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Lee W, Tecle N, Knapp E, Awad H, Oh I. Biomechanical Effects of Subtalar Joint Fusion and Medial Ligament Reconstruction in Simulated Progressive Collapsing Foot Deformity. Foot Ankle Int 2024; 45:279-290. [PMID: 38240174 DOI: 10.1177/10711007231220940] [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: 03/24/2024]
Abstract
BACKGROUND The purpose of this study is to investigate the biomechanical effect of medial displacement calcaneal osteotomy (MDCO), subtalar joint fusion (SF), and medial ligament reconstruction (MLR: deltoid-spring ligament) in a severe flatfoot model. We hypothesized that (1) combination of MDCO and SF improves the tibiotalar and foot alignment in severe progressive collapsing foot deformity (PCFD) cadaver model. (2) However, if a residual valgus heel alignment remains after MCDO and SF, it can lead to increased medial ligament strain, foot malalignment, and tibiotalar valgus tilt, which will be mitigated by the addition of MLR. METHODS Ten fresh-frozen cadaveric foot specimens were used to create a severe flatfoot model. The foot alignment changes, including the talo-first metatarsal angle in the axial and sagittal planes, subtalar angle, and tibiotalar angle in the coronal plane, were measured. The angles were measured at the initial condition, after creating the severe flatfoot model, and after each successive reconstructive procedure in the following order: (1) MDCO, (2) SF, and (3) MLR. RESULTS Tibiotalar valgus tilt was decreased with the MDCO procedure: 4.4 vs 1.0 degrees (P = .04). Adding in situ SF to the MDCO led to increased tibiotalar tilt to 2.5 degrees was different from the initial condition (P = .01). Although the tibiotalar valgus tilt was significantly decreased after adding the MLR to the MDCO/SF procedure compared with the severe flatfoot model (0.8 vs 4.4 degrees, P = .03), no significant difference in the tibiotalar valgus tilt was observed between MDCO/SF and MDCO/SF with MLR. CONCLUSION Our results demonstrated that MDCO significantly improved forefoot abduction and medial arch alignment, with no significant additional improvement observed with addition of SF. Following SF, a residual valgus heel alignment can contribute to subsequent tibiotalar valgus tilt. The addition of MLR did not show significantly decreased tibiotalar valgus tilt following SF. CLINICAL RELEVANCE Residual valgus heel alignment after subtalar joint fusion in the surgical treatment of PCFD can lead to increased medial ligament strain. Although MLR might be considered for providing medial stability, it may not necessarily prevent the development of tibiotalar valgus tilt.
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Affiliation(s)
- Wonyong Lee
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | - Nahom Tecle
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Emma Knapp
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Hani Awad
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Irvin Oh
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopaedic Surgery and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Suh JH, Yoon SY. Comparing the effects of University of California Biomechanics Laboratory and custom-made semi-rigid insole on pedobarographic parameters in pediatric flexible flat foot. Prosthet Orthot Int 2023; 47:614-620. [PMID: 37227812 DOI: 10.1097/pxr.0000000000000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Pediatric flexible flat foot (PFFF) is often associated with pain along the medial longitudinal arch and potential disability. There are several conservative treatment options for PFFF, ranging from intrinsic muscle exercises to orthosis, including University of California Biomechanics Laboratory (UCBL) and custom-made semi-rigid insoles. OBJECTIVES To investigate and compare the effect of UCBL and custom-made semi-rigid insoles on pedobarographic and radiologic parameters in PFFF. STUDY DESIGN This study prepared a retrospective chart review of 143 children diagnosed with PFFF between the age of 4 and 12 years. METHODS Data of twenty-seven children with PFFF who were prescribed foot orthoses between the age of 4 and 12 years were retrospectively reviewed. Medical charts were retrospectively reviewed, and pedobarographic and radiological parameters assessed before and 1 year after application of orthoses were reviewed. RESULTS The difference in the calcaneal pitch angle and the center of pressure excursion index (CPEI) were significantly improved in the custom-made semi-rigid insole group compared to that in the UCBL group. The contact area ratio of the midfoot and toe and CPEI at 1 year after wearing the insole was significantly improved in the custom-made semi-rigid insole group compared to that in the UCBL group. Moreover, the calcaneal pitch angle and CPEI were significantly improved 1 year after application of the insole in the custom-made semi-rigid insole group. CONCLUSIONS This result showed that the custom-made semi-rigid insole is more effective in improving the deviation of the center pressure curve and calcaneal pitch angle than the UCBL. The custom-made semi-rigid insole may help relieve foot instability during gait and improve the medial longitudinal arch in children with PFFF.
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Affiliation(s)
- Jee Hyun Suh
- Department of Rehabilitation Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Seo Yeon Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, South Korea
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Patil AR, Jawade S, Somaiya KJ, Boob MA. Efficacy of Faradic Foot Baths and Short Foot Exercises in Symptomatic Flatfoot: A Review. Cureus 2023; 15:e47803. [PMID: 38021688 PMCID: PMC10676730 DOI: 10.7759/cureus.47803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Flatfoot is a common condition among adults, according to orthopedic experts. Flatfoot is defined in this document as a foot condition that occurs after the completion of skeletal growth and is characterized by either partial or complete reduction of the medial longitudinal arch (MLA). The purpose of this study was to evaluate the effects of short foot exercise (SFE) and faradic foot baths on people who have flat feet. This review focused on comprehensive original primary articles written in English. Numerous studies have been conducted in order to determine the effects of both interventions. The search yielded a wide range of papers, including editorials, review articles, freely available full texts, and abstracts. The results showed that both SFE and faradic foot baths effectively improved flat feet.
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Affiliation(s)
- Anushri R Patil
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapna Jawade
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamya J Somaiya
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manali A Boob
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Milani C, Vyas K, Malik G. Evidence-Based Diagnosis and Treatments of Posterior Tibialis Tendinopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Adult-Acquired Flatfoot Deformity: Combined Talonavicular Arthrodesis and Calcaneal Displacement Osteotomy versus Double Arthrodesis. J Clin Med 2022; 11:jcm11030840. [PMID: 35160291 PMCID: PMC8837164 DOI: 10.3390/jcm11030840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Adult-acquired flatfoot deformity due to posterior tibial tendon dysfunction (PTTD) is one of the most common foot deformities among adults. Hypothesis: Our study aimed to confirm that the combined procedures of calcaneal displacement osteotomy and talonavicular arthrodesis are equivalent to double arthrodesis. Methods: Between 2016 and 2020, 41 patients (13 male and 28 females, mean age of 63 years) were retrospectively enrolled in the comparative study. All deformities were classified into Stages II and III of PTTD, according to Johnson and Strom. All patients underwent isolated bony realignment of the deformity: group A (n = 19) underwent calcaneal displacement osteotomy and talonavicular arthrodesis, and group B (n = 23) underwent double arthrodesis. Measurements from the Foot Function Index-D (FFI-D) and the SF-12 questionnaire were collected, with a comparison of pre- and post-operative radiographs conducted. The mean follow-up period for patients was 3.4 years. Results: The mean FFI-D was 33.9 (group A: 34.5; group B: 33.5), the mean SF-12 physical component summary was 43.13 (group A: 40.9; group B: 44.9), and the mean SF-12 mental component summary was 43.13 (group A: 40.9; group B: 44.9). The clinical data and corrected angles showed no significant intergroup differences. Conclusion: Based on the available data, our study confirmed that the combined procedures of talonavicular arthrodesis and calcaneal shift, with preservation of the subtalar joint, can be considered equivalent to the established double arthrodesis, with no significant differences in terms of clinical and radiological outcomes.
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Cen X, Gao L, Yang M, Liang M, Bíró I, Gu Y. Arch-Support Induced Changes in Foot-Ankle Coordination in Young Males with Flatfoot during Unplanned Gait Termination. J Clin Med 2021; 10:jcm10235539. [PMID: 34884238 PMCID: PMC8658682 DOI: 10.3390/jcm10235539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: The efficacy of arch orthoses in posture adjustment and joint coordination improvement during steady-state gait is well documented; however, the biomechanical changes of gait sub-tasks caused by arch support (AS), especially during gait termination, are poorly understood. Hence, this study aimed to investigate how the acute arch-supporting intervention affects foot–ankle coordination and coordination variability (CV) in individuals with flatfoot during unplanned gait termination (UGT). Methods: Twenty-five male patients with flatfoot were selected as subjects participated in this AS manipulation study. A motion capture system was used for the collection of the metatarsophalangeal joint (MPJ) and ankle kinematics during UGT. MPJ-Ankle coordination and CV were quantified using an optimized vector coding technique during the three sub-phases of UGT. A paired-sample t-test from the one-dimensional statistical parametric mapping of one-dimensional was applied to examine the data significance. Results: Significant differences for the joint kinematics between non-arch-support (NAS) and AS were exhibited only in the MPJ transverse plane during the middle and later periods of UGT (p = 0.04–0.026). Frontal plane MPJ-ankle coordination under AS during stimulus delay significantly decreased from 177.16 ± 27.41° to 157.75 ± 32.54° compared with under NAS (p = 0.026); however, the coordination pattern had not changed. Moreover, no significant difference was found in the coupling angle variability between NAS and AS in three planes during sub-phases of UGT (all p > 0.5). Conclusions: The detailed intrinsic characteristic of AS induced acute changes in lower extremity segment coordination in patients with mild flatfoot has been recorded. This dataset on foot-ankle coordination characteristics during UGT is essential for explaining foot function and injury prediction concerning AS manipulation. Further studies are expected to reflect lower limb inter-joint coordination during gait termination through the long-term effects of AS orthoses.
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Affiliation(s)
- Xuanzhen Cen
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (X.C.); (L.G.); (M.Y.); (M.L.)
- Doctoral School on Safety and Security Sciences, Obuda University, 1034 Budapest, Hungary
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
| | - Lidong Gao
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (X.C.); (L.G.); (M.Y.); (M.L.)
| | - Meimei Yang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (X.C.); (L.G.); (M.Y.); (M.L.)
| | - Minjun Liang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (X.C.); (L.G.); (M.Y.); (M.L.)
| | - István Bíró
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
- Correspondence: (I.B.); (Y.G.); Tel.: +36-62-54-6003 (I.B.); +86-574-8760-0456 (Y.G.)
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (X.C.); (L.G.); (M.Y.); (M.L.)
- Correspondence: (I.B.); (Y.G.); Tel.: +36-62-54-6003 (I.B.); +86-574-8760-0456 (Y.G.)
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Calcaneal Osteotomies in the Treatment of Progressive Collapsing Foot Deformity. What are the Restrictions for the Holy Grail? Foot Ankle Clin 2021; 26:473-505. [PMID: 34332731 DOI: 10.1016/j.fcl.2021.05.003] [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] [Indexed: 02/02/2023]
Abstract
The progressive collapsing foot deformity is a complex three-dimensional deformity, including valgus malalignment of the heel. The medial displacement calcaneal osteotomy is an established surgical procedure reliably resulting in an efficient correction of the inframalleolar alignment. However, complications are common, including undercorrection of underlying deformity, progression of hindfoot osteoarthritis and/or deformity, and/or symptomatic hardware.
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Abstract
Johnson and Strom stage I posterior tibialis tendon dysfunction presents with pain and swelling but preserved function and no deformity. Diagnosis is clinical. Pathomechanics explains the overloading of the tendon that may be worsened by a tight gastrocnemius, but systemic inflammatory disease may also be responsible for a stage I condition. Medial heel wedged orthoses are effective in most patients. Surgery usually consists of an open/endoscopic tenosynovectomy. In cases of complete tendon rupture, flexor digitorum longus tendon transfer may be considered. Stage I patients with a higher risk of progression-inflammatory conditions, excessive laxity, obese-may benefit from a "prophylactic" medializing calcaneal osteotomy.
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Hoang NTT, Chen S, Chou LW. The Impact of Foot Orthoses and Exercises on Pain and Navicular Drop for Adult Flatfoot: A Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158063. [PMID: 34360354 PMCID: PMC8345534 DOI: 10.3390/ijerph18158063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
Background: Adult flatfoot leads to injury and decreased quality of life. The most widely applied noninvasive approaches are wearing foot orthoses or exercising. Both interventions raise controversy about reducing pain and neutralizing foot posture. This study investigated the impact of foot orthoses and exercise on pain and navicular drop (present for foot posture). Methods: Four databases were used: MEDLINE, PubMed, Web of Science, and Cochrane, from the earliest records to November 2020. Randomized controlled studies focused on adult flatfoot that evaluated the effect of exercise and foot orthoses on pain and navicular drop were extracted. We used data analysis to estimate the relative effect of heterogeneity using I2 and publication bias using funnel plots. Results: Ten studies were identified through to November 2020. Active interventions (AIs) were exercise and exercise combined with foot orthoses; passive interventions (PIs) were foot orthoses and added stretching. Both AIs and PIs decreased pain significantly (SMD −0.94, 95% CI −1.35, −0.54 and SMD −1.4, 95% CI −1.87, −0.92). The AIs reduced pain level better than PIs. Controversially, no treatment was found to affect navicular drop. Conclusion: Both exercise and foot orthoses can reduce pain but not realign foot posture. Exercise alone or combined with foot orthoses showed a better effect on adult flatfoot than only wearing foot orthoses. Active intervention was shown to have better efficacy in reducing pain than passive intervention.
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Affiliation(s)
- Ngoc-Tuyet-Trinh Hoang
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan; (N.-T.-T.H.); (S.C.)
- Department Physiotherapy, Hong Bang International University, Ho Chi Minh City 700000, Vietnam
| | - Shuya Chen
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan; (N.-T.-T.H.); (S.C.)
| | - Li-Wei Chou
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan; (N.-T.-T.H.); (S.C.)
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung 413505, Taiwan
- Correspondence:
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González-Martín D, Herrera-Pérez M, Ojeda-Jiménez J, Rendón-Díaz D, Valderrabano V, Pais-Brito JL. "Safe incision" in calcaneal sliding osteotomies reduces the incidence of sural nerve injury. INTERNATIONAL ORTHOPAEDICS 2021; 45:2245-2250. [PMID: 34129071 DOI: 10.1007/s00264-021-05109-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to demonstrate whether application of the so-called safe incision when performing calcaneal sliding osteotomies reduces the risk of sural nerve injury. METHODS Patients who underwent either medial or lateral sliding calcaneal osteotomies between 2010 and 2018 were analysed retrospectively. A thorough neurological examination was performed, and the location of the surgical wound and the type of wound closure were recorded. The European Foot and Ankle Surgery (EFAS) score and 12-item Short Form Survey (SF-12) were also documented. RESULTS A total of 57 patients were included, of which 20 (35.1%) had a sural nerve injury. Five patients had a neurapraxia (8.8%), while 15 patients had a permanent injury (26.3%). Respecting the "safe incision" decreased sural nerve injury (p = 0.02). The type of osteotomy and closure was not significant. No significant differences were found in the functional tests between the different techniques, or between patients who presented sural nerve injury and those who did not. CONCLUSION Sural nerve injury after calcaneal sliding osteotomies is higher than previously reported in the scientific literature, with an incidence of 35.1% (20/57 patients). Respecting the so-called safe zone (oblique incision that runs through the point that is > 1/3 of the distance from the tip of the lateral malleolus to the posteroinferior margin of the calcaneus) clearly decreases the incidence of sural nerve injury. Finally, the majority of patients remained asymptomatic despite the neurological injury.
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Affiliation(s)
- David González-Martín
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain.,Universidad de La Laguna, Tenerife, Spain
| | - Mario Herrera-Pérez
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain. .,Universidad de La Laguna, Tenerife, Spain. .,Foot and Ankle Unit, Hospital Universitario de Canarias, Tenerife, Spain.
| | - Jorge Ojeda-Jiménez
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain.,Universidad de La Laguna, Tenerife, Spain.,Foot and Ankle Unit, Hospital Universitario de Canarias, Tenerife, Spain
| | - Diego Rendón-Díaz
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain.,Foot and Ankle Unit, Hospital Universitario de Canarias, Tenerife, Spain
| | - Victor Valderrabano
- Orthopaedic and Trauma Department, Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland
| | - José Luis Pais-Brito
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain.,Universidad de La Laguna, Tenerife, Spain
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Guenka LC, Carrasco AC, Pelegrinelli ARM, Silva MF, Dela Bela LF, Moura FA, Cardoso JR. Influence of the medial longitudinal arch of the foot in adult women in ankle isokinetic performance: a cross-sectional study. J Foot Ankle Res 2021; 14:43. [PMID: 34118961 PMCID: PMC8196527 DOI: 10.1186/s13047-021-00479-3] [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: 12/21/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maintenance of the medial longitudinal arch (MLA) of the foot is fundamental during functional tasks and disorders can lead to clinical alterations. Studies have demonstrated that deficits in ankle isokinetic performance can predispose an individual to lower limb injuries. OBJECTIVES To evaluate the muscular performance of cavus, planus, and normal feet by means of torque/body mass and the isokinetic phases, to generate 3D surface map analysis, and to verify whether there is a relationship between MLA height and arch height flexibility with isokinetic performance. METHODS The sample consisted of 105 healthy adult women, divided into three groups: normal, cavus, and planus. Assessment in concentric mode at 30, 60, and 90 °/s in the dorsiflexion and plantarflexion of the ankle joint were analyzed during the three isokinetic phases (acceleration, sustained velocity, and deceleration). The variables total range of motion, peak of torque (PT), and angle of PT were extracted within the sustained velocity. RESULTS In dorsiflexion at 60 °/s, the phase where the velocicty is sustained (load range phase) was higher in the planus group (MeanDifference=10.9 %; ω2p = 0.06) when compared with the cavus group. Deficits in the peak torque/body mass in dorsiflexion at 60 °/s (cavus feet: MD=-3 N.m/kg; ω2p = 0.06; and planus feet: MD=-1.1 N.m/kg; ω2p = 0.06) were also observed as well as in the 3D surface maps, when compared with the normal group. The flexibility of MLA had a negative correlation of PT at 30 °/s in cavus group. The heigth of MLA had a postive correlation with the PT for the cavus and planus group ate 60 °/s. All other results did not show differences between the groups. CONCLUSIONS The planus groups showed a better capacity of attain and sustained the velocity in dorsiflexion in relation the cavus group. The cavus and planus group had deficts in torque in relation the normal. The correlations were weak between the measures of MLA and PT. Thereby, in general the differences between foot types showed small effect in isokinetic muscle performance measures of the plantar and dorsi flexores. TRIAL REGISTRATION Study design was approved by the IRB (#90238618.8.0000.5231).
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Affiliation(s)
- Leandro C Guenka
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Av. Robert Koch, 60, 86038-440, Londrina, PR, Brazil
| | - Aline C Carrasco
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Av. Robert Koch, 60, 86038-440, Londrina, PR, Brazil.,Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | | | - Mariana F Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Av. Robert Koch, 60, 86038-440, Londrina, PR, Brazil
| | - Laís F Dela Bela
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Av. Robert Koch, 60, 86038-440, Londrina, PR, Brazil.,Universidade Positivo, Curitiba, PR, Brazil
| | - Felipe A Moura
- Laboratory of Applied Biomechanics, Universidade Estadual de Londrina, PR, Londrina, Brazil
| | - Jefferson Rosa Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Av. Robert Koch, 60, 86038-440, Londrina, PR, Brazil.
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Arbab D, Lüring C, Mutschler M, Gutteck N, Bouillon B. Der erworbene Plattfuß des Erwachsenen – Operative Therapie der flexiblen Deformität im frühen Stadium. DER ORTHOPADE 2020; 49:954-961. [DOI: 10.1007/s00132-020-03991-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Hadi H, Jabal Ameli M, Bagherifard A, Behrouzi A, Safi F, Azimi A, Ghanbari M, Azarnia Samarin G. The Effect of Total Knee Arthroplasty on Hindfoot Alignment in Patients with Severe Genu Varum and Genu Valgum. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:413-419. [PMID: 32766401 DOI: 10.22038/abjs.2019.33735.1883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The maintenance of deformity in the ankle and hindfoot after correction of knee deformity following knee arthroplasty may cause abnormal tension in the knee and patient dissatisfaction. The aim of this study was to determine the effect of knee arthroplasty on the hindfoot alignment in patients with severe genu varum and valgum. Methods A total of 84 patients with primary osteoarthritis, were enrolled in the study. The knee deformity was measured using a long leg film before surgery. The long axial radiographic view of hindfoot was taken in the standing position for all patients, before and six months after surgery. Comparisons were made on changes in the hindfoot angles measured before and after surgery. Results A total of 84 patients with mean age of 62.28 ± 7.77 years, 77 (92%) and seven patients (eight percent) had knee varus and valgus deformity, respectively. In the knee varus group, the mean preoperative hindfoot angle was + 5.32 ± 6.12 ° (valgus) which was changed to - 0.25 ± 4.91 ° (varus) in the postoperative phase. In the knee valgus group, the mean pre and postoperative hindfoot angles were - 7.71 ± 7.06° (varus) and - 2.14 ± 5.92 ° (varus), respectively. The mean preoperative hindfoot angle in severe and very severe varus knee groups were + 5.45 ± 3.30 and + 5.28 ± 6.86 °, respectively. These angles were changed to + 0.21± 5.17 and -1.60 ± 3.89° six months after surgery, respectively. The mean preoperative hindfoot angle in severe and very severe valgus knee deformity groups were - 7.00 ± 4.69 and -8.66 ± 10.69 °, respectively. These angles were changed to - 2.00 ± 5.71 and - 2.33 ± 7.50 °after surgery, respectively. There was no significant difference between patients with severe and very severe deformity in terms of pre and post-operative hindfoot angle. Conclusion The hindfoot alignment is significantly corrected after knee arthroplasty. The severity of knee deformity does not correlate with the severity of the hindfoot deformity before and after surgery.
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Affiliation(s)
- Hosseinali Hadi
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
| | - Mahmood Jabal Ameli
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran University of Medical Science, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran University of Medical Science, Tehran, Iran
| | | | - Fatemeh Safi
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Amir Azimi
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
| | - Mahtab Ghanbari
- Nursing Department, Qom University of Medical Sciences, Qom, Iran
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de Cesar Netto C, Shakoor D, Roberts L, Chinanuvathana A, Mousavian A, Lintz F, Schon LC, Demehri S. Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations. Foot Ankle Surg 2019; 25:790-797. [PMID: 30455094 DOI: 10.1016/j.fas.2018.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/16/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Clinical assessment of hindfoot alignment (HA) in adult acquired flatfoot deformity (AAFD) can be challenging and weightbearing (WB) cone beam CT (CBCT) may potentially better demonstrate this three-dimensional (3D) deformity. Therefore, we compared clinical and WB CBCT assessment of HA in patients with AAFD. METHODS In this prospective study, we included 12 men and 8 women (mean age: 52.2, range: 20-88) with flexible AAFD. All subjects also underwent WB CBCT and clinical assessment of hindfoot alignment. Three fellowship-trained foot and ankle surgeons performed six hindfoot alignment measurements on the CT images. Intra- and Inter-observer reliabilities were calculated using intra-class correlation (ICC). Measurements were compared by paired T-tests, and p-values of less than 0.05 were considered significant. RESULTS The mean of clinically measured hindfoot valgus was 15.2 (95% confidence interval [CI]: 11.5-18.8) degrees. It was significantly different from the mean values of all WB CBCT measurements: Clinical Hindfoot Alignment Angle, 9.9 (CI: 8.9-11.1) degrees; Achilles tendon/Calcaneal Tuberosity Angle, 3.2 (CI: 1.3-5.0) degrees; Tibial axis/Calcaneal Tuberosity Angle, 6.1 (CI: 4.3-7.8) degrees; Tibial axis/Subtalar Joint Angle 7.0 (CI: 5.3-8.8) degrees, and Hindfoot Alignment Angle 22.8 (CI: 20.4-25.3) degrees. We found overall substantial to almost perfect intra- (ICC range: 0.87-0.97) and inter-observer agreements (ICC range: 0.51-0.88) for all WB CBCT measurements. CONCLUSIONS Using 3D WB CBCT can help characterize the valgus hindfoot alignment in patients with AAFD. We found the different CT measurements to be reliable and repeatable, and to significantly differ from the clinical evaluation of hindfoot valgus alignment. LEVEL OF EVIDENCE Level II-prospective comparative study.
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Affiliation(s)
- Cesar de Cesar Netto
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States; Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States; Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.
| | - Delaram Shakoor
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States
| | - Lauren Roberts
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States
| | - Apisan Chinanuvathana
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States; Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States
| | - Alireza Mousavian
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States; Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States
| | - Francois Lintz
- Foot and Ankle Surgery Department, Clinique de l'Union, Saint-Jean, Toulouse, France
| | - Lew C Schon
- Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States
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Zhai J, Qiu Y, Wang J. Does Flexible Flatfoot Require Treatment?: Plantar Pressure Effects of Wearing Over-the-Counter Insoles when Walking on a Level Surface and Up and Down Stairs in Adults with Flexible Flatfoot. J Am Podiatr Med Assoc 2019; 109:299-304. [PMID: 29244535 DOI: 10.7547/16-103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Orthotic insole is a popular physiotherapy for flatfoot. However, the effects and whether flexible flatfoot needs orthotic insole treatment are not clear, and how the plantar pressure changes while walking up and down stairs has not been studied. Therefore, this study observed the plantar pressures of different walking conditions to find the answers. METHODS Fifteen adults with flexible flatfoot and 15 adults with normal foot were examined while walking on a level surface and while walking up and down 10- and 20-cm stairs before treatment. The maximum force and the arch index were acquired with a force plate system. Participants with flexible flatfoot were instructed to wear the orthotic insoles for 3 months, and plantar pressures were measured again after treatment. The repeated measure was performed to analyze the data. RESULTS The maximum force and the arch index of flatfoot after treatment were significantly decreased under different walking conditions (P < .01). When walking down 10- and 20-cm stairs, the plantar data of normal foot and flatfoot were significantly increased (P < .05). CONCLUSIONS Orthotic insoles could effectively improve the plantar pressure of flatfoot under different walking conditions. In addition, the arches of normal foot and flatfoot were obviously influenced when walking down stairs. It is, therefore, necessary to wear orthotic insoles for flexible flatfoot to prevent further deformation.
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Affiliation(s)
- JunNa Zhai
- Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - YuSheng Qiu
- Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jue Wang
- Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Soliman SB, Spicer PJ, van Holsbeeck MT. Sonographic and radiographic findings of posterior tibial tendon dysfunction: a practical step forward. Skeletal Radiol 2019; 48:11-27. [PMID: 29802532 DOI: 10.1007/s00256-018-2976-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/22/2018] [Accepted: 05/08/2018] [Indexed: 02/08/2023]
Abstract
The purpose of this article is to describe the sonographic and radiographic findings in the diagnosis and treatment of posterior tibial tendon dysfunction. Ultrasound and radiographs play a crucial role in the diagnosis of posterior tibial tendon dysfunction and in imaging the postoperative changes related to posterior tibial tendon dysfunction. Early detection and diagnosis of posterior tibial tendon dysfunction is important in helping to prevent further progression of disease, obviating the need for more invasive and complex procedures.
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Affiliation(s)
- Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
| | - Paul J Spicer
- Division of Musculoskeletal Radiology, Department of Radiology, University of Kentucky Healthcare, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Marnix T van Holsbeeck
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
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17
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Steiner CS, Gilgen A, Zwicky L, Schweizer C, Ruiz R, Hintermann B. Combined Subtalar and Naviculocuneiform Fusion for Treating Adult Acquired Flatfoot Deformity With Medial Arch Collapse at the Level of the Naviculocuneiform Joint. Foot Ankle Int 2019; 40:42-47. [PMID: 30317867 DOI: 10.1177/1071100718800295] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: A challenge in treating acquired flatfoot deformities is the collapse of the medial arch at the level of the naviculocuneiform (NC) joint. Triple fusions, being a treatment option, may lead to problems such as increased foot stiffness. We thus established a method that combines subtalar (ST) fusion with NC fusion while preserving the Chopart joint. We analyzed the radiographic correction, fusion rate, and patient satisfaction with this procedure. METHODS: 34 feet in 31 patients (female, 23; male, 8; age 67 [45-81] years) were treated with a ST and NC joint fusion. In 15 cases, a medial sliding-osteotomy was additionally necessary to fully correct hindfoot valgus. The following radiographic parameters were measured on weightbearing radiographs preoperatively and at 2 years: talo-first metatarsal angle, talocalcaneal angle, calcaneal pitch, talonavicular coverage angle and calcaneal offset. Fusion was radiologically confirmed. RESULTS: All parameters, except the calcaneal pitch, showed a significant improvement. Fusion was observed after 1 year in all but 2 cases (94.1%). One nonunion each occurred at the ST and NC joint without needing any subsequent treatment. One patient developed avascular necrosis of the lateral talus with need for total ankle replacement after 1 year. All patients were satisfied with the obtained results. CONCLUSION: Our data suggest that a combined fusion of the ST and NC joint was effective and safe when treating adult acquired flatfoot with collapse of the medial arch at the level of the NC joint. Although the talonavicular joint was not fused, its subluxation was significantly reduced. LEVEL OF EVIDENCE: Level IV, case series.
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Affiliation(s)
| | - Andrea Gilgen
- 1 Kantonsspital Baselland, Liestal, Switzerland.,2 Inselspital, Universitätsspital Bern, Switzerland
| | | | | | - Roxa Ruiz
- 1 Kantonsspital Baselland, Liestal, Switzerland
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18
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Ross MH, Smith MD, Vicenzino B. Reported selection criteria for adult acquired flatfoot deformity and posterior tibial tendon dysfunction: Are they one and the same? A systematic review. PLoS One 2017; 12:e0187201. [PMID: 29194449 PMCID: PMC5711021 DOI: 10.1371/journal.pone.0187201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 10/16/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Posterior tibial tendon dysfunction (PTTD) and adult acquired flatfoot deformity (AAFD) are used interchangeably, although both suggest quite different pathological processes. OBJECTIVE To investigate key differences in selection criteria used for inclusion into research studies. METHODS An electronic database search was performed from inception to June 2016. All primary research articles with clear inclusion/diagnostic criteria for PTTD or AAFD were included in the review. All criteria were extracted and synthesised into one aggregate list. Frequencies of recurring criteria were calculated and reported for each stage of the conditions. RESULTS Of the potentially eligible papers, 148 (65%) did not specify inclusion/selection criteria for PTTD or AAFD and were excluded. Eligibility criteria were reported 82 times in the 80 included papers, with 69 descriptions for PTTD and 13 for AAFD. After synthesis of criteria from all papers, there were 18 key signs and symptoms. Signs and symptoms were considered to be those relating to tendon pathology and those relating to structural deformity. The total number of individual inclusion/diagnostic criteria ranged from 2 to 9. The majority of articles required signs of both tendon dysfunction and structural deformity (84% for AAFD and 81% for PTTD). Across both groups, the most frequently reported criteria were abduction of the forefoot (11.5% of total criteria used), the presence of a flexible deformity (10.2%) and difficulty performing a single leg heel raise (10.0%). This was largely the case for the PTTD articles, whereas the AAFD articles were more focused on postural issues such as forefoot abduction, medial arch collapse, and hindfoot valgus (each 16.7%). CONCLUSION As well as synthesising the available literature and providing reporting recommendations, this review has identified that many papers investigating PTTD/AAFD do not state condition-specific selection criteria and that this limits their clinical applicability. Key signs and symptoms of PTTD and AAFD appear similar, except in early PTTD where no structural deformity is present. We recommend that PTTD is the preferred terminology for the condition associated with signs of local tendon dysfunction with pain and/or swelling along the tendon and difficulty with inversion and/or single leg heel raise characterising stage I and difficulty with single leg heel raise and a flexible flatfoot deformity characterizing stage II PTTD. While AAFD may be useful as an umbrella term for acquired flatfoot deformities, the specific associated aetiology should be reported in studies to aid consolidation and implementation of research into practice. TRIAL REGISTRATION Prospero ID: 42016046943.
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Affiliation(s)
- Megan H. Ross
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Michelle D. Smith
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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19
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Presentation, Diagnosis, and Nonsurgical Treatment Options of the Anterior Tibial Tendon, Posterior Tibial Tendon, Peroneals, and Achilles. Foot Ankle Clin 2017; 22:677-687. [PMID: 29078822 DOI: 10.1016/j.fcl.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Disorders of the anterior tibial tendon (ATT) are rare, and relatively few series have been described in the literature. Ruptures of the ATT are more common than tendinopathies of the ATT. For those patients with a tendinopathy, initial treatment may include activity and shoe-wear modifications.
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20
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Ruffilli A, Traina F, Giannini S, Buda R, Perna F, Faldini C. Surgical treatment of stage II posterior tibialis tendon dysfunction: ten-year clinical and radiographic results. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:139-145. [DOI: 10.1007/s00590-017-2011-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
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21
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Zhai JN, Wang J, Qiu YS. Plantar pressure differences among adults with mild flexible flatfoot, severe flexible flatfoot and normal foot when walking on level surface, walking upstairs and downstairs. J Phys Ther Sci 2017; 29:641-646. [PMID: 28533601 PMCID: PMC5430264 DOI: 10.1589/jpts.29.641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/25/2016] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study observed the plantar pressure between flexible flatfoot and normal
foot on different walking conditions to find out if flexible flatfoot needs the treatment
and how the plantar pressure change while walking upstairs and downstairs. [Subjects and
Methods] Fifteen adults with mild flexible flatfoot, fifteen adults with severe flexible
flatfoot and fifteen adults with normal foot were examined while walking on a level
surface, walking up and down 10 cm and 20 cm stairs. The max force and the arch index were
acquired using the RSscan system. The repeated measures ANOVA was performed to analyze the
data. [Results] Compared with normal foot, both max force and arch index of severe
flatfoot were significantly increased on different walking conditions. When walking down
10 cm and 20 cm stairs, the plantar data of both normal foot and flatfoot were
significantly increased. [Conclusion] The plantar pressure of severe flexible flatfoot
were significantly larger than that of normal foot on different walking conditions. In
addition, the arches of both normal foot and flatfoot were obviously deformed when walking
downstairs. It is therefore necessary to be treated for severe flexible flatfoot to
prevent further deformation.
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Affiliation(s)
- Jun Na Zhai
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Research Center of Rehabilitation Science and Technology, School of Life Science and Technology, Xi'an Jiaotong University, National Engineering Research Center of Health Care and Medical Devices, Xi'an Jiaotong University Branch, China
| | - Jue Wang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Research Center of Rehabilitation Science and Technology, School of Life Science and Technology, Xi'an Jiaotong University, National Engineering Research Center of Health Care and Medical Devices, Xi'an Jiaotong University Branch, China
| | - Yu Sheng Qiu
- Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, China
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22
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Smyth NA, Aiyer AA, Kaplan JR, Carmody CA, Kadakia AR. Adult-acquired flatfoot deformity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:433-439. [PMID: 28324203 DOI: 10.1007/s00590-017-1945-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/06/2017] [Indexed: 11/30/2022]
Abstract
Adult-acquired flatfoot deformity (AAFD) is a known and recognized cause of pain and disability. Loss of PTT function is the most important contributor to AAFD, and its estimated prevalence is thought to be over 3%. This review aims to summarize the current literature and encompass recent advances regarding AAFD.
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Affiliation(s)
- Niall A Smyth
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Anish R Kadakia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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23
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Arvinius C, Manrique E, Urda A, Cardoso Z, Galeote JE, Marco F. A mid-term follow-up of Koutsogiannis' osteotomy in adult-acquired flatfoot stage II and "early stage III". SICOT J 2017; 3:24. [PMID: 28304274 PMCID: PMC5356448 DOI: 10.1051/sicotj/2017011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/24/2017] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Koutsogiannis' osteotomy has been widely described to treat adult-acquired flatfoot. However, few articles describe its midterm follow-up. Our aim was to study clinical and radiological outcomes at least one year after surgery and to analyze whether a combined procedure on the medial soft tissue affected these outcomes. METHODS We performed a retrospective study of 30 feet of patients who underwent a Koutsogiannis' osteotomy due to adult-acquired flatfoot stage II and "early stage III": a stage III acquired flatfoot without any important structural deformities. The parameters studied were additional medial soft tissue procedures, clinical outcome through the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and midfoot score as well as complications and radiological measurements. RESULTS Sixteen cases were "early stage III" and 14 stage II. Thirteen patients underwent an associated posterior tibial tendon (PTT) revision: in three cases an end-to-end suture was possible, seven cases needed a FDL transposition, and three underwent synovectomy. Statistically significant improvement was found in the AOFAS score although no significant changes were seen radiologically. No additional benefit was found with the revision of the posterior tibial tendon. As to clinical and radiological results, no differences were found between stage II and "early stage III". Five cases presented a mild dysesthesia but only one patient needed neurolysis. CONCLUSIONS We consider the Koutsogiannis' osteotomy to be a safe and effective procedure to reduce pain in patients with stage II and "early stage III" adult-acquired flatfoot.
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Affiliation(s)
- Camilla Arvinius
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Elena Manrique
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Antonio Urda
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Zulema Cardoso
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Jose Enrique Galeote
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Fernando Marco
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
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Zhai JN, Qiu YS, Wang J. Effects of orthotic insoles on adults with flexible flatfoot under different walking conditions. J Phys Ther Sci 2016; 28:3078-3083. [PMID: 27942124 PMCID: PMC5140804 DOI: 10.1589/jpts.28.3078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study was to evaluate the effects of orthotics on adults with flexible
flatfoot when wearing orthotic insoles while walking on horizontal ground, walking up and
down stairs and to determine if flexible flatfoot needs treatment. [Subjects and Methods]
Fifteen college students with flexible flatfoot and fifteen college students with normal
feet were recruited. First, load rate and contact area were measured by RSscan force plate
when the subjects were walking on horizontal ground, walking up and down 10 cm and 20 cm
stairs. Then the subjects with flexible flatfoot were instructed to wear orthotic insoles
for 3 months, and plantar pressure was measured again. Finally, the data were subjected to
repeated measures ANOVA. [Results] After treatment for 3 months, the plantar pressure of
flatfoot was significantly improved. In addition, the data of the subjects with normal
feet and flatfoot were significantly influenced by walking down 10 cm or 20 cm stairs.
[Conclusion] Orthotic insoles could significantly improve the plantar pressure of
flatfoot. Additionally, the arches of subjects with normal feet and flatfoot can be
significantly deformed when walking down stairs. Therefore, it is essential for subjects
with flexible flatfoot to wear orthotic insoles to avoid needless injury.
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Affiliation(s)
- Jun Na Zhai
- Research Center of Rehabilitation Science and Technology, School of Life Science and Technology, Xi'an Jiaotong University, China
| | - Yu Sheng Qiu
- Research Center of Rehabilitation Science and Technology, School of Life Science and Technology, Xi'an Jiaotong University, China
| | - Jue Wang
- Research Center of Rehabilitation Science and Technology, School of Life Science and Technology, Xi'an Jiaotong University, China
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Abstract
Foot and ankle injuries account for nearly one-third of running injuries. Achilles tendinopathy, plantar fasciopathy, and ankle sprains are 3 of the most common types of injuries sustained during training. Other common injuries include other tendinopathies of the foot and ankle, bone stress injuries, nerve conditions including neuromas, and joint disease including osteoarthritis. This review provides an evidence-based framework for the evaluation and optimal management of these conditions to ensure safe return to running participation and reduce risk for future injury.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard University, 1575 Cambridge Street, Cambridge, MA 02138, USA
| | - Amy Yin
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Kenneth J Hunt
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94063, USA.
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Perinavicular Arthrodesis as Treatment of Advanced Navicular Osteonecrosis. TECHNIQUES IN FOOT AND ANKLE SURGERY 2015. [DOI: 10.1097/btf.0000000000000090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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27
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Sheykhi-Dolagh R, Saeedi H, Farahmand B, Kamyab M, Kamali M, Gholizadeh H, Derayatifar AA, Curran S. The influence of foot orthoses on foot mobility magnitude and arch height index in adults with flexible flat feet. Prosthet Orthot Int 2015; 39:190-6. [PMID: 24604086 DOI: 10.1177/0309364614521652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 01/06/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Flexible flat foot is described as a reduction in the height of the medial longitudinal arch and may occur from abnormal foot pronation. A foot orthosis is thought to modify and control excessive pronation and improve arch height. OBJECTIVE To compare the immediate effect of three types of orthoses on foot mobility and the arch height index in subjects with flexible flat feet. STUDY DESIGN A quasi-experimental study. METHOD The dorsal arch height, midfoot width, foot mobility and arch height index were assessed in 20 participants with flexible flat feet (mean age = 23.2 ± 3 years) for three different foot orthosis conditions: soft, semi-rigid and rigid University of California Biomechanics Laboratory (UCBL). RESULTS Maximum midfoot width at 90% with arch mobility in the coronal plane was shown in the semi-rigid orthosis condition. The semi-rigid orthosis resulted in the highest mean foot mobility in 90% of weight bearing, and the rigid orthosis (UCBL) had the lowest mean foot mobility. The soft orthosis resulted in foot mobility between that of the rigid and the semi-rigid orthosis. UCBL orthosis showed the highest arch height index, and the semi-rigid orthosis showed the lowest mean arch height index. CONCLUSION Due to its rigid structure and long medial-lateral walls, the UCBL orthosis appears to limit foot mobility. Therefore, it is necessary to make an orthosis that facilitates foot mobility in the normal range of the foot arch. Future studies should address the dynamic mobility of the foot with using various types of foot orthoses. CLINICAL RELEVANCE Although there are many studies focussed on flat foot and the use of foot orthoses, the mechanism of action is still unclear. This study explored foot mobility and the influence of foot orthoses and showed that a more rigid foot orthosis should be selected based on foot mobility.
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Affiliation(s)
- Roghaye Sheykhi-Dolagh
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, Iran University of Medical sciences, Republic of Iran
| | - Hassan Saeedi
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, Iran University of Medical sciences, Republic of Iran
| | - Behshid Farahmand
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, Iran University of Medical sciences, Republic of Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, Iran University of Medical sciences, Republic of Iran
| | - Mohammad Kamali
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hossein Gholizadeh
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala lumpur, Malaysia
| | - Amir A Derayatifar
- Department of Mechanical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Sarah Curran
- Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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28
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Chadwick C, Whitehouse SL, Saxby TS. Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction. Bone Joint J 2015; 97-B:346-52. [PMID: 25737518 DOI: 10.1302/0301-620x.97b3.34386] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Flexor digitorum longus transfer and medial displacement calcaneal osteotomy is a well-recognised form of treatment for stage II posterior tibial tendon dysfunction. Although excellent short- and medium-term results have been reported, the long-term outcome is unknown. We reviewed the clinical outcome of 31 patients with a symptomatic flexible flat-foot deformity who underwent this procedure between 1994 and 1996. There were 21 women and ten men with a mean age of 54.3 years (42 to 70). The mean follow-up was 15.2 years (11.4 to 16.5). All scores improved significantly (p < 0.001). The mean American Orthopedic Foot and Ankle Society (AOFAS) score improved from 48.4 pre-operatively to 90.3 (54 to 100) at the final follow-up. The mean pain component improved from 12.3 to 35.2 (20 to 40). The mean function score improved from 35.2 to 45.6 (30 to 50). The mean visual analogue score for pain improved from 7.3 to 1.3 (0 to 6). The mean Short Form-36 physical component score was 40.6 (sd 8.9), and this showed a significant correlation with the mean AOFAS score (r = 0.68, p = 0.005). A total of 27 patients (87%) were pain free and functioning well at the final follow-up. We believe that flexor digitorum longus transfer and calcaneal osteotomy provides long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction.
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Affiliation(s)
- C Chadwick
- OrtNorthern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - S L Whitehouse
- Orthopaedic Research Unit, Queensland University of Technology, Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Australia
| | - T S Saxby
- Brisbane Foot and Ankle Centre, Level 7 Arnold Janssen Centre, Brisbane Private Hospital, 259 Wickham Terrace, Brisbane 4000, Australia
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Geng X, Xu J, Ma X, Wang X, Huang J, Zhang C, Wang C, Muhammad H. Anatomy of the sural nerve with an emphasis on the incision for medial displacement calcaneal osteotomy. J Foot Ankle Surg 2014; 54:341-4. [PMID: 25201235 DOI: 10.1053/j.jfas.2014.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Indexed: 02/03/2023]
Abstract
An inappropriately positioned skin incision for medial displacement calcaneal osteotomy can put the sural nerve at risk; however, unanimous agreement has not been reached about the optimal strategy for making this incision. In the present cadaveric study, 20 cadaveric specimens were dissected to describe the anatomic course of the sural nerve within the operative area and to provide a more practical reference for surgeons to make a safe incision. The following points were used in the analyses: point A, the tip of the lateral malleolus; point B, the inferior margin of the calcaneus on the plumb line through point A; point C, the posteroinferior margin of the calcaneus; and point D, the lateral border of the Achilles tendon on the same level (collinear) with point A. With careful dissection, the distances of the sural nerve to points A and B in the vertical direction (lines D1 and D2, respectively), to points A and C in the diagonal direction (lines D3 and D4, respectively), and to points A and D in the horizontal direction (lines D5 and D6, respectively) were measured. The landmarks were identified and the distances measured by 3 independent researchers. The median ratio of D1 to D1+D2, D3 to D3+D4, and D5 to D5+D6 was 0.36 (range 0.20 to 0.47), 0.26 (range 0.19 to 0.32), and 0.43 (range 0.34 to 0.52), respectively. Accordingly, we believe it is relatively safe to make an oblique incision that runs through the point that is no less than one third of the distance from the tip of the lateral malleolus to the posteroinferior margin of the calcaneus.
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Affiliation(s)
- Xiang Geng
- Resident, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Xu
- Resident, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Ma
- Professor, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
| | - Xu Wang
- Associate Professor, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiazhang Huang
- Attending Physician, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Zhang
- Attending Physician, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Wang
- Resident, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Hassan Muhammad
- Resident, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
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Hentges MJ, Moore KR, Catanzariti AR, Derner R. Procedure selection for the flexible adult acquired flatfoot deformity. Clin Podiatr Med Surg 2014; 31:363-79. [PMID: 24980927 DOI: 10.1016/j.cpm.2014.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adult acquired flatfoot represents a spectrum of deformities affecting the foot and the ankle. The flexible, or nonfixed, deformity must be treated appropriately to decrease the morbidity that accompanies the fixed flatfoot deformity or when deformity occurs in the ankle joint. A comprehensive approach must be taken, including addressing equinus deformity, hindfoot valgus, forefoot supinatus, and medial column instability. A combination of osteotomies, limited arthrodesis, and medial column stabilization procedures are required to completely address the deformity.
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Affiliation(s)
- Matthew J Hentges
- Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA
| | - Kyle R Moore
- Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA
| | - Alan R Catanzariti
- Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
| | - Richard Derner
- Private Practice, Associated Foot and Ankle Centers of Northern Virginia, 1721 Financial Loop, Lake Ridge, VA 22192, USA
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Abstract
Adult acquired flatfoot deformity is a progressive disorder with multiple symptoms and degrees of deformity. Stage II adult acquired flatfoot can be divided into stage IIA and IIB based on severity of deformity. Surgical procedures should be chosen based on severity as well as location of the flatfoot deformity. Care must be taken not to overcorrect the flatfoot deformity so as to decrease the possibility of lateral column overload as well as stiffness.
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Yi LC, Neves ALS, Areia M, Neves JMO, Souza TPD, Caranti DA. Influencia do indice de massa corporal no equilibrio e na configuracao plantar em obesos adultos. REV BRAS MED ESPORTE 2014. [DOI: 10.1590/s1517-86922014000100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: A obesidade é uma doença crônica degenerativa multifatorial que pode levar a alterações do sistema musculoesquelético, como mudança do centro de gravidade e sobrecarga mecânica sobre os membros inferiores. OBJETIVOS: Correlacionar o índice de massa corporal (IMC) com o equilíbrio corporal e verificar associação entre o IMC e a configuração plantar. MÉTODOS: Foram avaliados 30 obesos, de ambos os gêneros, com IMC maior ou igual a 30 Kg/m². Inicialmente, os voluntários foram submetidos às avaliações de medidas antropométricas a fim de calcular o valor do IMC. Em seguida, foram submetidos ao teste de equilíbrio corporal estático Balance Error Scoring System (BESS) e a plantigrafia para a identificação da impressão plantar. Por meio do método de Viladot, os voluntários foram classificados em grupos: pé plano (GPP), pé cavo (GPC) e pé neutro (GPN). A correlação entre as variáveis IMC e BESS foi calculada por meio do coeficiente de correlação linear de Pearson e associação entre o IMC e a configuração plantar foi realizada por meio da análise de variância (Anova). Para todas as análises, nível de significância considerado foi p < 0,05. RESULTADOS: Os valores da correlação entre o IMC e o BESS foram r = - 0,1 e p = 0,59. Os valores da associação do IMC entre GPN - GPP; GPN - GPC; GPP - GPC foram respectivamente: p = 0,76; p = 0,001; p = 0,07. CONCLUSÃO: O índice de massa corporal de adultos obesos não influencia o equilíbrio corporal, porém influencia na configuração plantar.
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Abstract
This article is based on educating readers and physicians about the use of footwear and orthotics for themselves and their patients, to treat diseases and enhance functionality in sports and daily life.
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Affiliation(s)
- Muhammad Nausherwan Khan
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Penn State Hershey Medical Group, 121 Nyes Road, Suite A, Family Medicine Offices, Harrisburg, PA 17112, USA.
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Valderrabano V, Paul J, Monika H, Pagenstert GI, Henninger HB, Barg A. Joint-preserving surgery of valgus ankle osteoarthritis. Foot Ankle Clin 2013; 18:481-502. [PMID: 24008214 DOI: 10.1016/j.fcl.2013.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with posttraumatic ankle osteoarthritis (OA) typically present with asymmetric involvement of the tibiotalar joint, resulting in valgus or varus deformity of the ankle and hindfoot. Without appropriate treatment, patients with asymmetric ankle OA typically develop full end-stage ankle OA. Ankles with valgus deformities suffer from a lateral joint overload with subsequent lateral tibiotalar joint degeneration, which causes further lateral load shift. In these cases patients may benefit from joint-preserving realignment surgery to unload the degenerated lateral area and normalize joint biomechanics. This article describes the authors' algorithm for the treatment of patients with asymmetric valgus ankle OA.
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Affiliation(s)
- Victor Valderrabano
- Orthopaedic Department, Osteoarthritis Research Center Basel, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel 4031, Switzerland.
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Klaue K, Kaliyaperumal K, Swanson SA, Low WCJ. Central calcaneal osteotomy for correction of flexible pes planovalgus deformity. Foot Ankle Int 2013; 34:1079-89. [PMID: 23532798 DOI: 10.1177/1071100713483102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral column lengthening procedures have been extensively reported either as primary procedures or adjuncts to combined soft tissue procedures and osteotomies for the correction of the pes planovalgus deformity. There is also considerable debate as to the ideal procedure that is not followed by recurrence and obviates the need for revision surgeries and minimizes complications. We describe a technique and present the clinical results of lateral column lengthening that provides a powerful correction to restore normal foot alignment. METHODS We retrospectively reviewed 26 feet in 21 patients with a mean age of 35.4 years (range, 12-75) over an average follow-up period of 71 months (range, 12-147) who underwent reconstructive surgery for flexible pes planovalgus foot. The reconstructive procedures included a central calcaneal osteotomy in all patients, a medial column stabilization procedure, flexor digitorium transfer (FDL), and a gastrocnemius or Achilles tendon lengthening. Clinical evaluation was carried out with the AOFAS ankle-hindfoot scores. Standard weight-bearing anterior posterior (AP) and lateral radiographs before surgery and at follow-up were analyzed for radiographic parameters of correction. RESULTS The median AOFAS score increased from 50 to 90. Two patients reported dissatisfaction with the result. There were no nonunions nor complications related to hardware. Radiographic improvement of the talonavicular coverage angle was a 74% change from baseline value. All radiographic parameters improved (P < .001) except the lateral talocalcaneal angle (P = .48). No secondary subsidence of the arch was observed within the follow-up time. CONCLUSION Correction of flexible pes planovalgus deformity with a central calcaneal osteotomy was an effective, reproducible method to restore normal foot alignment and good function. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Kaj Klaue
- Reparto di Chirurgia Ortopedica, Clinica Luganese Moncucco, Lugano, Switzerland.
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The pictogram of the pes planus from the first century AD. INTERNATIONAL ORTHOPAEDICS 2013; 37:1871-3. [PMID: 23881065 DOI: 10.1007/s00264-013-2020-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study presents a pictogram engraved into the Marble Road of the ancient town of Ephesus, with a special emphasis on one part of it which represents a flat foot. Although the flat foot is a widespread and common disturbance in all time periods, we were motivated by a lack of its representation within iconographical, historical or other sources. METHOD Aiming to confirm the diagnosis objectively we applied the modern diagnostic methodology, arch index (AI). The result was 0.33, which is a mathematical proof that the Ephesus foot is definitely flat. CONCLUSION To the best of our knowledge, this picture from the first century AD is among the oldest representations of a flat foot in history.
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Ribbans WJ, Garde A. Tibialis posterior tendon and deltoid and spring ligament injuries in the elite athlete. Foot Ankle Clin 2013; 18:255-91. [PMID: 23707177 DOI: 10.1016/j.fcl.2013.02.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The tibialis posterior tendon and the spring and deltoid ligament complexes combine to provide dynamic and passive stabilization on the medial side of the ankle and hindfoot. Some of the injuries will involve acute injury to previous healthy structures, but many will develop insidiously. The clinician must be aware of new treatment strategies and the level of accompanying scientific evidence regarding injuries sustained by athletes in these areas, while acknowledging that more traditional management applied to nonathletic patients is still likely to be appropriate in the setting of treatment for elite athletes.
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Affiliation(s)
- William John Ribbans
- The University of Northampton, School of Health, Park Campus, Northampton NN2 7AL, UK.
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Xia J, Zhang P, Yang YF, Zhou JQ, Li QM, Yu GR. Biomechanical analysis of the calcaneocuboid joint pressure after sequential lengthening of the lateral column. Foot Ankle Int 2013; 34:261-6. [PMID: 23413067 DOI: 10.1177/1071100712464211] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lengthening of the lateral column by means of the Evans osteotomy is commonly used for reconstruction of adult and pediatric flatfoot. However, some reports have shown that the Evans osteotomy is linked with increased calcaneocuboid joint pressures and an increased risk of arthritis in the joint. The purpose of this study was to measure the pressure across the calcaneocuboid joint and demonstrate the changing trends of the pressure within the calcaneocuboid joint after sequential lengthening of the lateral column. METHODS Six cadaver specimens were physiologically loaded and the peak pressure of the calcaneocuboid joint was measured under the following conditions: (1) normal foot, (2) flatfoot, and (3) sequential lengthening of the lateral column by means of the Evans procedure (from 4 mm to 12 mm, in 2 mm increments). RESULTS Peak pressures across the joint increased significantly from baseline in the flatfoot (P < .05). In the corrected foot, with the increment of the graft, the peak pressure decreased initially and then increased. The pressure reached its minimum value (11.04 ± 1.15 kg/cm(2)) with 8 mm lengthening of the lateral column. The differences were significant compared to the flatfoot (P < .05) and corrected foot with the other sizes of grafts (P < .05), but differences were not significant compared to the intact foot (P = .143). CONCLUSIONS Lateral column lengthening within a certain extent will decrease the pressure in calcaneocuboid joint with a flatfoot deformity. CLINICAL RELEVANCE Performing the procedure with an 8 mm lengthening may reduce the risk of the secondary calcaneocuboid osteoarthritis.
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Affiliation(s)
- Jiang Xia
- Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, China
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39
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Hatic SO, Philbin TM. Management of the recurrent deformity in a flexible foot following failure of tendon transfer: is arthrodesis necessary? Foot Ankle Clin 2012; 17:299-307. [PMID: 22541527 DOI: 10.1016/j.fcl.2012.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recurrent deformity in the adult flatfoot following previous tendon transfer represents a challenging treatment dilemma for even the most experienced foot and ankle surgeon. The evaluation must be comprehensive, resulting in a clear understanding of the extent to which previous surgical procedures either failed to address the deformity initially or led to progressive recurrence. Particularly in younger, more high-demand patients, every effort to preserve normal joint mechanics while alleviating pain and restoring functional alignment must be made. LCL coupled with MDCO and a comprehensive medial soft tissue reconstruction represents a joint-sparing modality for approaching even the most challenging flexible flatfoot deformities. Care to avoid overcorrection, particularly with a double calcaneal osteotomy, must be taken. In the presence of progressive degenerative changes or patient factors such as morbid obesity and advanced age, hindfoot arthrodesis, particularly realignment subtalar joint arthrodesis, provides a technically straightforward, predictable means of achieving a pain-free plantigrade foot. Talonavicular arthrodesis and double arthrodesis, although reliable means of achieving pain relief and functional alignment, do sacrifice considerably more hindfoot motion and are likely more appropriately reserved for elderly, low-demand patients or those with more severe fixed deformities.
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Affiliation(s)
- Safet O Hatic
- Orthopedic Associates of SW Ohio, 4160 Little York Road, Suite 10, Dayton, OH 45414, USA
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40
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Abstract
The traditional surgical treatment for adults with a rigid, arthritic flatfoot is a dual-incision triple arthrodesis. Over time, this procedure has proved to be reliable and reproducible in obtaining successful deformity correction through fusion and good clinical results. However, the traditional dual-incision triple arthrodesis is not without shortcomings. Early complications include lateral wound problems, malunion, and nonunion. Long-term follow-up of patients after a triple arthrodesis has shown that many develop adjacent joint arthritis at the ankle or midfoot. This particular problem should be considered an expected consequence, rather than a failure of the procedure. Although the indications for and surgical techniques used in triple arthrodesis have evolved and improved with time (predictably improving results in the intermediate term), the triple arthrodesis should be regarded as a salvage procedure. Certain measures can be taken by the surgeon to avoid some problems. If patients are at risk for lateral wound complications, the arthrodesis could be performed through a single medial incision. However, this can make some aspects of the CC fusion more difficult. Implants would have to be inserted percutaneously, which prevents the surgeon from using either staples or plates. If a patient were to need a lateral column lengthening through a CC distraction fusion, this would not be possible medially. If either the ST or CC joints have minimal degenerative changes, they could be spared through a double or modified double arthrodesis, respectively. Although these procedures that deviate from the traditional triple arthrodesis offer promise, further study is required to better define their role in treatment of the rigid, arthritic AAFD. Triple arthrodesis is, by no means, a simple surgery. It requires preoperative planning, meticulous preparation of bony surfaces, cognizance of hindfoot positioning, and rigidity of fixation. The procedure also requires enough experience on the part of the operating surgeon to anticipate postoperative problems and provide modifications in traditional technique for certain patients.
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41
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Schinca N, Lasalle A, Alvarez J. Young's procedure for the treatment of valgus flatfoot deformity caused by a posterior tibial tendon dysfunction, stage II. Foot Ankle Clin 2012; 17:227-45. [PMID: 22541522 DOI: 10.1016/j.fcl.2012.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Young’s procedure contains an action mechanism that works better than other techniques on the pathophysiology of FFD. It respects the anatomy and biomechanics of the foot to reach the necessary muscular balance. The benefits of this technique include that the ATT is not detached, so its function mechanism is still active; the new trajectory of the ATT provides a powerful sling function at the level of the navicular; and the horizontal trajectory of the ATT and the osteoperiosteal flaps constitute a powerful inner capsular–tendinous–ligamentous support. What is more, an insufficiency of the ATT is created, which results in a predominance of the peroneus lateral longus, that descends and prones the forefoot. Additional procedures, such as medial displacement calcaneal osteotomy, should be considered to correct the entire deformity. The combination of these techniques do not sacrifice the joint mobility.
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Affiliation(s)
- Nuri Schinca
- Foot and Ankle Surgery Service, British Hospital, Italia Avenue 2420, CP 11600, Montevideo, Uruguay
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42
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Nam KS, Kwon JW, Kwon OY. The Relationship between Activity of Abductor Hallucis and Navicular Drop in the One-leg Standing Position. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ki Seok Nam
- Department of Physical Therapy, Yeungnam College of Science and Technology
| | - Jung Won Kwon
- Department of Rehabilitation Science, Graduate School, Daegu University
| | - Oh-Yun Kwon
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University
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43
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Biomechanical and clinical factors related to stage I posterior tibial tendon dysfunction. J Orthop Sports Phys Ther 2011; 41:776-84. [PMID: 21765219 DOI: 10.2519/jospt.2011.3545] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case control. OBJECTIVES To investigate differences in arch height, ankle muscle strength, and biomechanical factors in individuals with stage I posterior tibial tendon dysfunction (PTTD) in comparison to healthy individuals. BACKGROUND PTTD is a progressive condition, so early recognition and treatment are essential to help delay or reverse the progression. However, no previous studies have investigated stage I PTTD, and no single study has measured static anatomical structure, muscle strength, and gait mechanics in this population. METHODS Twelve individuals with stage I PTTD and 12 healthy, age- and gender-matched control subjects, who were engaged in running-related activities, participated in this study. Measurements of arch height index, maximum voluntary ankle invertor muscle strength, and 3-dimensional rearfoot and medial longitudinal arch kinematics during walking were obtained. RESULTS The runners with PTTD demonstrated significantly lower seated arch height index (P = .02) and greater (P = .03) and prolonged (P = .05) peak rearfoot eversion angle during gait, compared to the healthy runners. No differences were found in standing arch height index values (P = .28), arch rigidity index (P = .06), ankle invertor strength (P = .49), or peak medial longitudinal arch values (P = .49) between groups. CONCLUSION The increased foot pronation is hypothesized to place greater strain on the posterior tibialis muscle, which may partially explain the progressive nature of this condition.
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van Ooij B, Vos CJS, Saouti R. Arthroereisis of the subtalar joint: an uncommon complication and literature review. J Foot Ankle Surg 2011; 51:114-7. [PMID: 21956005 DOI: 10.1053/j.jfas.2011.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Indexed: 02/03/2023]
Abstract
Arthroereisis is an operation to prevent abnormal pronation in the subtalar joint in children and adults with symptomatic flexible flatfeet. In the present report, we describe an uncommon late complication of a former variation of this procedure, namely the case of an adult male who experienced migration of a xenogeneic bone graft that had been implanted 55 years earlier. A thorough review of the existing data was also undertaken to better understand the complications of this procedure.
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Affiliation(s)
- Bas van Ooij
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
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45
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Hintermann B, Knupp M. [Injuries and dysfunction of the posterior tibial tendon]. DER ORTHOPADE 2011; 39:1148-57. [PMID: 21088955 DOI: 10.1007/s00132-010-1692-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The function of the posterior tibial (PT) tendon is to stabilize the hindfoot against valgus and eversion forces. It functions as the primary invertor of the foot and assists the Achilles tendon in plantar flexion. The PT tendon is a stance phase muscle, firing from heel strike to shortly after heel lift-off. It decelerates subtalar joint pronation after heel contact. It functions as a powerful subtalar joint supinator and as a support of the medial longitudinal arch. The action of the tendon travels to the transverse tarsal joints, locking them and allowing the gastrocnemius to support heel rise. Acute injuries of the PT tendon are rare and mostly affect the active middle-aged patient or they are the result of complex injuries to the ankle joint complex. Dysfunction of the PT tendon following degeneration and rupture, in contrast, has shown an increasing incidence in recent years. To which extent changed lifestyle, advancing age, comorbidities, and obesity play a role has not yet been clarified in detail. Dysfunction of the PT tendon results in progressive destabilization of the hind- and midfoot. Clinically, the ongoing deformation of the foot can be classified into four stages: in stage 1, the deformity is distinct and fully correctable; in stage II, the deformity is obvious, but still correctable; in stage III, the deformity has become stiff; and in stage IV, the ankle joint is also involved in the deformity. Treatment modalities depend on stage: while conservative measures may work in stage I, surgical treatment is mandatory for the later stages. Reconstructive surgery is advised in stage II, whereas in stage III and IV correcting and stabilizing arthrodeses are advised. A promising treatment option for stage IV may be adding an ankle prosthesis to a triple arthrodesis, as long as the remaining competence of the deltoid ligament is sufficient. An appropriate treatment is mandatory to avoid further destabilization and deformation of the foot. Failures of treatment result mostly from underestimation of the problem or insufficient treatment of existing instability and deformity.
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Affiliation(s)
- B Hintermann
- Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Orthopädische Klinik Kantonsspital, Rheinstraße 26, CH-4410 Liestal, Schweiz.
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46
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Barg A, Brunner S, Zwicky L, Hintermann B. Subtalar and naviculocuneiform fusion for extended breakdown of the medial arch. Foot Ankle Clin 2011; 16:69-81. [PMID: 21338931 DOI: 10.1016/j.fcl.2010.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Combined subtalar and naviculocuneiform fusion was successful in restoring the longitudinal medial arch after extended breakdown while preserving the talon avicular joint. This surgical technique was shown to give a reliable fusion and biomechanically stable position of the foot. In this review article, we summarize the medial column procedures for flatfoot deformity and present our surgical technique and results of 10 consecutive patients treated with this method at a minimum 1-year follow-up.
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Affiliation(s)
- Alexej Barg
- Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
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47
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Oh I, Williams BR, Ellis SJ, Kwon DJ, Deland JT. Reconstruction of the symptomatic idiopathic flatfoot in adolescents and young adults. Foot Ankle Int 2011; 32:225-32. [PMID: 21477539 DOI: 10.3113/fai.2011.0225] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The surgical indications, timing, and procedure for flexible flatfoot reconstruction in young patients remains controversial. This retrospective study reports the clinical results of reconstruction of flexible, idiopathic, symptomatic flatfoot in adolescent and young adults indicated for surgery by persistent pain and functional limitations. The hypothesis was that the results of these procedures allow patients to return to sports activities with minimal discomfort or pain. MATERIALS AND METHODS Sixteen consecutive idiopathic flatfeet in ten patients with a mean age of 15.6 years at the time of surgery (range, 10 to 22) were assessed at a final followup visit at average of 5.2 (range, 2 to 10) years. Reconstruction included combined medializing calcaneal osteotomy and lateral column lengthening in all 16 patients. Flexor digitorum longus transfer (nine), medial column stabilization (eight), and gastroncnemius recession (eight) were carried out as needed. The AOFAS, SF-36, and FAOS questionnaires were completed. Sports activity and patient satisfaction were also assessed. Standard preoperative and postoperative radiographic parameters were measured. RESULTS The mean AOFAS score increased on average from 49.1 to 93.4. Only one patient reported a postoperative restriction in sports. The satisfaction level was excellent in 15 feet and good in one foot. Significant improvement in radiographic parameters was noted for the AP talonavicular coverage angle (p < 0.001) and lateral talar-first metatarsal angle (p < 0.001). CONCLUSION Flexible flatfoot reconstruction in a cohort of symptomatic adolescent and young adult patients achieved a reduction of pain and improved functional outcome including the ability to participate in sporting activities.
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Affiliation(s)
- Irvin Oh
- Hospital For Special Surgery, New York City, NY 10021, USA.
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Zaw H, Calder JDF. Operative management options for symptomatic flexible adult acquired flatfoot deformity: a review. Knee Surg Sports Traumatol Arthrosc 2010; 18:135-42. [PMID: 20049416 DOI: 10.1007/s00167-009-1015-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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