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Fadle AA, Khalifa AA, Bahy A, El-Gammal YT, Abubeih H, El-Adly W, Osman AE. Joint preservation surgery for correcting adolescents' spasmodic flatfoot deformity: early results from a specialized North African foot and ankle unit. Int Orthop 2024; 48:1543-1552. [PMID: 37861704 PMCID: PMC11076396 DOI: 10.1007/s00264-023-06011-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE We aimed to report early results of performing joint-preserving surgeries for managing spasmodic flatfoot deformity (SFFD) in adolescents. METHODS A prospective case series study including 24 patients (27 feet) diagnosed with idiopathic SFFD not responding to conservative management. After reassessment under anesthesia, surgical procedures included soft tissue releases (Achilles tendon (AT), peroneus brevis (PB), peroneus tertius (PT) (if present), and extensor digitorum longus (EDL)), bony osteotomies (lateral column lengthening (LCL), medial displacement calcaneal osteotomy (MDCO), and double calcaneal osteotomy (DCO)), and medial soft tissue reconstruction or augmentation if needed. Functional evaluation was performed per the American Orthopedic Foot and Ankle Society (AOFAS) score, while radiological parameters included talo-navicular coverage angle (TNCA), talo-first metatarsal angle (AP Meary's angle), calcaneal inclination angle (CIA), talo-calcaneal angle (TCA), talo-first metatarsal angle (Lat. Meary's angle), and tibio-calcaneal angle (TibCA). The preoperative parameters were compared to the last follow-up using the Wilcoxon signed test. RESULTS The mean age was 15.37 ± 3.4 years, 18 (75%) were boys, and the mean BMI was 28.52 ± 3.5 (kg/m2). Release of AT and fractional lengthening of PL, PT, and EDL were performed in all patients. LCL was needed in eight feet (29.6%), MDCO in 5 (18.5%), and DCO in 14 (51.9%). FDL transfer was required in 12 (44.4%) feet, and repair of the spring ligament in seven (25.9%). The mean operative time was 99.09 ± 15.67 min. All osteotomies were united after a mean of 2.3 ± 0.5 months. After a mean follow-up of 24.12 ± 8.88 months (12 and 36 months), the AOFAS improved from a preoperative mean of 43.89 ± 11.49 to a mean of 87.26 ± 9.92 (P < 0.001). All radiological parameters showed significant improvement, AP Meary's angle from a mean of 20.4 ± 5.3 to a mean of 9.2 ± 2.1, Lat. Meary's angle from - 15.67° ± 6.31 to - 5.63° ± 5.03, TNCA from - 26.48° ± 5.94 to 13.63° ± 4.36, CIA from 12.04° ± 2.63 to 16.11° ± 3.71, TibCA from - 14.04° ± 3.15 to - 9.37° ± 3.34, and TCA Lat. from 42.65° ± 10.68 to 25.60° ± 5.69 (P ≤ 0.001). One developed wound dehiscence (over an MDCO), managed with daily dressings and local antibiotics. Another one developed lateral foot pain after having LCL managed by metal removal. CONCLUSION Careful clinical and radiological evaluation for the correct diagnosis of SFFD is paramount. Joint-preserving bony osteotomies combined with selective soft tissue procedures resulted in acceptable functional and radiological outcomes in this young age group.
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Affiliation(s)
- Amr A Fadle
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
| | - Ahmed Bahy
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | | | - Hossam Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Wael El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed E Osman
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
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Galán-Olleros M, Del Baño Barragán L, Figueroa MJ, Prato de Lima CH, Fraga-Collarte M, Torres-Izquierdo B, Hosseinzadeh P, Martínez-Caballero I. Outcomes of the "Calcaneo-stop" procedure for treating symptomatic flexible flatfoot in children: A systematic review and meta-analysis of 2394 feet. Foot Ankle Surg 2024:S1268-7731(24)00084-5. [PMID: 38714453 DOI: 10.1016/j.fas.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/23/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND This study evaluates the efficacy of the calcaneo-stop (C-Stop) procedure's effectiveness in treating symptomatic flexible flatfoot (FFF) in children. METHODS A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane databases to identify studies until 2023 on the outcomes of the C-Stop procedure in children with FFF. The risk of bias was assessed using MINORS criteria. RESULTS Of 85 studies screened, 20 involving 2394 feet from 1415 patients (mean age 11.2 ± 1.3 years) were included. Post-procedure, significant improvements were noted in pain reduction (93.5%), heel alignment (95.21%), and radiological measures, including reductions in Kite (7.32º), Meary (11.65º), Costa-Bartani angles (17.11º), talar declination (12.63º) and increase in Calcaneal Pitch Angle (5.92º). AOFAS scores increased by 22.32 points on average, with 94.83% reporting high satisfaction. Complication rate was low (7.8%). CONCLUSIONS The C-Stop procedure is effective for treating FFF in children, offering significant clinical, radiological, and functional improvements with high patient satisfaction and a low complication rate. LEVEL OF EVIDENCE Level IV, Systematic review of Level-IV studies.
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Affiliation(s)
- María Galán-Olleros
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Laura Del Baño Barragán
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - María Jesús Figueroa
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos H Prato de Lima
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Manuel Fraga-Collarte
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Beltran Torres-Izquierdo
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Pooya Hosseinzadeh
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ignacio Martínez-Caballero
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Szesz A, Małecki K, Sibiński M, Niedzielski KR. An evaluation of subtalar titanium screw arthroereisis for the treatment of symptomatic paediatric flatfeet - early results. BMC Musculoskelet Disord 2023; 24:825. [PMID: 37858058 PMCID: PMC10585733 DOI: 10.1186/s12891-023-06937-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Idiopathic flexible flatfoot is a common condition in children which typically improves with age and remains asymptomatic. However, the condition can sometimes be more severe, and cause mechanical impairment or pain. The aim of the study was to perform a prospective clinical, radiological, podoscopic and pedobarographic assessment (static and dynamic) of subtalar titanium screw arthroereisis for the treatment of symptomatic, idiopathic, flexible flatfeet. METHODS A prospective, consecutive, non-controlled, cohort, clinical follow-up study was performed. In total, 30 patients (41 feet), mean age 10 (6 to 16 years), were evaluated. Clinical and standing radiological assessments, static and dynamic pedobarography, as well as podoscopy, were performed before surgery and at final follow-up. RESULTS Treatment was associated with significant improvements in heel valgus angle, radiographic parameters (lateral and dorso-planar talo-first metatarsal angle, calcaneal inclination angle, talar declination angle, longitudinal arch angle) and podoscopic parameters (Clark's angle, Staheli's arch index and Chippaux-Smirak index). Significant increases were noted for lateral loading, forefoot contact phase and double support / swing phase, and reduced medial loading (dynamic pedobarography), as well as lateral midfoot area and loading, but decreased were observed for medial forefoot loading (static pedobarography). Four patients reported persistent pain in the sinus tarsi region (six feet), and in one case, the implant was replaced for a larger one due to undercorrection. No overcorrections or infection complications were noted in the study group. CONCLUSIONS Subtalar arthroereisis is a minimally-invasive and effective surgical method for treating symptomatic, idiopathic, flexible flatfeet; it has an acceptable complication rate with good early clinical results. LEVEL OF EVIDENCE II b.
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Affiliation(s)
- Anna Szesz
- Clinic of Orthopaedics and Traumatology, Polish Mother's Hospital Research Institute, Lodz, Poland
| | - Krzysztof Małecki
- Clinic of Orthopaedics and Traumatology, Polish Mother's Hospital Research Institute, Lodz, Poland
| | - Marcin Sibiński
- Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, ul Pomorska 251, Lodz, 92-213, Poland.
| | - Kryspin R Niedzielski
- Clinic of Orthopaedics and Traumatology, Polish Mother's Hospital Research Institute, Lodz, Poland
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Mehanna J, Massaad A, Assi A, Rassi J, Atallah A, Ghanem I. Risk Factors for Failure of Calcaneal Lengthening Osteotomy in Children and Adolescents With Planovalgus Foot Deformity: A Retrospective Study. Cureus 2023; 15:e43157. [PMID: 37692710 PMCID: PMC10484500 DOI: 10.7759/cureus.43157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION The calcaneal lengthening procedure (CLP) is a well-known surgical technique used for the correction of symptomatic planovalgus foot deformities. Literature shows a significant rate of relapse and undercorrection of the foot post-operatively. Factors determining the failure or success of CLP are still not well understood. The purpose of this retrospective study was to assess the most significant factors related to the failure of this procedure. METHODS A case-control retrospective study was conducted on 50 patients (80 feet) aged 12.4±2.5 years who underwent CLP. A clinical (demographic parameters, etiology, Gross Motor Function Classification System (GMFCS) level) and radiological evaluation were assessed preoperatively and repeated postoperatively at 56.5±32.5 months. Two methods of osteotomy bone fixation were studied: K-wires vs. eight-plate. Standing anteroposterior (AP) and lateral (L) radiographs were done, and the following radiographic parameters were measured: calcaneocuboid (CC) joint subluxation classified into normal, moderate, and severe (L); AP and L talo-first metatarsal (T1MT) angle; AP talonavicular (TN) coverage angle; AP and L talocalcaneal (TC) angle; calcaneal pitch (CP) angle; and L talo-horizontal (TH) angle. Mosca's criteria were used for clinical and radiological assessments. The association between demographic data, clinical and radiological results, and the variation between preoperative and postoperative angles were studied. The main risk factors affecting clinical results and CC joint subluxation were investigated (logistic regression and analysis of covariance (ANCOVA)). RESULTS Satisfactory clinical results were associated with satisfactory radiological ones on Mosca's criteria (p<0.001). The use of an eight-plate for osteotomy fixation gave better results than K-wires (79% vs. 59%). Radiological angles were improved in both techniques postoperatively (increase of CP and L-TC and decrease of AP-T1MT, AP-TC, AP-TN, and L-T1MT, all p<0.05). Non-satisfactory clinical results were associated with a high GMFCS level, a low preoperative AP-TN coverage angle, and a low preoperative CP angle (R2=0.45). Both a young age and a low CP angle preoperatively were associated with CC subluxation (R2=0.31). CONCLUSION The neurological status and the severity of the planovalgus foot deformity preoperatively were the main risk factors affecting clinical outcomes after CLP. However, young age and the severity of the deformity preoperatively were the main risk factors behind CC joint subluxation affecting CLP outcomes.
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Affiliation(s)
- Joe Mehanna
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Joe Rassi
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Alexis Atallah
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
- Orthopedic Surgery, Hôtel-Dieu de France Hospital, Beirut, LBN
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Schmidt S, Böhm H, Dussa CU, Bienias K, Fujak A. Characteristic 3D foot motion patterns during gait of patients with Charcot-Marie-Tooth identified by cluster analysis. Gait Posture 2023; 104:43-50. [PMID: 37307763 DOI: 10.1016/j.gaitpost.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND CMT is a clinically and genetically heterogenous disease with varying degrees of progression. Different foot deformities, gait and movement patterns are observed. In order to achieve an improved, targeted treatment strategy, the participants are divided into characteristic groups using a mathematical cluster analysis based on the data from the three-dimensional foot kinematics during walking. METHODS Outpatients from age 5-64 years (N = 33 participants, 62 feet) with a proven CMT type 1 (N = 16, 31 feet) or CMT without any further type assignment (N = 17, 31 feet) were retrospectively analyzed. After a standard clinical examination, participants underwent 3D gait analysis using the Oxford Foot Model. To classify the movement patterns, a k-means cluster analysis was calculated based on the principal component analysis (PCA) of the foot kinematics data. Gait parameters, clinical parameters and X-ray data were statistically tested. RESULTS The cluster analysis divided the gait data of the participants into two groups. Cluster 1 (N = 21 participants, 34 feet) showed increased dorsiflexion of the hindfoot and increased plantarflexion of the forefoot with cavus position in the sagittal plane, a hindfoot inversion and forefoot pronation with hindfoot varus in the frontal plane and in the transversal plane a forefoot adduction. Cluster 2 (N = 17 participants, 28 feet) deviated significantly from the norm mainly in the frontal plane and were characterized by a strong eversion of the hindfoot with a supination in the forefoot. DISCUSSION Based on the findings, the resultant clusters can be interpreted as cavovarus feet (cluster 1) and pes valgus (cluster 2). The most reliable variables in the 3D gait analysis to classify CMT feet with regard to significance are the ones in the frontal plane. This subdivision of participants goes hand in hand with the various necessary guidelines for orthopedic treatment.
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Affiliation(s)
- Selena Schmidt
- Department of Trauma and Orthopaedic Surgery, Pediatric and Neuro Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Germany.
| | - Harald Böhm
- Department of Paediatric Orthopaedics, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83209 Aschau i. Chiemgau, Germany
| | - Chakravarthy U Dussa
- Department of Trauma and Orthopaedic Surgery, Pediatric and Neuro Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Germany; Department of Paediatric Orthopaedics, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83209 Aschau i. Chiemgau, Germany
| | | | - Albert Fujak
- Department of Trauma and Orthopaedic Surgery, Pediatric and Neuro Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Germany
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Vergillos Luna M, Khal AA, Milliken KA, Solla F, Rampal V. Pediatric Flatfoot: Is There a Need for Surgical Referral? J Clin Med 2023; 12:jcm12113809. [PMID: 37298004 DOI: 10.3390/jcm12113809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Pediatric foot deformities are a common finding, concerning up to 44% of preschool aged children. The absence of accepted international guidelines, as well as heterogeneity in definitions and measurements, makes management of pediatric flatfoot a challenge, and decisions surrounding specialized care referral confusing and biased. The objective of this narrative review is to provide guidance to primary care physicians treating these patients. A non-systematic review of the literature regarding the development, etiology, and clinical and radiographic assessment of flatfeet using the PubMed and Cochrane Library databases was performed. The exclusion criteria for the review were adult populations, papers detailing the outcome of a specific surgical procedure, and publications prior to 2001. The included articles showed great heterogeneity in definition and proposed management, which makes the study of pediatric flatfoot challenging. Flatfoot is a common finding in children under 10 years old, and should not be considered pathological unless stiffness or functional limitation are present. Surgical referral should be reserved to children with stiff or painful flatfoot, while simple observation is indicated for flexible, asymptomatic flatfeet.
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Affiliation(s)
- Manuel Vergillos Luna
- Department of Orthopedics, Regina Montis Regalis Hospital, 12084 Mondovì, Italy
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Adyb-Adrian Khal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Kara A Milliken
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Federico Solla
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Virginie Rampal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
- Laboratoire Motricité Humaine Expertise Sport Santé, Unité de Formation et Recherche Sciences et Techniques des Activités Physiques et Sportives, 06205 Nice, France
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Badawy MA, Kholeif AM, Radwan YA, EL Sersawy AM. Comparative study between medial displacement calcaneal osteotomy using modified step plate and arthroereisis for management of planovalgus feet. Journal of Orthopaedics, Trauma and Rehabilitation 2023. [DOI: 10.1177/22104917221136283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Flexible flatfoot is a common condition that is characterized by hindfoot valgus with longitudinal medial-arch collapse. Many strategies for treatment have been reported but according to the current literature, controversy remains. Objectives: To compare the clinical and radiological outcomes of medializing calcaneal osteotomy utilizing modified step plate and subtalar arthroereisis utilizing conical subtalar implant for patients with symptomatic flexible pes planus. Methods: A prospective, randomized, double center study was conducted between May 2017 and May 2019 at the Foot and Ankle Department of Cairo University Hospital and El Sahel Teaching Hospital on 26 patients (37 feet) with flexible flat feet to compare between medial displacement calcaneal osteotomy using modified locked step plate (group A) compromising 17 feet and arthroereisis using subtalar implant (group B) compromising 20 feet. Results: By the end period of the study, 25 males and 12 females were available for our analysis of results with a mean follow-up period of 10.14 months (range 7–14 months), clinical scoring (American Orthopaedic Foot and Ankle Society score, Foot Functional Index) with radiological analysis revealed a non-significant difference between both groups, the overall complication rate was 16.2%. Conclusion: Both medial displacement calcaneal osteotomy and subtalar arthroereisis significantly improved radiographic and subjective clinical outcome measures in the surgical treatment of painful flexible planovalgus feet. The less-invasive nature and lower potential morbidity suggest that judicious use of arthroereisis implants is an appropriate alternative.
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Affiliation(s)
| | - Ahmed M Kholeif
- Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser A Radwan
- Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Böhm H, Dussa CU. Clinical, Radiographic and Gait Parameters Associated with Medial Arch Pain in the Flexible Pediatric Flatfoot. J Foot Ankle Surg 2023:S1067-2516(23)00013-3. [PMID: 36822970 DOI: 10.1053/j.jfas.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 02/25/2023]
Abstract
Pain in the flexible flatfoot is a common complaint, if present it is important to find its exact location and causes Therefore, the study aimed to find differences between children with and without medial arch pain and relate them to the reduction of pain following surgical treatment. Children with idiopathic flexible flatfeet were retrospectively included in the study. All children underwent a clinical, radiographic, and gait examination. The feet were subdivided into 2 groups: asymptomatic and those with medial arch pain. Factors associated with medial arch pain were identified via t test. Significant radiological and gait parameters were correlated to the change in medial arch pain score following surgery. Included were 322 feet belonging to 177 children, with the mean age of 11.8 (SD = 2.2) years. The pain was perceived in 52% of the feet, of these, 74% in the medial arch. In the group with pain, 31 feet received a gait analysis following surgery. The radiological parameters, talus-1 and -2 metatarsal angles and the gait parameter, calcaneal lateral shift during walking showed a significant difference (p ≤ .004) between the no pain and pain groups and were associated (R2 ≥0.14, p ≤ .04) with the reduction in pain following surgery. The increased talus-1 and -2 metatarsal angles and the calcaneal lateral shift may cause increased tension on the soft-tissues along the medial side of the foot and may produce pain. Therapies aiming at improving the medial arch pain should be directed to normalize the talus-1 or -2 metatarsal angles and the calcaneal lateral shift.
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Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, KIZ Chiemgau GmbH, Aschau im Chiemgau, Germany; Centre for Healthcare Technology, PFH- Private University Göttingen, Göttingen, Germany.
| | - Chakravarthy U Dussa
- Orthopaedic Hospital for Children, KIZ Chiemgau GmbH, Aschau im Chiemgau, Germany; Department of Orthopaedic Trauma and Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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Le Gall C, Lakhal W, Mayrargue E, Fraisse B, Marleix S, Lucas G, Losson A, Fréger N, Violas P. Functional and radiological outcome of subtalar arthroereisis for flexible pes planovalgus in children: A retrospective analysis. Orthop Traumatol Surg Res 2022:103488. [PMID: 36435370 DOI: 10.1016/j.otsr.2022.103488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pediatric idiopathic pes planovalgus can correct itself with growth. Otherwise, in the event of functional impairment and after failed conservative treatment, surgery can be considered. Based on a multicenter retrospective study, we report the functional and radiographic results obtained after subtalar arthroereisis. HYPOTHESIS We hypothesized that this surgery improves functional and radiological parameters in childhood. MATERIAL AND METHOD Forty-eight medical records of children (78 feet) operated on between 2010 and 2019 were studied. Functional (FAOS score) and radiographic (Djian angle, calcaneal slope, lateral talocalcaneal divergence and calcaneus/M5 alignment, talonavicular coverage measurement, AP talocalcaneal divergence) results were studied. The analysis of these different criteria was carried out between the preoperative period and the last follow-up. RESULTS The functional outcome was satisfactory with an average FAOS questionnaire score of 95.5 out of 100 total points. All the radiographic parameters studied were significantly improved (p<0.001). The average age at the time of surgery was 11.3 years (range: 7 to 16) with a mean follow-up of 35 months (range: 18 months to 84). Spontaneous screw expulsion and subtalar pain were the main complications found. DISCUSSION The results obtained are consistent with those in the literature. The age at the time of the surgery is an essential factor to consider with the goal of optimal correction. CONCLUSION This technique is reliable and effective in the short term. It can be offered as first-line therapy in the management of symptomatic pes planovalgus in children. The follow-up is short, which necessitates longer term studies of this population. The ideal age for surgery remains to be determined. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Caroline Le Gall
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France
| | - Walid Lakhal
- Service de chirurgie pédiatrique, CHRU Tours - Clocheville, 49, boulevard Beranger, 37000 Tours, France
| | - Emmanuelle Mayrargue
- Service de chirurgie pédiatrique, CHU Nantes, 1, Place Alexis-Ricordeau, 44093 Nantes, France
| | - Bernard Fraisse
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France
| | - Sylvette Marleix
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France
| | - Gregory Lucas
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France
| | - Alexandre Losson
- Service de chirurgie orthopédique et traumatologique, CHU Poitiers, 2 rue de la Miletrie, 86021 Poitiers, France
| | - Nicolas Fréger
- Service de chirurgie orthopédique et traumatologique, CHU Poitiers, 2 rue de la Miletrie, 86021 Poitiers, France
| | - Philippe Violas
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France.
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Kang MS, Bae K, Kim HY, Park SS. Clinico-radiological factors predicting the failure risk of conservative management in moderate to severe pediatric idiopathic flexible flatfoot. J Pediatr Orthop B 2022; 31:e213-e218. [PMID: 34860780 DOI: 10.1097/bpb.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the clinico-radiological factors of related future surgical treatment in patients with pediatric flexible flatfoot (FFF) who first visited the orthopedic clinic before the age of 10 years. Sixty-five patients diagnosed with moderate/severe idiopathic FFF deformity between the ages of 2-10 years were included. We developed prognostic models for the risk of the surgery during the follow-up period. Twenty (30.8%) patients required surgical treatment, and all of them underwent calcaneal lengthening osteotomy. Among them, 7 (10.8%) patients required concomitant Achilles-lengthening surgery. Unilateral involvement, older age, smaller calcaneal pitch angle, and higher talo-first metatarsal malalignment were considered high-risk factors for pediatric FFF surgery. Prognostic models identified three prognostic risk groups based on those factors, and survival curves revealed significant differences among the groups. Our prognostic models help predict the failure risk of conservative management of pediatric idiopathic FFF. Level of Evidence: Level III, prognostic study.
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Affiliation(s)
- Michael Seungcheol Kang
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine
| | - Kunhyung Bae
- Department of Orthopedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ho Yeon Kim
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine
| | - Soo-Sung Park
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine
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Cho DJ, Ahn SY, Bok SK. Effect of Foot Orthoses in Children With Symptomatic Flexible Flatfoot Based on Ultrasonography of the Ankle Invertor and Evertor Muscles. Ann Rehabil Med 2022; 45:459-470. [PMID: 35000371 PMCID: PMC8743848 DOI: 10.5535/arm.21137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the changes in the cross-sectional area (CSA) ratio of the ankle invertors and evertors following rigid foot orthosis (RFO) application in children with symptomatic flexible flatfoot and to determine the correlation between the degree of change in CSA ratio and pain-severity after RFO application. Methods We included 24 children with symptomatic flexible flatfoot without comorbidities and measured the CSAs of tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) using ultrasonography, resting calcaneal stance position (RCSP) angle, calcaneal pitch (CP), Meary’s angle, talonavicular coverage angle, and talocalcaneal angle using radiography, and foot function index (FFI) at baseline and 12 months after RFO application. We analyzed 48 data by measuring both feet of 24 children. The CSA ratios, the ratio of CSA of each muscle to the sum of CSA of TA, TP, and PL, were also compared. Correlations between the degree of change in FFI, each muscle’s CSA ratio, RCSP angle, and radiographic measurements were investigated. Results Following RFO application, significant increase in the PL ratio and CP and significant decrease in the RCSP angle, FFI total, pain, and disability scores were observed. The degree of change in the total score, pain, and disability score of FFI were significantly correlated with the degree of change in the PL ratio and RCSP angle. Conclusion RFOs applied to children with symptomatic flexible flatfoot might reduce the compensatory activities of the ankle invertors, thereby increasing the PL ratio, and pain decreases as the PL ratio increases.
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Affiliation(s)
- Dong Joon Cho
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - So Young Ahn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
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12
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Pavone V, Vescio A, Andreacchio A, Memeo A, Gigante C, Lucenti L, Farsetti P, Canavese F, Moretti B, Testa G, De Pellegrin M. Results of the Italian Pediatric Orthopedics Society juvenile flexible flatfoot survey: diagnosis and treatment options. J Pediatr Orthop B 2022; 31:e17-e23. [PMID: 34101678 DOI: 10.1097/bpb.0000000000000881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objectives of this study were to collect and analyze current diagnosis and treatment options of symptomatic flexible flatfoot (FFF), as well as to identify treatment expectations, among the members of the Italian Pediatric Orthopedics Society (SITOP). Diagnosis and treatment preferences were recorded according to a web-based survey. The survey was divided into six main sections: (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; (6) treatment options. One hundred and ten out of 248 SITOP members answered to the questionnaire. Age (85.5%), pain at the level of the plantar arch or fascia (61.8%), fatigue (59.1%) were the clinical parameters of crucial importance. Heel valgus (85.4%), flexibility (61.8%) and forefoot supination (47.3%) were identified as the most important foot aspects. Ninety-two responders (83.6%) identified the 'improved ability to walk longer without symptoms or discomfort' as the principal treatment expectation. Pain evaluated through the visual analog scale (VAS) was considered crucial in 31.8% of cases. All respondents confirmed they also treat patients with FFF surgically; in particular, 97.3% of SITOP affiliates declare to perform arthroereisis followed by lateral column lengthening (29.1%) and medializing calcaneal osteotomy (9.1%). Although in this survey heterogeneous findings for diagnosis and treatment of patients with symptomatic FFF within SITOP members were found, a large preference for age, heel valgus, flexibility as clinical aspects and parameters, as well as nonoperative treatment and arthroereisis, was reported.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
| | | | - Antonio Memeo
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan
| | - Cosimo Gigante
- Pediatric Orthopaedic Unit, Department of Woman and Child Health, Padua General Hospital, Padua
| | - Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
| | - Pasquale Farsetti
- Department of Orthopaedics Surgery, University of Rome "Tor Vergata", Rome
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lill
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Bari
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
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13
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Abstract
Flatfoot is commonly encountered in the paediatric population and describes a spectrum of clinical and radiological presentations which encompass both normally developing and pathological feet. Flatfoot can be categorised as flexible or rigid, a distinction which has important implications when considering the potential underlying aetiology and treatment options, and therefore imaging is an important component of the diagnostic workup. Weight-bearing plain radiographs are established initial investigations, although the significance of a number of the commonly derived quantitative parameters in children remains unclear. CT and MRI are important additional imaging modalities reserved for the investigation of symptomatic cases or those in which an underlying structural abnormality is suspected, rigid flatfoot commonly falling into one of these two categories. We review and illustrate the multimodality imaging of the paediatric flatfoot, with reference to both qualitative and quantitative radiographic assessment and cross-sectional imaging appearances.
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Affiliation(s)
- Rupert Berkeley
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK.
| | - Sally Tennant
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK
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14
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Pavone V, Testa G, Vescio A, Wirth T, Andreacchio A, Accadbled F, Canavese F. Diagnosis and treatment of flexible flatfoot: results of 2019 flexible flatfoot survey from the European Paediatric Orthopedic Society. J Pediatr Orthop B 2021; 30:450-457. [PMID: 33399292 DOI: 10.1097/bpb.0000000000000849] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of the study was to evaluate flexible flatfoot (FFF) diagnostic and current therapeutic modalities, as well as treatment expectations, among members of the European Paediatric Orthopaedic Society (EPOS). A 59-questions survey on FFF diagnosis and treatment preferences was distributed to EPOS members. The survey consisted of six sections (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; and (6) management options. Descriptive statistics were performed. A total of 93 responses were analysed. In general, clinical parameters, age (91.4% of cases), laxity (81.7%), diffuse pain (84.9%), and pain at the ankle joint (81.7%) were rated as 'average' and 'crucial importance' by the vast majority of respondents. Meary's angle (47.3% of cases), talonavicular coverage (35.5%), and lateral talocalcaneal angle (35.5%) were assessed as main radiological tools in the FFF evaluation. Among respondents, 61.3% rated 'improved ability to walk longer without symptoms' as of 'crucial importance'. Eighty-two percent of the respondents felt less than 10% of patients with FFF are candidates for corrective surgery. Arthroereisis (29.3%) was the most common surgical procedure (16.4% for subtalar and 12.9% for extra-articular arthroereisis, respectively), followed by lateral column lengthening (17.9%) and medializing calcaneal osteotomy (12.3%). There is great variation among respondents in diagnostic and treatment preferences in the management of children with FFF. The results of the EPOS 2019 FFF survey clearly show that large-scale, multicentric, international studies are necessary to elucidate which diagnostic and treatment practices lead to the best outcomes.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Thomas Wirth
- Orthopaedic Department, Olgahospital, Stuttgart, Germany
| | - Antonio Andreacchio
- Department of Pediatric Orthopedic Surgery, "V. Buzzi" Children Hospital, Milan, Italy
| | - Franck Accadbled
- Department of Orthopaedics, Children's Hospital, Toulouse University Hospital, Toulouse
| | - Federico Canavese
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand, France
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15
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Hamel J, Hörterer H, Harrasser N. [The talometatarsal-index ("TMT-Index") : A valuable X-ray parameter for differentiating between normal feet and planovalgus deformity in children and adolescents]. Orthopade 2021; 50:481-488. [PMID: 32761421 DOI: 10.1007/s00132-020-03954-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The development of the shape of the shape from childhood to adulthood is a complex continuum. Deviations from this process occur frequently and, especially in asymptomatic patients, do not always include the need for therapeutic intervention. In the current S2-guideline on the juvenile flexible flatfoot, established x‑ray parameters for assessing the flatfoot deformity were judged to be sensitive, whereby no statement was made regarding the value of the parameters among themselves. The aim of the present work is to assess the talometatarsal Index (TMTInd) in comparison to established angle measurements. METHODS Twenty-two feet with and 22 feet without planovalgus deformity (age: 10-14 years) were investigated. Established radiological parameters (lateral view: talocalcaneal angle (TC-lat), calcaneal pitch angle (Calc-B), Costa-Bartani angle (Costa-B), talometatarsal‑I angle (TMTI-lat); dorsoplantar view: talometatarsal-I-basis angle (TMTIB), talonavicular coverage (TNG), calcaneal metatarsal- V angle (Calc-MTV), talocalcaneal angle (TC-dp), and talometatarsal‑I angle (TMTI-dp)) were measured on standardized X‑ray images and compared with the values of the TMTInd. RESULTS All parameters other than Calc-MTV, TC-dp, TC-lat and Calc‑B, showed a statistically significant difference between normal and planovalgus feet, although for almost all values measured (apart from TMTI-lat and TMTInd) there was a large overlap area (>10°) between the two groups. The comparison of TMTInd to all other parameters showed the highest discrimination factor (area-under-the-curve) for the TMTInd in the distinction between the groups. CONCLUSION Compared to conventional radiological parameters, the TMTInd shows the highest validity in the distinction between normal and planovalgus feet and can provide valuable information in clinical decision-making with regard to therapy specification.
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Affiliation(s)
- J Hamel
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Deutschland.
| | - H Hörterer
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Deutschland.,Klinik für Allgemeine- Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nussbaumstraße 20, 80336, München, Deutschland
| | - N Harrasser
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar, TU München, Ismaninger Straße 22, 81675, München, Deutschland.,ECOM® - Excellent Center of Medicine, Arabellastraße 17, 81925, München, Deutschland
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16
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Tan JHI, Tan SHS, Lim AKS, Hui JH. The outcomes of subtalar arthroereisis in pes planus: a systemic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141:761-73. [PMID: 32377845 DOI: 10.1007/s00402-020-03458-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Subtalar arthroereisis has been increasingly accepted as a solution to manage symptomatic pes planus. However, despite the recent developments related to arthroereisis, no other published literature has aimed to review the outcomes in paediatric patients since 2010. This systematic review and meta-analysis, therefore, aims to evaluate the current outcomes of subtalar arthroereisis in the treatment of symptomatic pes planus among the paediatric population. MATERIALS AND METHODS The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reported on the clinical outcomes of subtalar arthroereisis in children aged 21 or younger were included. RESULTS A total of 17 publications were included, with 1536 feet. The average duration of follow-up of the studies included in the review is 43.52 months. The studies consistently reported improvement in the radiological outcomes, approximating that of a normal population. Subtalar arthroereisis has shown to restore the collapsed medial longitudinal arch, supported by the decrease in Meary's angle to 5.267° (95% CI: 4.695°-5.839°, normal: 0°-10.0°) post-operatively and an increased calcaneal pitch of 15.70° (95% CI: 15.41°-15.99°, normal 18.0°-20.0°). Deformities associated with pes planus such as heel valgus was also significantly reduced, evident by the post-operative lateral talocalcaneal angle of 27.19° (95% CI: 26.44°-27.93°, normal: 25.0°-45.0°) and a post-operative Kite's angle of 18.13° (95% CI: 17.73°-18.52°, normal: 15.0°-30.0°). Subjectively, subtalar arthroereisis has generally resulted in an improvement in the grading of outcomes postoperatively from the patient's point of view. CONCLUSIONS Subtalar arthroereisis could serve as a procedure to correct radiological abnormalities, as well as relieve pain in selected patients with symptomatic pes planus.
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17
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Byrnes SK, Wearing S, Böhm H, Dussa CU, Horstmann T. Effects of idiopathic flatfoot deformity on knee adduction moments during walking. Gait Posture 2021; 84:280-286. [PMID: 33418453 DOI: 10.1016/j.gaitpost.2020.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Flatfoot deformity is commonly characterized by a subtalar valgus, a low medial longitudinal arch, and abduction of the forefoot. Although flatfoot deformity has been associated with lower first (KAM1) and second (KAM2) peak knee adduction moments during walking, the biomechanical connection remains unknown. RESEARCH QUESTION We hypothesized that hindfoot eversion, lateral calcaneal shift correlate with KAM1 and forefoot abduction and arch height with KAM2, due to the lateralization of the ground reaction force vector resulting from shifted heel and forefoot in flatfoot deformity. METHODS Gait data from 103 children with flatfoot deformity who underwent three-dimensional gait analysis with the Oxford Foot Model were retrospectively included. Children with knee varus/valgus, in- and out-toeing were excluded. Fifteen healthy children with a rectus foot type were also collected from the database. Lateral calcaneal shift was defined as the distance between the projection of the ankle joint center onto the calcaneal axis and the midpoint of the calcaneal axis formed by the medial and lateral calcaneal markers. A subgroup of children with idiopathic flatfoot deformity that had received corrective surgery was also identified. Statistical analysis included Pearson's correlations and independent and paired t-tests (α < .05). RESULTS When compared to a norm cohort, flatfooted children had significant lower KAM1 and KAM2 (t-test, P < .001). Lateral calcaneal shift correlated with KAM1 and KAM2 (r = 0.42, p < .001 and r = 0.32, P < .001, respectively). Arch height correlated with KAM2 (r = 0.23, p = 0.017). KAM1 and KAM2 normalized after surgery and the change in KAM1 correlated with the change in lateral calcaneal shift for children who underwent corrective surgery. SIGNIFICANCE Lateral calcaneal shift explains the reduction of KAM1 by lateralization of the point of force application in flatfooted children. It is recommended to consider the lateral calcaneal shift when investigating KAM in gait analysis research.
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Affiliation(s)
- S Kimberly Byrnes
- Orthopedic Children's Hospital, Behandlungszentrum Aschau GmbH, Germany; Department of Sports and Health Sciences, Institute for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Germany.
| | - Scott Wearing
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia; Medical Park St. Hubertus Klinik, Bad Wiessee, Germany
| | - Harald Böhm
- Orthopedic Children's Hospital, Behandlungszentrum Aschau GmbH, Germany
| | | | - Thomas Horstmann
- Department of Sports and Health Sciences, Institute for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Germany; Medical Park St. Hubertus Klinik, Bad Wiessee, Germany
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18
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Hamel J, Hörterer H, Harrasser N. Is it possible to define reference values for radiographic parameters evaluating juvenile flatfoot deformity? A case-control study. BMC Musculoskelet Disord 2020; 21:838. [PMID: 33308201 PMCID: PMC7731564 DOI: 10.1186/s12891-020-03854-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Numerous radiographic parameters are described to evaluate juvenile flexible flatfeet. Reference values for these measurements are based on few studies. The purpose of this study was to determine boundary values among the most widely used radiographic measurements to evaluate juvenile flatfeet. Methods Twenty-two patients with normal hind-, midfoot configuration (group A: control group; 22 ft, mean age: 12,1 years) and 19 patients with flatfoot deformity (group B: study group; 22 ft, mean age: 12,4 years) were retrospectively analyzed. Nine radiographic parameters were measured (Talocalcaneal-angles, Calcaneal-pitch-angle, Costa-Bartani-angle, Talo-metatarsal-I-angles, Talo-first-metatarsal-base-angle, Talo-navicular-coverage, Calcaneus-fifth-metatarsal-angle). ROC curve analysis was used to calculate optimal differentiating thresholds of each parameter. Results Four out of nine parameters (TC-dp, TC-lat, Calc-MTV, Calc-P) were not statistically different between the groups and their ability to distinct between normal foot and flatfoot was low (AUC values = 0,660 - 0,819). Calculation of reference values for these parameters was not performed due to threshold ranges between the groups of > 10°. Reference values could be defined only for three parameters: TMTInd >(−)31°, TMTIB >(−)7,5°, TMT-lat > (−)13,5°. The TMTInd was shown to be a very reliable and valid combination of two measurements (TMTIB and TMT-lat) in the differentiation of normal feet and flatfeet (AUC = 0,998). Conclusion The calculation of reference values for established radiographic parameters used to evaluate juvenile flatfeet is difficult for most parameters. The TMTInd as a combination of TMTIB and TMT-lat has been shown to be reliable and valuable to distinct normal feet from flatfeet.
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Affiliation(s)
- Johannes Hamel
- Schoen Clinic Munich-Harlaching, Specialist Centre for Foot and Ankle Joint Surgery, Harlachinger Str. 51, 81547, Munich, Germany
| | - Hubert Hörterer
- Schoen Clinic Munich-Harlaching, Specialist Centre for Foot and Ankle Joint Surgery, Harlachinger Str. 51, 81547, Munich, Germany.,Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nussbaumstrasse 20, 80336, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
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19
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Leonchuk SS, Dyachkov K, Neretin AS, Blanchard AJ, Popkov D. Subtalar arthroereisis for treatment of children with flexible planovalgus foot deformity and analysis of CT data in long-term period. J Orthop 2020; 22:478-484. [PMID: 33093758 DOI: 10.1016/j.jor.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/04/2020] [Indexed: 01/01/2023] Open
Abstract
The aim of the study is to analyze the long-term results of the subtalar arthroereisis of the feet according to Grice in children with flexible symptomatic planovalgus foot deformity. Methods 29 children (58 feet) were treated with symptomatic flexible planovalgus foot deformity. Results The average value of AOFAS increased from 63 (51-84) to 92 (53-96) points. According to CT size of the bone graft corresponded to 83% of the size of the subtalar sinus. Conclusion In compliance with all the technical features of this operation, it is effective for correction of flexible planovalgus foot deformity with pronounced verticalization of talus. Level of evidence IV.
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Affiliation(s)
- Sergey S Leonchuk
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics 6, M. Ulianova Street, 640014, Kurgan, Russia
| | - Konstantin Dyachkov
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics 6, M. Ulianova Street, 640014, Kurgan, Russia
| | - Andrey S Neretin
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics 6, M. Ulianova Street, 640014, Kurgan, Russia
| | - Anthony J Blanchard
- University of Cincinnati, College of Medicine, 231 Albert Sabin Way ML0513, 45219, Cincinnati, OH, USA
| | - Dmitry Popkov
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics 6, M. Ulianova Street, 640014, Kurgan, Russia
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Böhm H, Döderlein L, Fujak A, Dussa CU. Is there a correlation between static radiographs and dynamic foot function in pediatric foot deformities? Foot Ankle Surg 2020; 26:801-809. [PMID: 31694790 DOI: 10.1016/j.fas.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 06/04/2019] [Accepted: 10/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Idiopathic flexible flatfeet, congenital clubfeet and pes cavovarus are the most common foot deformities in children. Accurate assessment to quantify the severity of these deformities by clinical examination alone can be challenging. Radiographs are a valuable adjunct for accurate diagnosis and effective treatment. However, static radiographs during relaxed standing may not reflect the dynamic changes in the foot skeleton during functional activities such as walking. Therefore, the aim of this study is to predict dynamic foot movements during walking from planar standing radiographs to reveal the significance of the radiographic analysis for the assessment of foot function. METHODS Patients 8-17 years with flexible flatfeet (FFF, n=217) recurrent clubfeet (RCF n=38) and overcorrected clubfeet (OCCF, n=71) of non-neurogenic or syndromic origin and pes cavovarus due to peripheral neuropathy (PNP, n=48) were retrospectively included. Patients underwent gait analysis with the Oxford Foot Model and radiographic examination in anterior-posterior and lateral view during standing. Multilinear predictor analysis of selected gait parameters was performed based on radiographic measures. RESULTS The variance that was explained by radiography was greatest for the transverse plane forefoot abduction with 33% for OCCF, 50% for RCF and 59% for PNP. Flatfeet and foot kinematics in the other planes or between rearfoot and tibia showed little or no relation. CONCLUSIONS The static measures of foot deformities by radiography could explain only a small amount of variance in foot kinematics during walking, in particular for FFF. An explanation may be that the forces during weight bearing bear little resemblance to those during gait in terms of neither magnitude nor direction. These findings suggest that foot function cannot be accurately assessed solely from static radiographic observations of the foot, commonly undertaken in clinical practice.
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Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau gGmbH, Bernauer str. 18, 83229 Aschau i. Chiemgau, Germany.
| | | | - Albert Fujak
- Friedrich-Alexander-University of Erlangen-Nürnberg, Department of Orthopaedic Surgery Rathsberger str. 57, 91054 Erlangen, Germany
| | - Chakravarty U Dussa
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau gGmbH, Bernauer str. 18, 83229 Aschau i. Chiemgau, Germany; Friedrich-Alexander-University of Erlangen-Nürnberg, Department of Orthopaedic Surgery Rathsberger str. 57, 91054 Erlangen, Germany
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21
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Abstract
PURPOSE Calcaneus lengthening can be used in symptomatic flat foot in children, but few details on its medium-term results and complementary procedures are available. METHODS A total of 20 flexible, symptomatic, idiopathic valgus flat feet (in 15 children; mean age 13.9 years (10 to 17)) were operated on. Complementary procedures were based on preoperative and intraoperative analyses. Radiographic measurements were obtained preoperatively and with at least four years follow-up. RESULTS At a mean of 8.3 years (4 to 15) postoperatively, 13 feet had good clinical and radiological results, with significant improvement in American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scale scores and radiological measurements. Seven feet had residual pain. Six of them had no osteotomy of the first cuneiform. CONCLUSION Calcaneus lengthening with adequate complementary musculo-tendinous and/or bone procedures according to preoperative and intraoperative foot deformation leads to good medium-term results. Forefoot supination is the most frequent residual defect. If present intraoperatively, first cuneiform pronation-flexion osteotomy is indicated. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Khouri Nejib
- Hôpital Necker-Enfants Malades, Department of Orthopedic Surgery, Paris, France,Correspondence should be sent to Nejib Khouri, Hôpital Necker-Enfants Malades, Department of Orthopedic Surgery.164 rue de Sèvres, 75015 Paris, France. E-mail:
| | - Marion Delpont
- CHU Montpellier, Hôpital Lapeyronie, Department of Pediatric Surgery, University of Montpellier, Montpellier, France,CHU Armand-Trousseau, Department of Pediatric Orthopedic Surgery, Paris. France
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Dussa CU, Böhm H, Döderlein L, Forst R, Fujak A. Does an overcorrected clubfoot caused by surgery or by the Ponseti method behave differently? Gait Posture 2020; 77:308-314. [PMID: 32135471 DOI: 10.1016/j.gaitpost.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Overcorrection is a recognized problem following surgical treatment of congenital clubfoot. Recently this complication has also been mentioned following Ponseti treatment. RESEARCH QUESTION Do overcorrected clubfeet (OCCF) caused by surgery behave differently from those caused by Ponseti treatment in terms of segmental motion of the feet and show differences in the severity of deformity on X-rays? METHODS Children between 7 and 12 years with OCCF were included in this study. Depending on the aetiology causing them, the feet were divided into 2 groups (Ponseti and peritalar release surgery). 25 typically developing children served as controls. All subjects were subjected to clinical and radiological examination and 3-Dimensional gait analysis using the Oxford Foot Model. RESULTS Thirty-two children with OCCF, of these 18 feet in the surgical and 14 feet in the Ponseti group, were included in the study. No radiological differences were seen in the flatfoot parameters between OCCF groups except in the calcaneal inclination angle that was more pathological in the Ponseti group. The clinical ankle plantar flexion was significantly reduced in the surgical group. During walking the range motion of the hindfoot in the frontal plane was significantly reduced in surgically treated feet compared to the Ponseti group. The other parameters did not show any significant difference between groups. SIGNIFICANCE The overcorrected clubfeet following surgery and Ponseti showed similar appearance and showed no significant differences in 11/12 radiological parameters. The segmental motion of the feet showed no significant differences between groups except the in the range of motion of the subtalar eversion. A considerable subtalar joint motion was present even in the surgical group. These findings might help plan the treatment of these feet.
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Affiliation(s)
- Chakravarthy U Dussa
- Department of Paediatric Orthopaedics, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83229 Aschau i. Chiemgau, Bavaria, Germany.
| | - Harald Böhm
- Gait Laboratory, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83229 Aschau i. Chiemgau, Bavaria, Germany
| | - Leonhard Döderlein
- Peadiatric Orthopaedic Surgeon, Bismarckstrasse 60, 69198 Schriesheim, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, D-91054 Erlangen, Bavaria, Germany
| | - Albert Fujak
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, D-91054 Erlangen, Bavaria, Germany
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Choi JY, Hong WH, Suh JS, Han JH, Lee DJ, Lee YJ. The long-term structural effect of orthoses for pediatric flexible flat foot: A systematic review. Foot Ankle Surg 2020; 26:181-8. [PMID: 30765257 DOI: 10.1016/j.fas.2019.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/20/2018] [Accepted: 01/23/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to evaluate the structural effects of the long-term use of orthoses for pediatric flexible flat foot (PFFF) using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies. METHODS A comprehensive literature search using five databases, namely MEDLINE, the Cochrane Library, Scopus, the Web of Science, and EMBASE, was performed for pertinent articles published before March 30, 2018. Studies with quantitative data on the effects of the long-term use of orthoses for PFFF were included. The search strategy was adapted as appropriate for all other databases searched considering the differences in indexing terms and search syntax for each database. RESULTS Randomized controlled trials and prospective cohort studies could not prove the estimated effects of orthoses on the medial longitudinal arch. They revealed that flexible flat feet in young children slowly improved with growth, regardless of the type of footwear used. However, three of four case series studies revealed that positive long-term effects could be achieved using orthoses. CONCLUSION There is no strong evidence that the long-term use of orthoses improved the structural problem of PFFF.
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Bernasconi A, Iervolino C, D'Alterio R, Lintz F, Patel S, Sadile F. Midterm assessment of subtalar arthroereisis for correction of flexible flatfeet in children. Orthop Traumatol Surg Res 2020; 106:185-191. [PMID: 31848065 DOI: 10.1016/j.otsr.2019.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/20/2019] [Accepted: 10/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The role of subtalar arthroereisis (STA) for treating flexible flatfoot (FFF) in children is controversial. We hypothesized that (1) STA provided significant radiographic correction of low longitudinal arch and forefoot abduction in paediatric FFF and that (2) mid-term clinical outcomes were satisfactory and comparable to a normal population. METHODS A retrospective comparative study was performed of paediatric patients with symptomatic FFF who underwent STA between 2012 and 2015. Multiple measurements on preoperative and latest follow-up radiographs were recorded by two observers and compared to assess for correction of the FFF. Intra- and inter-observer reliability was also assessed. Ankle and hindfoot range of motion (ROM), AOFAS hindfoot score and VAS-FA score were compared with controls without foot symptoms or deformity. From 70 consecutive feet, 62 (31 patients) treated at 10.5 years of age were identified and compared to 48 controls (24 patients). Mean follow-up was 62 months. RESULTS Intra- and inter-observer reliability was excellent for all angles (range, 0.81-0.97). Radiographic measurements demonstrated significant improvement after surgery (p<0.001) but significance was not reached in talonavicular coverage angle (p=0.49) and calcaneo-fifth metatarsal angle (p=0.53) on dorsoplantar view. At latest follow-up, patients had less hindfoot inversion than controls (15.1̊ vs. 19.3̊, p=0.03), lower AOFAS scores (94.1 vs. 99.6 points, p=0.01), due to pain (p=0.01) and alignment (p=0.006) subscores. Using the VAS-FA score, patients were found to demonstrate higher pain at rest (prange, 0.02-0.03) and during activity (p=0.009), and felt limited when standing on one leg (p range, 0.01-0.03) and running (p=0.04). No loss of correction was found after removal of the implant. CONCLUSION This study showed that STA corrected the low longitudinal arch in symptomatic paediatric FFF, but did not correct forefoot abduction in relation to the hindfoot. Mid-term assessment revealed STA provided satisfactory ankle and hindfoot ROM, pain and function levels, but limitations are witnessed compared to unaffected individuals. This aspect should be considered when counselling patients and their parents or caregivers to allow for realistic expectations. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, HA7 4LP, Brockley Hill, Stanmore, United Kingdom; Orthopaedic Division, Department of Public Health, University of Naples Federico II, Via Pansini 80131, Napoli, Italy.
| | - Cecilia Iervolino
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Via Pansini 80131, Napoli, Italy
| | - Rosa D'Alterio
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Via Pansini 80131, Napoli, Italy
| | - François Lintz
- Ankle and Foot Surgery Centre, Clinique de l'Union, Boulevard de Ratalens, 31240 Saint-Jean, France
| | - Shelain Patel
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, HA7 4LP, Brockley Hill, Stanmore, United Kingdom
| | - Francesco Sadile
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Via Pansini 80131, Napoli, Italy
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Agoada D, Kramer PA. Radiographic measurements of the talus and calcaneus in the adult pes planus foot type. Am J Phys Anthropol 2020; 171:613-627. [PMID: 31930491 DOI: 10.1002/ajpa.23994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 12/02/2019] [Accepted: 12/13/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A distinctive feature of the modern human foot is the presence of a medial longitudinal arch when weight-bearing. Although the talus and calcaneus play a major role in the structure and function of the human foot, the association between the morphology of these bones and longitudinal arch height has not been fully investigated. A better understanding of this relationship may assist in the interpretation of pedal remains of fossil hominins, where features of the foot and ankle morphology have been described as providing evidence for the presence of a longitudinal arch. METHODS For this study, weight-bearing radiographs of 103 patients from an urban US Level 1 trauma center, taken as part of a clinical examination for medical evaluation, were selected. These radiographs were classified as to foot type by arch height as defined using the calcaneal inclination angle. From this group, 68 radiographs were suitable for linear and angular measurements of the talus and 74 of the calcaneus. The relationships between these measurements and arch height were explored using least squared linear regression analysis. RESULTS The results demonstrate that angular measurements of the calcaneus (particularly those that reflect the relationship of the talar articular facets to each other and the tilt of the calcaneocuboid joint to the longitudinal axis of the calcaneus) are predictive of arch height (r2 = .29-.44 p ≤ .001). All angular measurements of the talus and all examined linear measurements of both the talus and calcaneus were not predictive of arch height. DISCUSSION These results suggest that certain angular measurements of the calcaneus are associated with arch height in the modern human foot. While this information is useful in the interpretation of hominin pedal remains, the relationship of the morphology of these bones, as well as other bones of the foot, to arch height is complex, requiring further investigation.
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Affiliation(s)
- David Agoada
- Department of Anthropology, University of Washington, Seattle, Washington
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Abstract
Abnormalities of foot alignment can be a cause of significant morbidity in children, and some require complex surgical intervention to improve functionality and decrease pain. Imaging plays a key role in management decisions. We address some of the most common surgical strategies for selected diagnoses including pes planus, congenital vertical talus, pes cavus, and clubfoot, with a focus on imaging findings.
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Affiliation(s)
- Matthew J Winfeld
- Lancaster Radiology Associates, Lancaster General Hospital, Penn Medicine, 555 North Duke St., Lancaster, PA, 17602, USA.
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Turati M, Bigoni M, Omeljaniuk RJ, Griffet J, Zatti G, Courvoisier A. Pediatric navicular dorsal osteochondroma: a rare case of navicular-cuneiform impingement. J Pediatr Orthop B 2019; 28:602-6. [PMID: 30855546 DOI: 10.1097/BPB.0000000000000625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Osteochondroma is one of the most common benign bone tumors; however, as it rarely affects any bones in feet, it may easily escape detection without rigorous examination. We present an exceptionally rare case of tarsal navicular dorsal osteochondroma diagnosed in an 11-year-old female child affected by chronic foot pain. Radiographs, MRI, and computed tomography scan revealed bony excrescences extending outward from the navicular bone. After conservative treatment failed, the navicular dorsal exostosis was excised in open surgery with complete resolution of symptoms. Navicular-cuneiform impingement was diagnosed by instrumental and intraoperative techniques. Histological analysis confirmed the diagnosis of navicular dorsal osteochondroma. This case report illustrates the necessity of particularly rigorous evaluation of the substrates of pediatric chronic foot pain.
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Hohmann E, Myburgh J, Keough N, Tetsworth K, Glatt V. Inter- and intraclass correlations for three standard foot radiographic measurements for plantar surface angles. Which measure is most reliable? Foot Ankle Surg 2019; 25:646-653. [PMID: 30321930 DOI: 10.1016/j.fas.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the reliability and reproducibility of three commonly used radiographic measures for plantar surface angles. METHODS The calcaneal angle (CA), calcaneal pitch angle (CPA), and length-height index (LHI) was measured by three independent examiners on two occasions on lateral foot radiographs. Intra- and inter-rater correlations were calculated using a general linear estimate model and post-hoc tests for repeated measures. Bland-Altman's plots with limits of agreement were used for observer differences in scores. RESULTS The intra-class correlations for the CA ranged from 0.91 to 0.94, for the CPA from 0.93 to 0.98, and for the LHI from 0.96 to 0.97. The inter-class correlations were 0.80 for CA, 0.83 for CPA and 0.93 for LHI. CONCLUSIONS The results of this study strongly suggest that the length-height index was the most consistent and reliable measure for arch height. LEVEL OF EVIDENCE Diagnostic Level II, validity.
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Affiliation(s)
- Erik Hohmann
- Medical School, University of Pretoria, South Africa; Valiant Clinic/Houston Methodist Group, United Arab Emirates.
| | - Jolandie Myburgh
- Department of Anatomy, School of Medicine, University of Pretoria, South Africa
| | - Natalie Keough
- Department of Anatomy, School of Medicine, University of Pretoria, South Africa
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; Department of Surgery, School of Medicine, University of Queensland, Australia; Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia
| | - Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center, San Antonio, TX, USA
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Ohuchi H, Chavez JS, Alvarez CAD. Changes in calcaneal pitch and heel fat pad thickness in static weight bearing radiographs while wearing shoes with arch support and heel cup orthotics. Asia Pac J Sports Med Arthrosc Rehabil Technol 2019; 17:21-24. [PMID: 31453111 PMCID: PMC6700667 DOI: 10.1016/j.asmart.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/12/2019] [Accepted: 07/16/2019] [Indexed: 11/28/2022] Open
Abstract
Background Foot orthoses have been shown to reduce the collapse of the longitudinal arch and to constrain soft tissue displacement under the heel. However, there has not been a study that has shown the effectiveness of both the arch and heel features in the same orthosis. This study quantitatively analyzed if the calcaneal pitch and the heel pad thickness will be affected by the use of an arch support and heel cup insole in a static weightbearing stance while wearing sports shoes. Methods Twenty-four (24) feet from 12 elite-level female soccer players with a mean age of 25 ± 3.99 years (20–33 years old) were studied. Lateral weightbearing radiographs with and without orthotics were obtained in order to measure the calcaneal pitch angle and heel fat pad thickness for each foot. A subjective outcome measure was used and the scores were classified as bad (0–2), fair (3–5), good (6–8), or excellent (9-10). Results The calcaneal pitch angle increased in all but three cases by an average of 1.05° (range, −1.14 to 3.19) after wearing orthotics (p < 0.01). The heel fat pad thickness increased in all cases with an average of 1.25 mm (range, 1.05 to 1.47; p < 0.01)). 9 of 12 subjects (75%) reported excellent (n = 2) or good (n = 7) overall subjective scores with insole wear. Conclusion Under static weightbearing conditions, the arch support and heel cup features of a foot orthosis help improve the height of the calcaneal pitch and the thickness of the heel fat pad, respectively.
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Affiliation(s)
- Hiroshi Ohuchi
- Department of Sports Medicine, Kameda Medical Center, Japan
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Böhm H, Oestreich C, Rethwilm R, Federolf P, Döderlein L, Fujak A, Dussa CU. Cluster analysis to identify foot motion patterns in children with flexible flatfeet using gait analysis-A statistical approach to detect decompensated pathology? Gait Posture 2019; 71:151-156. [PMID: 31071537 DOI: 10.1016/j.gaitpost.2019.04.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/21/2019] [Accepted: 04/25/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The paediatric flexible flatfoot constitutes the major cause of clinic visits for orthopaedic foot problems. It shows variations of deformities in different planes and locations of the foot and its indication for treatment have been extensively discussed. Despite its high prevalence there exists no classification of flatfeet during walking as a prerequisite for treatment decision. Therefore, the aim of this study is to classify flexible flatfeet based on 3D foot kinematics during walking. METHODS Patients age 7-17 years with flexible flatfeet (N = 129, 255 feet) of non-neurogenic or syndromic origin, were retrospectively included. Patients underwent gait analysis using the Oxford Foot Model after standard clinical examination. A k-means cluster analysis was performed on 3 scores derived from the principal component analysis of the foot kinematic waveforms over the gait cycle. Gait and clinical parameters were then statistically tested between clusters. RESULTS Cluster analysis revealed two groups of flexible flatfeet that were discriminated best by the inversion at push-off during walking. Cluster 2, including 110 feet, showed an average eversion instead of an inversion at push-off and a lower number of heel rises in the clinical test. Both was significantly different between clusters (p < 0.001). DISCUSSION Based on the findings, the resultant clusters can be interpreted as describing compensated and decompensated feet, with the latter presenting a group that may require surgical interventions, even if they are not yet present with pain. The hindfoot inversion capability at push-off is the most important variable in the 3D gait analysis to classify flexible flat feet.
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Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany.
| | - Claudia Oestreich
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany; Chair of Preventive pediatric, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, München, Germany
| | - Roman Rethwilm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany; Department of Sport Science, University of Innsbruck, Fürstenweg, 6020, Innsbruck, Austria
| | - Peter Federolf
- Department of Sport Science, University of Innsbruck, Fürstenweg, 6020, Innsbruck, Austria
| | - Leonhard Döderlein
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany
| | - Albert Fujak
- Friedrich-Alexander-University of Erlangen-Nürnberg, Department of Orthopaedic Surgery, Rathsberger str 57, 91054, Erlangen, Germany
| | - Chakravarty U Dussa
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany
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Ghanem I, Massaad A, Assi A, Rizkallah M, Bizdikian AJ, El Abiad R, Seringe R, Mosca V, Wicart P. Understanding the foot's functional anatomy in physiological and pathological conditions: the calcaneopedal unit concept. J Child Orthop 2019; 13:134-146. [PMID: 30996737 PMCID: PMC6442506 DOI: 10.1302/1863-2548.13.180022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A thorough review of the available orthopaedic literature shows significant controversies, inconsistencies and sparse data regarding the terminology used to describe foot deformities. This lack of consensus on terminology creates confusion in professional discussions of foot anatomy, pathoanatomy and treatment of deformities. The controversies apply to joint movements as well as static relationships between the bones. DESCRIPTION The calcaneopedal unit (CPU) is a specific anatomical and physiological entity, represented by the entire foot excepted the talus. The calcaneus, midfoot and forefoot are solidly bound by three strong ligaments that create a unit that articulates with the talus. The movement of the CPU is complex, as it rotates under the talus, around the axis of Henke that coincides with the talo-calcaneal ligament of Farabeuf.This calcaneopedal unit is deformable. It is compared with a twisted plate, able to adapt to many physiological situations in standing position, in order to acheive a plantigrade position.Moreover, the calcaneopedal unit and the talo-tibiofibular complex are interdependent; rotation of the latter produces morphologic modifications inside the former and vice versa. PURPOSE This paper is a review article of this concept and of its physiopathological applications.
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Affiliation(s)
- I. Ghanem
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon,Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon, Correspondence should be sent to I. Ghanem, MD, Hôtel-Dieu de France Hospital, A. Naccache Avenue- Achrafieh, University of Saint-Joseph, Beirut, Lebanon. E-mail:
| | - A. Massaad
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - A. Assi
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - M. Rizkallah
- Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon
| | - A. J. Bizdikian
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - R. El Abiad
- Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon
| | - R. Seringe
- Orthopedic Surgery Department, Cochin University Hospital – University of Rene Descartes, Paris, France
| | - V. Mosca
- Department of Orthopedic Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - P. Wicart
- Orthopedic Surgery Department, Hôpital Necker-Enfants Malades, University of Paris Descartes, Paris, France
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Thévenin-Lemoine C, Khouri N. Surgical treatment of idiopathic pes planovalgus in paediatric patients. Orthop Traumatol Surg Res 2019; 105:S187-S198. [PMID: 29709656 DOI: 10.1016/j.otsr.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 02/02/2023]
Abstract
Idiopathic pes planus is common and usually physiologic. Decompensation, when it occurs, may be obvious or on the contrary difficult to identify, raising challenges in patient selection for surgical treatment. The physical examination of a child with pes planus must include an evaluation in the supine position, which helps to adjust the amount of correction during surgery. The many reported surgical procedures include repositioning (talus-reseating, subtalar implants and calcaneo-stop screw), osteotomies and joint fusions. The primary treatment goal is to achieve full architectural correction of the deformity. Selection of the procedure depends on patient age and reducibility of the deformity. The joint lines should be preserved whenever possible. Triceps surae contracture should be sought and corrected if found.
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Affiliation(s)
- Camille Thévenin-Lemoine
- Service de chirurgie orthopédique pédiatrique, hôpital des enfants, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
| | - Néjib Khouri
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris, France
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Rohan PY, Perrier A, Ramanoudjame M, Hausselle J, Lelièvre H, Seringe R, Skalli W, Wicart P. Three-Dimensional Reconstruction of Foot in the Weightbearing Position From Biplanar Radiographs: Evaluation of Accuracy and Reliability. J Foot Ankle Surg 2019; 57:931-937. [PMID: 30001938 DOI: 10.1053/j.jfas.2018.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 02/03/2023]
Abstract
The initial assessment and postoperative monitoring of patients with various abnormalities of the foot in clinical routine practice is primarily based on the analysis of radiographs taken in the weightbearing position. Conventional x-ray imaging, however, only provides a 2-dimensional projection of 3-dimensional (3D) bony structures, and the clinical parameters assessed from these images can be affected by projection biases. In the present work, we addressed this issue by proposing an accurate 3D reconstruction method of the foot in the weightbearing position from low-dose biplanar radiographs with clinical index measurement assessment for clinical routine practice. The accuracy of the proposed reconstruction method was evaluated for both shape and clinical indexes by comparing 3D reconstructions of 6 cadaveric adult feet from computed tomographic images and from biplanar radiographs. For the reproducibility study, 3D reconstructions from the biplanar radiographs of the foot of 6 able-bodied subjects were considered, with 2 observers repeating each measurement of anatomic landmarks 3 times. Baseline assessment of important 3D clinical parameters was performed on 17 subjects (34 feet; mean age 27.7, range 20 to 52 years). The average point to surface distance between the 3D stereoradiographic reconstruction and the computed tomographic scan-based reconstruction was 1 mm (range 0mm to 6mm). The selected radiographic landmarks were highly reproducible (95% confidence interval <2.0 mm). The greatest interindividual variability for the clinical parameters was observed for the twisting angle (mean 87°, range 73° to 100°). Such an approach opens the way for routine 3D quantitative analysis of the foot in the weightbearing position.
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Affiliation(s)
- Pierre-Yves Rohan
- Assistant Professor, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Antoine Perrier
- Podiatrist, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Mira Ramanoudjame
- Orthopaedic Surgeon, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Jérôme Hausselle
- Assistant Professor, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France; Assistant Professor, BAMM Laboratory, Mechanical Aerospace and Engineering, Oklahoma State University Stillwater, Stillwater, OK
| | - Henri Lelièvre
- Orthopaedic Surgeon, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Raphael Seringe
- Orthopaedic Surgeon, Hôpital Necker-Enfants-Malades, Université Paris Descartes, AP-HP, Paris, France
| | - Wafa Skalli
- Professor, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Philippe Wicart
- Orthopaedic Surgeon, Hôpital Necker-Enfants-Malades, Université Paris Descartes, AP-HP, Paris, France
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Dana C, Péjin Z, Cadilhac C, Wicart P, Glorion C, Aurégan JC. Long-Term Results of the "Horseman" Procedure for Severe Idiopathic Flatfoot in Children: A Retrospective Analysis of 41 Consecutive Cases With Mean 8.9 Year Duration of Follow-Up. J Foot Ankle Surg 2019; 58:10-16. [PMID: 30340919 DOI: 10.1053/j.jfas.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Indexed: 02/03/2023]
Abstract
The "horseman" procedure is a surgical technique used to correct the talocalcaneal joint displacement of severe idiopathic flatfoot in children while maintaining the reduction with a temporary talocalcaneal screw. While this technique has been used since the early 1960s, very little has been reported on its results. Our objectives were to estimate the correction, functional results, and postoperative complications of the "horseman" procedure. We conducted a retrospective study on 23 consecutive patients (41 cases) who underwent the "horseman" procedure for a talocalcaneal joint displacement. Mean follow-up was 8.9 (range 1 to 28) years, and 8 patients (12 feet) had reached bone maturity at last follow-up. Mean age at surgery was 6.6 (range 4 to 9.5) years. At last follow-up, all the patients were asymptomatic except 2 [8.7%] (4 [9.8%] cases). The talocalcaneal divergence on anteroposterior and lateral radiographic views was reduced by 8.9° and 11.4°, respectively, after the surgery, and the correction was maintained with loss of 0.7° and 2.9°, respectively, at final follow-up. The talonavicular coverage angle was reduced by 25° without loss of correction at last follow-up. The calcaneal pitch angle did not change after the surgery. Mean American Orthopedic Foot and Ankle Society score increased from 88.7 of 100 (63 of 100 to 93 of 100) preoperatively to 99 of 100 (97 to 100 of 100) at last follow-up. No major complication occurred. The "horseman" procedure allows an immediate and lasting correction of severe idiopathic flatfoot in children.
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Affiliation(s)
- Caroline Dana
- (1)Surgeon, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(2)Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(3)Associate Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France
| | - Zagorka Péjin
- (1)Surgeon, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(2)Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(3)Associate Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France
| | - Céline Cadilhac
- (1)Surgeon, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(2)Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(3)Associate Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France
| | - Philippe Wicart
- (1)Surgeon, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(2)Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(3)Associate Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France
| | - Christophe Glorion
- (1)Surgeon, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(2)Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(3)Associate Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France
| | - Jean-Charles Aurégan
- (1)Surgeon, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(2)Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France(3)Associate Professor, Department of Orthopedic Pediatrics, Necker-Enfants Malades Hospital, University Paris-Descartes, Paris, France.
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Rampal V, Rohan PY, Saksik R, Wicart P, Skalli W. Assessing 3D paediatric foot morphology using low-dose biplanar radiography: Parameter reproducibility and preliminary values. Orthop Traumatol Surg Res 2018; 104:1083-1089. [PMID: 30253989 DOI: 10.1016/j.otsr.2018.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/10/2018] [Accepted: 07/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The physical examination and weight-bearing radiography are the two main available methods for assessing the feet and lower limbs. The anatomy and function of these two structures interact with each other. These two assessment methods are affected by subjectivity and projection bias. Low-dose biplanar radiography (LDBR) is now a promising alternative for evaluating the lower limbs in children. At present, however, the foot cannot be assessed using LDBR. The objective of this study was to work towards developing a new method for 3D radiographic analysis of the paediatric foot during weight-bearing, first by determining the reproducibility of landmarks defined by LDBR then by reporting the values of the calculated radiographic parameters. HYPOTHESIS A new radiographic method based on LDBR can be used to obtain a 3D evaluation of the foot in paediatric patients. PATIENTS AND METHODS Two biplanar radiographs in perpendicular planes were obtained simultaneously in a standardised position using the EOS system (EOS® Imaging, Paris, France) in each of 10 healthy children. To assess measurement uncertainty, two observers performed 3D reconstructions of each of the 10 feet three times (60 reconstructions). The standard error of reproducibility of the anatomic landmarks and clinical parameters was computed. Measurement uncertainty was then estimated based on the 95% confidence interval (95%CI). To obtain reference values, the mean±SD of each variable was computed after checking that the data were normally distributed. RESULTS Reproducibility was high for the anatomical landmarks of interest, calcaneal pitch angle, tibio-calcaneal angle on the lateral view, and first metatarsal pitch angle (95%CI<5%). The values of these angles in the study population are reported. DISCUSSION AND CONCLUSION The data reported here pave the way towards developing new parameters for describing 3D foot morphology and for simultaneously assessing the lower limb and foot in the standing position. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Virginie Rampal
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151, boulevard de l'hôpital, 75013 Paris, France; Service d'orthopédie pédiatrique, hôpitaux pédiatriques de Nice CHU Lenval, 57, avenue de la Californie, 06000 Nice, France.
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151, boulevard de l'hôpital, 75013 Paris, France
| | - Rebekah Saksik
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151, boulevard de l'hôpital, 75013 Paris, France
| | - Philippe Wicart
- Service d'orthopédie pédiatrique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151, boulevard de l'hôpital, 75013 Paris, France
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Abstract
BACKGROUND Children with flatfeet are frequently referred to pediatric orthopaedic clinics. Most of these patients are asymptomatic and require no treatment. Care must be taken to differentiate patients with flexible flatfeet from those with rigid deformity that may have underlying pathology and have need of treatment. Rigid flatfeet in infants may be attributable to a congenital vertical talus (CVT); whereas those in older children and adolescents may be due to an underlying tarsal coalition. We performed a review of the recent literature regarding evaluation and management of pediatric flatfeet to discuss new findings and suggest areas where further research is needed. METHODS We searched the PubMed database for all papers related to the treatment of pediatric flatfoot, tarsal coalition, and CVT published from January 1, 2011 to December 31, 2014, yielding 85 English language papers. RESULTS A total of 18 papers contributed new or interesting findings. CONCLUSIONS The pediatric flexible flatfoot (FFF) remains poorly defined, making the understanding, study, and treatment of the condition extremely difficult.Pediatric FFF is often unnecessarily treated. There is very little evidence for the efficacy of nonsurgical intervention to affect the shape of the foot or to influence potential long-term disability for children with FFF. The treatment of tarsal coalition remains challenging, but short-term and intermediate-term outcome studies are satisfactory, whereas long-term outcome studies are lacking. Management of the associated flatfoot deformity may be as important as management of the coalition itself. The management of CVT is still evolving; however, early results of less invasive treatment methods seem promising. LEVEL OF EVIDENCE Level 4-literature review.
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Abstract
BACKGROUND The timing and strategy for operative treatment of flatfoot are still controversial. The purpose of this study was to evaluate clinical outcomes and radiographic changes following calcaneal Z osteotomy combined with subtalar arthroereisis for severe adolescent flexible flatfoot. METHODS Data were analyzed for 16 patients (20 feet) who had flatfoot without tibialis posterior tendon dysfunction and were treated by calcaneal Z osteotomy combined with arthroereisis between October 2011 and February 2015. The mean age of patients at the time of surgery was 12.8 ± 1.4 years (range, 10-14 years). Preoperative and postoperative measurements included changes in hindfoot valgus angles; changes in talonavicular uncoverage angles on anteroposterior (AP) radiographic view; and changes in talo-first metatarsal angles, talar pitch angles, and calcaneal pitch angles on lateral radiographic view. The American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AH) was used to assess foot function. The mean follow-up was 18.9 ± 6.9 months (range, 13-33 months). RESULTS The hindfoot valgus angle improved from 14.9 ± 4.2 degrees to 2.3 ± 1.7 degrees. On the AP view, the preoperative and postoperative talonavicular uncoverage angles were 30.5 ± 9.4 degrees and 9.8 ± 4.8 degrees, respectively. On lateral radiographs, the preoperative talo-first metatarsal angle, talar pitch angle, and calcaneal pitch angle were -22.1 ± 7.9 degrees, 36.1 ± 4.4 degrees, and 14.4 ± 4.0 degrees, respectively. Postoperative lateral radiographs demonstrated talo-first metatarsal angle, talar pitch angle, and calcaneal pitch angle of -6.2 ± 4.7 degrees, 27.3 ± 4.9 degrees, and 19.0 ± 4.3 degrees, respectively. The AOFAS-AH score improved from 66.8 ± 24.1 preoperatively to 96.5 ± 3.4 postoperatively. CONCLUSIONS For adolescents with flatfoot, calcaneal Z osteotomy combined with subtalar arthroereisis provided satisfactory results. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
| | - Xing-Chen Li
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
| | - Xiang-Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China .,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
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Zhou B, Tang K, Hardy M. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review. J Orthop Surg Res 2014; 9:129. [PMID: 25499625 PMCID: PMC4276075 DOI: 10.1186/s13018-014-0129-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 11/24/2014] [Indexed: 01/28/2023] Open
Abstract
Talocalcaneal coalition often leads to a flatfoot deformity in children. Previous reports have uncovered many aspects of tarsal coalition and flatfoot respectively, including the etiology, clinical presentation, and diagnostic imaging, as well as treatment. However, the optimum surgical procedure for talocalcaneal coalition combined with flatfoot has not been definitively determined. The nonconformity of treatment options is due to our incomplete knowledge of biomechanics, diagnosis, and indication of treatment for talocalcaneal coalition with flatfoot. The objectives of this review are to provide an overview of the current knowledge about etiology, biomechanics, classification, diagnosis, and treatment options for talocalcaneal coalitions with flatfoot and highlight its therapies in children.
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Affiliation(s)
- Binghua Zhou
- Department of Orthopedic Surgery, Third Military Medical University Affiliated Southwest Hospital, Gaotanyan Str. 30, Chongqing, 400038, People's Republic of China.
| | - Kanglai Tang
- Department of Orthopedic Surgery, Third Military Medical University Affiliated Southwest Hospital, Gaotanyan Str. 30, Chongqing, 400038, People's Republic of China.
| | - Mark Hardy
- Department of Foot & Ankle Surgery, HealthSpan Physicians Group, 10 Severance Circle, Cleveland Heights, OH, 44118, USA.
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Seringe R, Wicart P; French Society of Pediatric Orthopaedics. The talonavicular and subtalar joints: the "calcaneopedal unit" concept. Orthop Traumatol Surg Res 2013; 99:S345-55. [PMID: 23978710 DOI: 10.1016/j.otsr.2013.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 02/02/2023]
Abstract
The talonavicular (TN) joint and the three subtalar (ST) joints are linked anatomically and functionally. Together they form the subtalar joint complex, where movement occurs between the calcaneopedal unit (CPU) (entire foot except the talus) and the talotibiofibular unit (talus held tightly by the ankle mortise). Many are unaware of the TN joint's dual membership: it is a component of the subtalar joint complex (talocalcaneonavicular joint) and also the transverse tarsal joint (with the calcaneal-cuboid joint). The anatomy of the articulating surfaces, movement of the CPU when unloaded, shifts and changes in CPU shape with weight bearing, application to clinical tests and X-ray interpretation, and the pathophysiology applications to pes cavovarus, pes planovalgus and congenital talipes equinovarus (club foot) will be reviewed here. The CPU concept corresponds to a horizontal segmentation of the foot. This is a useful supplement to the two other segmentation methods: frontal (hindfoot, midfoot and forefoot) and sagittal (medial and lateral columns). This horizontal segmentation solves the issues with the ST joint complex, which straddles the hindfoot and midfoot, and also the issues with the dual membership of the TN joint. This concept makes it easier to understand foot deformities, better interpret the clinical and radiological signs and deduce logical treatments.
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