05 was considered statistically significant. RESULTS For the whole cohort, the overall diagnostic accuracy, class diagnostic accuracy, and stage diagnostic accuracy rates were 71.0%, 78.3%, and 81.7%, respectively There was a statistically significant difference between group 1 and 2, and group 1 and 3, in overall diagnostic accuracy and class diagnostic accuracy, with no significant difference among the 3 groups regarding stage diagnostic accuracy. Class B had a significantly higher overdiagnosis rate than the rest of the classes, whereas class D was significantly underdiagnosed than others. The misdiagnosis rates for classes A to E were 3.3%, 17.5%, 11.1%, 26.0%, and 3.7%, respectively. CONCLUSION The PCFD classification showed overall fair diagnostic accuracy rates. The highest diagnostic accuracy was for "hindfoot valgus deformity" and "ankle instability." Further content validation of the PCFD classification is needed to examine the terminology and interpretation of those classes with low diagnostic accuracy including "midfoot/forefoot abduction deformity," "forefoot varus deformity/medial column instability," and "peritalar subluxation/dislocation."Level of Evidence: Level II, prospective comparative study.
Collapse
Affiliation(s)
- Shuyuan Li
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO, USA.,Steps2Walk, Inc, Denver, CO, USA
| | - Mingjie Zhu
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Wanjun Gu
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Mary Hamati
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Kenneth J Hunt
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedic and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Tatum S Simonson
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Mark S Myerson
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO, USA.,Steps2Walk, Inc, Denver, CO, USA
| |
Collapse
|
29
|
Obey MR, Johnson JE, Backus JD. Managing Complications of Foot and Ankle Surgery: Reconstruction of the Progressive Collapsing Foot Deformity. Foot Ankle Clin 2022; 27:303-325. [PMID: 35680290 DOI: 10.1016/j.fcl.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Our understanding of the cause and principles of treatment of progressive collapsing foot deformity (PCFD) has significantly evolved in recent decades. The goals of treatment remain improvement in symptoms, correction of deformity, maintenance of joint motion, and return of function. Although notable advancements in understanding the deformity have been made, complications still occur and typically result from (1) poor decision making, (2) technical errors, and (3) patient-related conditions. In this article, we discuss common surgical modalities used in the treatment of PCFD and further highlight the common complications that occur and the techniques that can be used to prevent them.
Collapse
Affiliation(s)
- Mitchel R Obey
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave CB8233 St. Loiuis, MO 63110, USA
| | - Jeffrey E Johnson
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave CB8233 St. Loiuis, MO 63110, USA
| | - Jonathon D Backus
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave CB8233 St. Loiuis, MO 63110, USA.
| |
Collapse
|
30
|
Lôbo CFT, Pires EA, Bordalo-Rodrigues M, de Cesar Netto C, Godoy-Santos AL. Imaging of progressive collapsing foot deformity with emphasis on the role of weightbearing cone beam CT. Skeletal Radiol 2022; 51:1127-1141. [PMID: 34693455 DOI: 10.1007/s00256-021-03942-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
The term progressive collapsing foot deformity (PCFD) is currently recommended as the replacement to adult-acquired flatfoot deformity and posterior tibial tendon dysfunction to better reflect its pathology, which consists of a complex three-dimensional deformity involving the foot and ankle. The new consensus has also provided a new classification that requires clinical and radiographic findings for patient stratification into each class. However, conventional radiographs are susceptible to errors resulting from the inadequate positioning of patients, incorrect angulation of the X-ray tube, and overlapping of bone structures. Weightbearing cone beam computed tomography (WBCBCT), which has greater diagnostic accuracy than conventional radiograph, is useful for evaluating progressive collapsing foot deformity to determine medial arch collapse, hindfoot alignment, peritalar subluxation, posterior subtalar joint valgus, intrinsic talus valgus, and lateral extra-articular bone impingement. The present review aimed to discuss the new recommendations for nomenclature, classification, and imaging evaluation of PCFD, with an illustrative and quantitative focus on the measurements used in conventional radiography and WBCBCT. The measurements presented here are important criteria for decision-making.
Collapse
Affiliation(s)
- Carlos Felipe Teixeira Lôbo
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.
| | - Eduardo Araújo Pires
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil
| | - Marcelo Bordalo-Rodrigues
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Cesar de Cesar Netto
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Alexandre Leme Godoy-Santos
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.,Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, SP, 05652-900, Brazil
| |
Collapse
|
31
|
Lee HY, Barbachan Mansur NS, Lalevée M, Dibbern KN, Myerson MS, Ellis SJ, Femino JE, de Cesar Netto C. Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity. Foot Ankle Int 2022; 43:582-589. [PMID: 34852647 DOI: 10.1177/10711007211058154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Historical concept of flatfoot as posterior tibial tendon dysfunction (PTTD) has been questioned. Recently, the consensus group published a new classification system and recommended renaming PTTD to Progressive Collapsing Foot Deformity (PCFD). The new PCFD classification could be effective in providing comprehensive information on the deformity. To date, there has been no study reporting intra- and interobserver reliability and the frequency of each class in PCFD classification. METHODS This was a single-center, retrospective study conducted from prospectively collected registry data. A consecutive cohort of PCFD patients evaluated from February 2015 to October 2020 was included, consisting of 92 feet in 84 patients. Classification of each patient was made using characteristic clinical and radiographic findings by 3 independent observers. Frequencies of each class and subclass were assessed. Intraobserver and inteobserver reliabilities were analyzed with Cohen kappa and Fleiss kappa, respectively. RESULTS Mean sample age was 54.4, 38% was male and 62% were female. 1ABC (25.4%) was the most common subclass, followed by 1AC (8.7%) and 1ABCD (6.9%). Only a small percentage of patients had isolated deformity. Class A was the most frequent component (89.5%), followed by C in 86.2% of the cases. Moderate interobserver reliability (Fleiss kappa = 0.561, P < .001, 95% CI 0.528-0.594) was found for overall classification. Very good intraobserver reliability was found (Cohen kappa = 0.851, P < .001, 95% CI 0.777-0.926). CONCLUSION Almost half (49.3%) of patients had a presentation dominantly involving the hindfoot (A) with various combinations of midfoot and/or forefoot deformity (B), (C) with or without subtalar joint involvement (D). The new system may cover all possible combinations of the PCFD, providing a comprehensive description and guiding treatment in a systematic and individualized manner, but this initial study suggests an opportunity to improve overall interobserver reliability. LEVEL OF EVIDENCE Level III, retrospective diagnostic study.
Collapse
Affiliation(s)
- Hee Young Lee
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, SP, Brazil
| | - Matthieu Lalevée
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | - Kevin N Dibbern
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Mark S Myerson
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott J Ellis
- Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, New York, NY, USA
| | - John E Femino
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | | | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
32
|
Yoshimoto K, Noguchi M, Maruki H, Nasu Y, Ishibashi M, Okazaki K. How does the postoperative medial arch height influence the patient reported outcomes of stage Ⅱ acquired adult flatfoot deformity? J Orthop Sci 2022; 27:429-434. [PMID: 33509698 DOI: 10.1016/j.jos.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to assess how the postoperative medial arch height influenced postoperative patient-reported clinical outcomes after surgery for stage Ⅱ acquired adult flatfoot deformity. METHODS A total of 30 feet of 30 patients (7 males, 23 females) who underwent surgery for stage Ⅱ acquired adult flatfoot deformity and could be followed up for at least 2 years were included. The average age at surgery was 60.0 (standard deviation, 13.0) years, and the average follow-up period was 40 (standard deviation, 15.4) months. Among them, 16 patients underwent lateral column lengthening and 14 patients did not. Patient-reported clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire. Radiographic alignment was evaluated by the talonavicular coverage angle, lateral talo-1st metatarsal angle, medial cuneiform height, medial cuneiform to 5th metatarsal height, and calcaneal pitch. The correlation between postoperative Self-Administered Foot Evaluation Questionnaire and radiographic alignment was assessed with Pearson's correlation analysis. RESULTS Self-Administered Foot Evaluation Questionnaire and radiographic alignment significantly improved postoperatively in all patients (P < 0.0001). In patients with severe deformity who needed lateral column lengthening, lateral talo-1st metatarsal angle was negatively and medial cuneiform to 5th metatarsal height was positively correlated with physical functioning Self-Administered Foot Evaluation Questionnaire subscales (r = -0.56 and 0.55), and medial cuneiform height was positively correlated with physical functioning, social functioning and general health Self-Administered Foot Evaluation Questionnaire subscales (r = 0.70, 0.55 and 0.73, respectively). CONCLUSION Postoperative medial arch height could influence physical functioning, social functioning, and general health in patients with severe stage II adult-acquired flatfoot deformity.
Collapse
Affiliation(s)
- Kensei Yoshimoto
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-0054, Japan; Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan
| | - Masahiko Noguchi
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-0054, Japan; Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan; Kohno Clinical Medicine Research Institute, 3-3-7, Kitashinagawa, Shinagawa-ku, Tokyo, 140-0001, Japan.
| | - Hideyuki Maruki
- Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan
| | - Yuki Nasu
- Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan
| | - Mina Ishibashi
- Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-0054, Japan
| |
Collapse
|
33
|
Haraguchi N. Analysis of Whole Limb Alignment in Ankle Arthritis. Foot Ankle Clin 2022; 27:1-12. [PMID: 35219359 DOI: 10.1016/j.fcl.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A full-length standing posteroanterior radiograph that includes the calcaneus (hip-to-calcaneus radiograph) is obtained for evaluation of the mechanical axis of the entire lower limb in patients with a lower limb condition involving malalignment. Such evaluation clarifies several pathomechanical aspects of hindfoot disorders, facilitates surgical planning, and elucidates factors contributing to unsatisfactory results of a particular operation. Whole limb alignment is influenced not only by the knee joint but also by the ankle joint; thus, knee realignment influences hindfoot alignment and vice versa. It is essential to analyze alignment of the whole limb in planning corrective lower limb surgery.
Collapse
Affiliation(s)
- Naoki Haraguchi
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan.
| |
Collapse
|
34
|
Abstract
The standard for diagnostic radiographic imaging in foot and ankle surgery was until 2012 radiographs with full weight-bearing without any useful alternative. Weight-bearing cone-beam computed tomography (WBCT) was introduced 2012 for foot and ankle use as a new technology that allows 3D imaging with full weight-bearing which should be not influenced by projection and/or foot orientation. The assessment of ankle osteoarthritis with WBCT including the description of healthy status, effect of alignment and7or (in)stability is extensively illustrated in this review article.
Collapse
|
35
|
Postural Control Differences between Patients with Posterior Tibial Tendon Dysfunction and Healthy People during Gait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031301. [PMID: 35162324 PMCID: PMC8835140 DOI: 10.3390/ijerph19031301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with posterior tibial tendon dysfunction (PTTD) may exhibit postural instability during walking likely due to a loss of medial longitudinal arch, abnormal foot alignment, and pain. While many studies have investigated gait alterations in PTTD, there is no understanding of dynamic postural control mechanisms in this population during gait, which will help guide rehabilitation and gait training programs for patients with PTTD. The purpose of the study was to assess dynamic postural control mechanisms in patients with stage II PTTD as compared to age and gender matched healthy controls. METHODS Eleven patients with stage II PTTD (4 males and 7 females; age 59 ± 1 years; height 1.66 ± 0.12 m; mass 84.2 ± 16.0 kg) and ten gender and age matched controls were recruited in this study. Participants were asked to walk along a 10 m walkway. Ten Vicon cameras and four AMTI force platforms were used to collect kinematic and center of pressure (COP) data while participants performed gait. To test differences between PTTD vs. control groups, independent t-tests (set at α < 0.05) were performed. RESULTS Patients with PTTD had significantly higher double stance ratio (+23%) and anterior-posterior (AP) time to contact (TTC) percentage (+16%) as compared to healthy control. However, PTTD had lower AP COP excursion (-19%), AP COP velocity (-30%), and medial-lateral (ML) COP velocity (-40%) as compared to healthy controls. Mean ML COP trace values for PTTD were significantly decreased (-23%) as compared to controls, indicating COP trace for PTTD tends to be closer to the medial boundary than controls during single-support phase of walking. CONCLUSION PTTD patients showed more conservative and cautious postural strategies which may help maintain balance and reduce the need for postural adjustment during PTTD gait. They also showed more medially shifted COP patterns than healthy controls during single-support phase of walking. Dynamic postural control outcomes could be used to develop effective gait training programs aimed at alleviating a medial shift of COP (everted foot) for individuals with PTTD in order to improve their functionality and gait efficiency.
Collapse
|
36
|
Wang CS, Tzeng YH, Yang TC, Lin CC, Chang MC, Chiang CC. First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction. Foot Ankle Int 2022; 43:55-65. [PMID: 34350795 DOI: 10.1177/10711007211034516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. METHODS Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. RESULTS Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. CONCLUSION In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. LEVEL OF EVIDENCE Level IV, case series study.
Collapse
Affiliation(s)
- Chien-Shun Wang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei.,Department of Radiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzu-Cheng Yang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chun-Cheng Lin
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ming-Chau Chang
- Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
| |
Collapse
|
37
|
Abstract
Adult acquired flatfoot deformity (AAFD) is a condition commonly seen by orthopaedic surgeons. Posterior tibial tendon dysfunction is thought to be the initial pathoanatomic etiology that leads to this deformity. Successful resolution of the pain associated with AAFD can be achievable with nonsurgical methods. Patients who continue to have pain or functional limitations despite nonsurgical treatment can find improvement with appropriately selected surgical interventions. This article addresses new advances in treatment based on the stage of AAFD and will identify areas of continued development with a focus on surgical management. The literature continues to evolve as demonstrated by a recent update regarding the nomenclature and treatment of this condition to progressive collapsing flatfoot deformity. Future goals of research include understanding the natural history of the disease, from asymptomatic to symptomatic, and studying a wide array of newer treatments and implants that have not been prospectively evaluated.
Collapse
|
38
|
Koltak C, Yurt Y. Comparison of the effects of low level laser and insoles on pain, functioning, and muscle strength in subjects with stage 2 posterior tibial tendon dysfunction: A randomized study. J Back Musculoskelet Rehabil 2021; 34:1069-1078. [PMID: 34151822 DOI: 10.3233/bmr-200199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low level laser therapy (LLLT) is known to be effective in tendinopathies. No study yet investigated the effect of LLLT on posterior tibial tendon dysfunction (PTTD) in comparison to orthotic treatment. OBJECTIVE The aim was to compare the effects of LLLT and insole application on pain, function and muscle strength in subjects with stage 2 PTTD. METHODS Fifty-two subjects with stage 2 PTTD were randomly assigned to the LLLT and insole groups. The foot pain, function and strength of invertor and evertor muscles of the subjects was evaluated before and after treatment, and after 9 months. RESULTS Significant improvement was observed in the foot function and pain (p< 0.05) in both groups after treatment, but in the 9-month follow-up, the insole group had better values. The increase in 180∘.sec-1 concentric invertor muscle strength was found significant after the treatment and in month-9 as compared to the initial values (p< 0.05). CONCLUSIONS Both treatments are effective in reducing treating foot pain, as well as improving the function in subjects with stage 2 PTTD. However, at the end of the 9-month follow-up, it was seen that insoles were more effective. Neither method had a clinically important effect on muscle strength.
Collapse
|
39
|
Abousayed MM, Coleman MM, Wei L, de Cesar Netto C, Schon LC, Guyton GP. Radiographic Outcomes of Cotton Osteotomy in Treatment of Adult-Acquired Flatfoot Deformity. Foot Ankle Int 2021; 42:1384-1390. [PMID: 34109855 DOI: 10.1177/10711007211015175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated the long-term radiographic outcomes of the Cotton osteotomy performed at our institution by the 2 senior authors in conjunction with other reconstruction procedures to correct adult-acquired flatfoot deformity (AAFD). METHODS We retrospectively studied patients who underwent Cotton osteotomy between 2005 and 2010 with minimum 4-year follow-up. Radiographic assessment was made on weightbearing radiographs taken at 4 different time intervals: preoperative, early (first postoperative full weightbearing), intermediate (between 1 and 4 years postoperatively), and final (over 4 years postoperatively). RESULTS Nineteen patients were included. Final follow-up was 8.6 ± 2.6 years. The lateral talus-first metatarsal angle improved significantly from preoperative to early radiographs (n = 15; mean change: 30 degrees, 95% CI, 21.6-38.7; P < .0001). A significant loss of correction was observed between intermediate and final radiographs (n = 11; mean change: 17 degrees, 95% CI, 8.1-26.4; P < .0001). Of 14 patients with early radiographs, 8 lost >50% of the correction initially achieved. Medial column height decreased by 3.0 mm (95% CI, 1.80-7.90; P = .35) between early radiographs and final follow-up. DISCUSSION This is the longest reported radiographic follow-up of the Cotton osteotomy performed to address forefoot varus deformity as part of AAFD. The Cotton osteotomy achieved radiographic correction of the medial longitudinal arch at early follow-up, but approximately half of the patients had lost over 50% of that correction at final follow-up. The lengthened angular shape of the cuneiform did not collapse, implying that further collapse occurred through the medial column joints. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Mostafa M Abousayed
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Michelle M Coleman
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lawrence Wei
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lew C Schon
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Gregory P Guyton
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
40
|
Mattesi L, Ancelin D, Severyns MP. Is subtalar arthroereisis a good procedure in adult-acquired flatfoot? A systematic review of the literature. Orthop Traumatol Surg Res 2021; 107:103002. [PMID: 34216843 DOI: 10.1016/j.otsr.2021.103002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/29/2021] [Accepted: 04/20/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of the present systematic literature review was to determine results and complications in subtalar arthroereisis for stage-2 adult-acquired flatfoot. METHOD A search of the PubMed, Medline, CINAHL, Cochrane and Embase databases used MeSH terms "arthroereisis" AND "flatfoot" OR "adult-acquired flatfoot" OR "pes planovalgus" OR "pes planus". Two of the authors analyzed 125 articles. After reading titles and Abstracts, 105 articles were read in full text and their references were analyzed. Finally, 12 articles were selected and divided into 2 groups: isolated and associated arthroereisis. RESULTS Improvement in functional scores was greater in associated arthroereisis. Whether isolated or associated, arthroereisis achieved radiologic correction. However, the rate of complications was high, mainly concerning tarsal sinus pain. CONCLUSION Subtalar arthroereisis for stage-2 adult-acquired flatfoot is rarely performed in isolation. When it is associated to other procedures, good radiologic and clinical results can be expected. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Lucas Mattesi
- Department of Orthopaedic Surgery, Hôpital Pierre Zobda Quitman, 97261 Fort-de-France Cedex, France
| | - David Ancelin
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, 31059 Toulouse, France; I2R, Institut de Recherche Riquet, 31059 Toulouse, France
| | - Mathieu Pierre Severyns
- Department of Orthopaedic Surgery, Hôpital Pierre Zobda Quitman, 97261 Fort-de-France Cedex, France.
| |
Collapse
|
41
|
Wapner K, Freeland E, Kirwan G, Baldwin K. A Retrospective Radiographic Evaluation of a Modified Method of Lateral Column Lengthening. Foot Ankle Spec 2021; 14:386-392. [PMID: 32370634 DOI: 10.1177/1938640020919187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Lateral column lengthening (LCL) is a commonly performed procedure for patients with stage II adult-acquired flatfoot deformity (AAFD) to correct forefoot abduction. This procedure is frequently completed concomitantly with both soft-tissue and bony procedures, including a medial slide calcaneal osteotomy to further reduce hindfoot valgus. The purpose of this study is to investigate and identify the radiographic outcomes of a modified step-cut LCL utilized as an alternative approach for correction of stage II AAFD. Methods: A retrospective radiographic review was performed on 15 feet in 14 patients who underwent correction of stage II AAFD using a step-cut LCL between August 2009 and January 2012. Two independent examiners utilizing 6 radiographic parameters evaluated preoperative and postoperative weight-bearing radiographs of the foot. Results: At a mean follow-up of 13.4 (range 12-16) weeks, weight-bearing radiographs demonstrated a significant median decrease in the lateral talometatarsal angle of 14.4° (P < .001), lateral talocalcaneal angle of 7° (P < .001), anteroposterior talometatarsal angle of 14.5° (P < .001), anteroposterior talocalcaneal angle of 5.5° (P < .001), and talonavicular coverage angle of 26.5° (P < .001). Additionally, a significant median increase in calcaneal pitch of 8.5° (P < .001) was noted. Conclusion: This study demonstrates statistically significant improvement of radiographic outcomes with use of a modified step-cut LCL as an alternative approach for correction of stage II AAFD.Levels of Evidence: Level IV: Retrospective case series.
Collapse
Affiliation(s)
- Keith Wapner
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania (KW, KB).,Department of Orthopaedic Surgery, Cooper University Hospital, Camden, New Jersey (EF).,Orthopedic and Sports Medicine Associates, Green Bay, Wisconsin (GK)
| | - Erik Freeland
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania (KW, KB).,Department of Orthopaedic Surgery, Cooper University Hospital, Camden, New Jersey (EF).,Orthopedic and Sports Medicine Associates, Green Bay, Wisconsin (GK)
| | - Gregory Kirwan
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania (KW, KB).,Department of Orthopaedic Surgery, Cooper University Hospital, Camden, New Jersey (EF).,Orthopedic and Sports Medicine Associates, Green Bay, Wisconsin (GK)
| | - Keith Baldwin
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania (KW, KB).,Department of Orthopaedic Surgery, Cooper University Hospital, Camden, New Jersey (EF).,Orthopedic and Sports Medicine Associates, Green Bay, Wisconsin (GK)
| |
Collapse
|
42
|
Krautmann K, Kadakia AR. Spring and Deltoid Ligament Insufficiency in the Setting of Progressive Collapsing Foot Deformity. An Update on Diagnosis and Management. Foot Ankle Clin 2021; 26:577-590. [PMID: 34332736 DOI: 10.1016/j.fcl.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The spring ligament and deltoid ligament are important stabilizers of the medial ankle. Together, they form a complex along the medial ankle and foot that is critical to stability of both the ankle and the medial longitudinal arch. Incompetence of the spring and deltoid ligament is a component of both the early and late stages of progressive collapsing foot deformity. As the importance of this medial ligament complex has been recognized, repair and reconstruction of these ligaments have progressively evolved, initially as separate reconstructions, and more recently as combined techniques.
Collapse
Affiliation(s)
- Kurt Krautmann
- Northwestern Medicine Department of Orthopedics, 259 East Erie Street, 13th Floor, Chicago, IL 60611, USA
| | - Anish R Kadakia
- Orthopedic Foot and Ankle, Northwestern Medicine Department of Orthopedics, 259 East Erie Street, 13th Floor, Chicago, IL 60611, USA.
| |
Collapse
|
43
|
Surgical Management of Musculotendinous Balance in the Progressive Collapsing Foot Deformity: The Role of Peroneal and Gastrocnemius Contracture. Foot Ankle Clin 2021; 26:559-575. [PMID: 34332735 DOI: 10.1016/j.fcl.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Surgical treatment of progressive collapsing foot deformity (PCFD) relies on understanding the dynamic and deforming musculotendinous structures that contribute to hindfoot valgus, forefoot abduction, forefoot varus, and collapse or hypermobility of the medial column. Equinus commonly is seen in PCFD and consideration should be given to isolated gastrocnemius or Achilles lengthening. Although transfer of the flexor digitorum longus tendon is performed in PCFD attributed to dysfunction and pathology of the posterior tibialis tendon (PTT), retention of PTT is an area for further research. The peroneus brevis, which contributes to hindfoot imbalance in chronic cases, is a possible component of tendon rebalancing.
Collapse
|
44
|
Won SH, Kim J, Cho J, Chun DI, Kim K, Yi Y. Calcifying aponeurotic fibroma around posterior tibialis tendon in an elderly patient with flatfoot: A case report. Medicine (Baltimore) 2021; 100:e26803. [PMID: 34397738 PMCID: PMC8322532 DOI: 10.1097/md.0000000000026803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/12/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Calcifying aponeurotic fibroma (CAF) is a rare benign fibroblastic tumor that is commonly in the hand or foot of children or adolescents. PATIENT CONCERNS A 74-year-old female presented with a progressive pain on the medial foot for 3 years ago. The pain aggravated while walking or in a standing position for more than 20 minutes. She also complained of skin contact along the medial aspect of the foot while trying to wear a shoe. DIAGNOSIS Physical examination revealed a firm, immobile, nontender mass accompanied with flexible flatfoot. On the single heel raise test, loss of the balance and intensification of the pain were observed. Faintly calcified soft tissue mass is shown in plain radiographs without bone involvement. Magnetic resonance imaging revealed a subcutaneous mass with ill-defined circumscribed subcutaneous mass adherent to the thickened PTT. INTERVENTIONS The patient underwent a complete excisional biopsy, followed by medial displacement calcaneal osteotomy. OUTCOMES The excised mass was diagnosed to be CAF on the histologic examination. At the 1-year follow-up, patient remained asymptomatic with no evidence of recurrence and all the radiographic parameters demonstrating flat foot improved. LESSONS This is the first case of CAF located at PTT presenting with both foot pain and functional disability. In this case, complete excision of the causative structure along with alignment correction can contribute to successful postoperative outcome.
Collapse
Affiliation(s)
- Sung Hun Won
- Department of Orthopaedic Surgery, Bone & Joint center, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jahyung Kim
- Department of Orthopaedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Kwonwoo Kim
- Department of Health Administration, Sejong Public Health Center, Sejong, Korea
| | - Young Yi
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Republic of Korea
| |
Collapse
|
45
|
Analysis of the main soft tissue stress associated with flexible flatfoot deformity: a finite element study. Biomech Model Mechanobiol 2021; 20:2169-2177. [PMID: 34331169 DOI: 10.1007/s10237-021-01500-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/25/2021] [Indexed: 01/01/2023]
Abstract
A better understanding of soft tissue stress and its role in supporting the medial longitudinal arch in flexible flatfoot could help to guide the clinical treatment. In this study, a 3-Dimensional finite element (FE) foot model was reconstructed to measure the stress of the soft tissue, and its variation in different scenarios related to flexible flatfoot. All bones, cartilages, ligaments and related tendons around the ankle, and fat pad were included in the finite element model. The equivalent stress on the articular surface of the joints in the medial longitudinal arch and the maximum principal stress of the ligaments around the ankle were obtained. The results show that the plantar fascia (PF) is the main tissue in maintaining the medial longitudinal arch. The equivalent stress of all the joints in the medial longitudinal arch increases when the PF attenuation and the talonavicular joint increases, while other joints decreases when all the three tissue attenuation. Moreover, the maximum principal stress variation of calcaneofibular ligament is largest when the PF attenuation and the tibionavicular ligament and posterior tibiotalar ligament are largest when the posterior tibial tendon (PTT) attenuation. The maximum principal stress variation of tibionavicular ligament and posterior tibiotalar ligament are even larger when all the three tissue attenuation. These findings support that the PF is the main factor in maintaining the medial longitudinal arch. The medial longitudinal arch collapse mainly affects the talonavicular joint and the calcaneofibular ligament, the tibionavicular ligament and the posterior tibiotalar ligament. This approach could help to improve the understanding of adult-acquired flatfoot deformity (AAFD).
Collapse
|
46
|
Robinson D, Mitchkash M, Wasserman L, Tenforde AS. Nonsurgical Approach in Management of Tibialis Posterior Tendinopathy With Combined Radial Shockwave and Foot Core Exercises: A Case Series. J Foot Ankle Surg 2021; 59:1058-1061. [PMID: 32360329 DOI: 10.1053/j.jfas.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 11/25/2019] [Accepted: 03/15/2020] [Indexed: 02/03/2023]
Abstract
Tibialis posterior tendinopathy is a common debilitating condition seen by foot and ankle providers. Non-operative management is difficult as patients often present in later stages of the disease. This case series evaluated the combination of radial shockwave therapy and a foot core progression exercise regimen on 10 patients who had failed standard conservative treatment techniques. Median follow-up time was 4 months. Clinically important differences in the Foot and Ankle Ability Measure were met in 9 (90%) and 8 (80%) of patients for activities of daily living and sport sub-scores, respectively. No adverse effects were observed.
Collapse
Affiliation(s)
- David Robinson
- Resident, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, Massachusetts
| | - Matthew Mitchkash
- Resident, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, Massachusetts
| | - Lindsay Wasserman
- Physical Therapist, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Spaulding National Running Center, Cambridge, Massachusetts
| | - Adam S Tenforde
- Assistant Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation, Hospital/Harvard Medical School, Charlestown, Massachusetts.
| |
Collapse
|
47
|
Catani O, Cautiero G, Sergio F, Cattolico A, Calafiore D, de Sire A, Zanchini F. Medial Displacement Calcaneal Osteotomy for Unilateral Adult Acquired Flatfoot: Effects of Minimally Invasive Surgery on Pain, Alignment, Functioning, and Quality of Life. J Foot Ankle Surg 2021; 60:358-361. [PMID: 33472755 DOI: 10.1053/j.jfas.2020.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/18/2020] [Accepted: 11/22/2020] [Indexed: 02/03/2023]
Abstract
We aimed to assess the effects of medial displacement calcaneal osteotomy (MDCO) through a minimal skin incision in terms of pain, function, and alignment in patients with unilateral adult acquired flatfoot. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale and Numeric Pain Rating Scale (NPRS) were assessed as outcomes at the baseline (T0), at 6 months (T1), and at 1 year (T2) from surgery. We analyzed data of 20 patients (7 male and 13 female), mean aged 46.6 ± 5.34 years, showed significant differences after 6 months in terms of AOFAS total score (44.30 ± 7.39 vs 96.50 ± 4.89; p = .0001), AOFAS subitems (p < .001), and pain (NPRS: 7.95 ± 1.36 vs 1.05 ± 1.05; p = .0001). At 1 year after surgery (T2), all outcome measures still significantly differ from baseline (p < 01). Therefore, percutaneous MDCO through a minimal skin incision seemed to be safe and effective in the middle and long term in reducing pain and improving function and alignment in patients with unilateral adult acquired flatfoot.
Collapse
Affiliation(s)
- Ottorino Catani
- Foot and Ankle Surgeon, Department of Orthopaedic and Traumatology, Casa di Cura S. Maria della Salute, Santa Maria Capua Vetere, Caserta, Italy
| | - Giovanni Cautiero
- Foot and Ankle Surgeon, Department of Orthopaedic and Traumatology, Casa di Cura S. Maria della Salute, Santa Maria Capua Vetere, Caserta, Italy
| | - Fabrizio Sergio
- Foot and Ankle Surgeon, Department of Orthopaedic and Traumatology, Casa di Cura S. Maria della Salute, Santa Maria Capua Vetere, Caserta, Italy
| | - Alessandro Cattolico
- Resident in Orthopaedics, Clinical Orthopaedics, Department of Medical and Surgical Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dario Calafiore
- Physiatrist, Neuromotor Rehabilitation Unit, Neuroscience Department, Azienda Socio Sanitaria Territoriale di Mantova, Bozzolo, Mantova, Italy
| | - Alessandro de Sire
- Assistant Professor of Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy; Physiatrist, Rehabilitation Unit, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy.
| | - Fabio Zanchini
- Assistant Professor of Orthopaedics, Clinical Orthopaedics, Department of Medical and Surgical Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
48
|
Osman AE, El-Gafary KA, Khalifa AA, El-Adly W, Fadle AA, Abubeih H. Medial displacement calcaneal osteotomy versus lateral column lengthening to treat stage II tibialis posterior tendon dysfunction, a prospective randomized controlled study. Foot (Edinb) 2021; 47:101798. [PMID: 33957531 DOI: 10.1016/j.foot.2021.101798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Adult-acquired flatfoot deformity (AAFD) requires optimum planning that often requires several procedures for deformity correction. The objective of this study was to detect the difference between MDCO versus LCL in the management of AAFD with stage II tibialis posterior tendon dysfunction regarding functional, radiographic outcomes, efficacy in correction maintenance, and the incidence of complications. PATIENT AND METHODS 42 Patients (21 males and 21 females) with a mean age of 49.6 years (range 43-55), 22 patients had MDCO while 20 had LCL. Strayer procedure, spring ligament plication, and FDL transfer were done in all patients. Pre- and Postoperative (at 3 and 12 months) clinical assessment was done using AOFAS and FFI questionnaire. Six radiographic parameters were analyzed, Talo-navicular coverage and Talo-calcaneal angle in the AP view, Talo- first metatarsus angle, Talo-calcaneal angle and calcaneal inclination angle in lateral view and tibio-calcaneal angle in the axial view, complications were reported. RESULTS At 12 months, significant improvement in AOFAS and FFI scores from preoperative values with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups were maintained at 12 months. However, the calcaneal pitch angle and the TNCA were better in the LCL at 12 months than MDCO, 17̊±2.8 versus 13.95̊±2.2 (p=0.001) and 13.70̊±2.2 versus 19.05̊±3.2 (p<0.001) respectively. 11 patients (26.2%) had metal removal, seven (16.6%) in the MDCO, and four (9.6%) in the LCL. Three (7.1%) in the LCL group had subtalar arthritis, only one required subtalar fusion. CONCLUSION LCL produced a greater change in the realignment of AAFD, maintained more of their initial correction, and were associated with a lower incidence of additional surgery than MDCO, however, a higher incidence of degenerative change in the hindfoot was observed with LCL.
Collapse
Affiliation(s)
- Ahmed E Osman
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | | | - Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | - Wael El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Amr A Fadle
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Hossam Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| |
Collapse
|
49
|
Goss M, Stauch C, Lewcun J, Ridenour R, King J, Juliano P, Aynardi M. Natural History of 321 Flatfoot Reconstructions in Adult Acquired Flatfoot Deformity Over a 14-Year Period. Foot Ankle Spec 2021; 14:226-231. [PMID: 32189513 DOI: 10.1177/1938640020912859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to report the natural history, demographics, and mechanisms of requirement for additional surgery in patients undergoing flatfoot reconstruction for adult acquired flatfoot. A total of 321 consecutive patients undergoing flatfoot reconstruction over a 14-year period were included (2002-2016). All procedures were performed by a senior orthopaedic foot and ankle surgeon at our institution. Demographic data, operative reports, clinic notes, and radiographs were available for review. Statistical analysis included calculation of relative risk (RR) ratios. The majority of patients were female (83.2%,) and most patients were overweight with a body mass index greater than 25 kg/m2 (56.4%). Patient comorbidities included diabetes (13.7%) and rheumatoid arthritis (3.7%). Additional surgery was required for 54 patients (16.8%). The most common reasons for additional surgery were the following: painful calcaneal hardware (57.4%), conversion to triple arthrodesis (16.7%), and wound healing complications (9.1%). An increased risk of need for additional surgery was associated with female gender (RR = 3.4; P = .0005), smoking status (RR = 1.9; P = .0081), and age (<60 years of age; RR = 1.8; P = .042). Although retrospective, the results provide insight into the natural history of this procedure. Clinicians may use these data to appropriately counsel patients who are at increased risk of requirement for additional surgery, such as smokers, women, and patients <60 years old, regarding treatment options.Levels of Evidence: Level IV.
Collapse
Affiliation(s)
- Madison Goss
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Christopher Stauch
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Joseph Lewcun
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Ryan Ridenour
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Jesse King
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Paul Juliano
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| | - Michael Aynardi
- Penn State College of Medicine, Hershey, Pennsylvania (MG, JL, JK).,Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (CS).,Orthopaedic Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania (RR).,Foot and Ankle Orthopaedics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania (PJ, MA)
| |
Collapse
|
50
|
Clinical Tests of Tibialis Posterior Tendinopathy: Are They Reliable, and How Well Are They Reflected in Structural Changes on Imaging? J Orthop Sports Phys Ther 2021; 51:253-260. [PMID: 33779216 DOI: 10.2519/jospt.2021.9707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the reliability of common clinical tests for tibialis posterior tendinopathy (TPT) and to investigate their relationship with grayscale ultrasound findings in individuals who have medial foot/ankle pain. DESIGN Prospective cohort. METHODS Fifty-two individuals reporting medial foot/ankle pain were clinically examined by 2 physical therapists using 4 clinical tests for TPT: pain on tendon palpation, swelling around the tendon, pain/weakness with tibialis posterior contraction, and pain during or inability to perform a single-leg heel raise (SLHR). Individuals also underwent an ultrasound examination by a sonographer. Physical therapists and the sonographer were blind to each other's findings. Positive ultrasound examination included at least 1 of the following grayscale changes: hypoechogenicity, fibrillar disruption, or thickening of the tendon. For reliability between the 2 physical therapists, we calculated kappa coefficients and 95% confidence intervals (CIs). To assess relationships between clinical and imaging findings, we calculated odds ratios and 95% CIs. RESULTS The SLHR was the most reliable test, with substantial agreement between physical therapists (κ = 0.74; 95% CI: 0.54, 0.93), while the other tests had moderate levels of reliability. Of all clinical tests, the SLHR was most related to grayscale findings on ultrasound (odds ratio = 5.8), but was imprecisely so, with a 95% CI of 1.7 to 20.4. CONCLUSION Of all tests, the SLHR was the most reliable between clinicians and best related to imaging findings in individuals presenting with TPT, aligning with contemporary thinking of tendinopathy as a load-related clinical presentation. There was a disconnect between clinical findings and ultrasound grayscale changes in the tibialis posterior tendon in individuals with TPT. J Orthop Sports Phys Ther 2021;51(5):253-260. Epub 28 Mar 2021. doi:10.2519/jospt.2021.9707.
Collapse
|