1
|
Xu Y, Zhu Y, Cao Y, Chen G, Xu X. Does the Sagittal Radiographic Morphology of Subtalar Joint Affect the Alignment of Foot? Orthop Surg 2024; 16:1269-1276. [PMID: 38618706 PMCID: PMC11144509 DOI: 10.1111/os.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVES The etiology of flatfoot and cavus foot is multicausal and controversial. So far, no literature reports the relationship between the sagittal morphology of subtalar joint and the alignment of foot. The purpose of this study was to explore whether the subtalar alignment would influence the configuration of foot. METHODS From January 2017 to January 2020, we included 109 feet in the flatfoot group, 95 feet in the cavus group, and 104 feet in the control group in this retrospective comparative study. The Gissane angle and calcaneal posterior articular surface inclination angle represented the sagittal morphology of the subtalar joint. Meary's angle, calcaneal pitch angle, and talar pitch angle reflected the alignment of foot. They were measured in the weightbearing foot X-rays. The angles in different groups were compared via Mann-Whitney U test. We calculated the correlation between the sagittal alignment of subtalar joint and the alignment of foot using Spearman's correlation analysis. Interobserver and intraobserver reliability were calculated. RESULTS The Gissane angle, calcaneal posterior articular surface inclination angle, Meary's angle, talar pitch angle, and calcaneal pitch angle were significantly different in the three groups. The Gissane angle had an excellent correlation with the Meary's angle (r = 0.850, p < 0.0001), and the talar pitch angle (r = -0.825, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = 0.638, p < 0.0001). The calcaneal posterior articular surface inclination angle had an excellent correlation with the Meary's angle (r = -0.902, p < 0.001), and the talar pitch angle (r = 0.887, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = -0.702, p < 0.0001). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent. CONCLUSION A subtalar joint with a larger Gissane angle and a more horizontal calcaneal posterior articular surface angle tended to have a higher foot arch and vice versa. The inspiration from this study was that the deformities of flatfoot and cavus foot may relate to the subtalar deformity.
Collapse
Affiliation(s)
- Yang Xu
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yuan Zhu
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yong‐xing Cao
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Gang Chen
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Xiang‐yang Xu
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| |
Collapse
|
2
|
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] [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.
Collapse
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.
| |
Collapse
|
3
|
Silva MGAN, Koh DTS, Tay KS, Koo KOT, Singh IR. Lateral column osteotomy versus subtalar arthroereisis in the correction of Grade IIB adult acquired flatfoot deformity: A clinical and radiological follow-up at 24 months. Foot Ankle Surg 2021; 27:559-566. [PMID: 32811742 DOI: 10.1016/j.fas.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/02/2020] [Accepted: 07/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adult acquired flat foot deformity (AAFD) is a spectrum of conditions which can be progressive if untreated. Surgical correction and restoration of anatomical relationship are often required in the treatment of symptomatic Grade II AAFD after a failed course of conservative treatment. There is a paucity of literature recommending best practice-especially in the adult population. The authors aim to compare radiological and clinical outcomes of two widely employed surgical techniques in the treatment of symptomatic AAFD. METHODS A retrospective study of 76 patients with Grade IIB AAFD and had undergone either lateral column lengthening (LCL) or subtalar arthroereisis (STA) surgical correction of their symptomatic AAFD. Each technique was augmented with both bony osteotomy and soft tissue transfer as determined by on table assessment. Clinical and radiological outcomes were reviewed 24 months after surgery. RESULTS LCL and STA groups had comparable radiological outcomes at 24 months after surgery. However, LCL group demonstrated superior American Orthopaedic Foot and Ankle Society (AOFAS) midfoot (90.3 ± 12.6 vs 81.1 ± 20.6, p < 0.001) as well as Visual Analogue Scale (VAS) midfoot scores (0.5 ± 1.6 vs 1.3 ± 2.4, p < 0.001) at 24 months compared to the STA group. STA had a higher complication rate (20.6% vs 4.4%), with all cases complaining of sinus tarsi pain requiring subsequent removal of implant. CONCLUSION There is a role for either techniques in the treatment of symptomatic AAFD. LCL whilst more invasive has demonstrated superior outcome scores and lower complication rates at 24 months compared to STA. Patients need to be counselled appropriately to appreciate the benefits of each technique.
Collapse
Affiliation(s)
- M G A N Silva
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Don T S Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kevin O T Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Inderjeet R Singh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
4
|
Walley KC, Greene G, Hallam J, Juliano PJ, Aynardi MC. Short- to Mid-Term Outcomes Following the Use of an Arthroereisis Implant as an Adjunct for Correction of Flexible, Acquired Flatfoot Deformity in Adults. Foot Ankle Spec 2019; 12:122-130. [PMID: 29644885 DOI: 10.1177/1938640018770242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The use of an arthroereisis implant for the treatment of adolescent flatfoot deformity has been described. However, data that address the outcomes of patients treated with an arthroereisis implant in adults are limited. The purpose of this study was to investigate the radiographic and clinical outcomes and complications following the use of a subtalar arthroereisis implant as an adjunct for correction acquired flatfoot deformity secondary to posterior tibial tendon dysfunction. METHODS A retrospective case-control study was performed querying all patients undergoing surgical flatfoot correction between January 1, 2010 and January 1, 2015. The experimental group included patients undergoing arthroereisis augmentation at the time of flatfoot correction. Patients undergoing the same flatfoot correction without the use of an arthroereisis implant were used as controls. Radiographic measurements were evaluated preoperatively and at final radiographic follow-up and included talonavicular (TN) coverage angle, and lateral talar-first metatarsal angle (T1MA). Patient-reported outcomes were assessed using preoperative visual analog scale (VAS) pain scores and postoperative Short Form-36, VAS, and satisfaction at final orthopedic follow-up. RESULTS A total of 15 patients underwent flatfoot correction and were augmented with an arthroereisis implant and were matched with 30 controls. Postoperative, mid-term T1MA and regional analysis was found to be improved in the experimental group versus control. Patients undergoing adjunct subtalar arthroereisis demonstrated an increased likelihood of achieving radiographically normal talonavicular coverage <7° compared with our control group at follow-up. CONCLUSIONS The adjunct use of an arthroereisis implant resulted in improved and maintained radiographic and clinical measurements in patients undergoing stage II flatfoot. CLINICAL SIGNIFICANCE These results suggest utility of a subtalar arthroereisis implant as an adjunct to flatfoot correction with little additional risk of harm to the patient. LEVELS OF EVIDENCE Level III: Case-control study.
Collapse
Affiliation(s)
- Kempland C Walley
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Gearin Greene
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jesse Hallam
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Paul J Juliano
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael C Aynardi
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
5
|
Wang B, Zhang X, Huo Y, Liu W, Wang W, Shao X. Calcaneal lengthening for partial traumatic loss of the calcaneus. Injury 2019; 50:796-803. [PMID: 30685108 DOI: 10.1016/j.injury.2019.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/07/2019] [Accepted: 01/12/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this article was to introduce calcaneal lengthening for partial traumatic loss of the calcaneus. Effectiveness with the use of the technique was also assessed. METHODS From January 2013 to May 2016, calcaneal lengthening was performed in 15 patients who sustained a partial traumatic loss of the tuberosity portion of calcaneus. There were 13 men and 2 women with an average age of 36 years (range, 19-53 years). Combined Achilles tendon rupture was noted in 7 patients, and the tendon was reinserted to the calcaneus before calcaneal lengthening. Calcaneal lengthening was performed using an Ilizarov frame. Clinical outcome was assessed based on the American Orthopedic Foot and Ankle score. RESULTS The mean loss of calcaneus was 27% (range, 19%-35%). Calcaneal lengthening (mean total time is157 days; range, 111-226 days) included three periods, i.e., latency (mean 7 days; range, 7-9 days), distraction (mean 43 days; range, 32-57 days), and consolidation (mean 108 days; range, 84-162 days). The mean amount of lengthening was 28% (range, 19%-38%). The mean follow-up duration was 25 months (range, 24-27 months). Based on the American Orthopaedic Foot and Ankle, there were 8 excellent, 6 good, and 1 fair result. CONCLUSIONS For the treatment of partial traumatic loss of the calcaneus, calcaneal lengthening using an Ilizarov frame is a preferable technique to restore the length of calcaneus and foot function.
Collapse
Affiliation(s)
- Bin Wang
- Orthopaedics Department, The Second Hospital of Tangshan, Tangshan, Hebei, 063000, China.
| | - Xu Zhang
- Orthopaedics Department, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China.
| | - Yongxin Huo
- Orthopaedics Department, The Second Hospital of Tangshan, Tangshan, Hebei, 063000, China
| | - Wei Liu
- Orthopaedics Department, The Second Hospital of Tangshan, Tangshan, Hebei, 063000, China
| | - Wei Wang
- Orthopaedics Department, The Second Hospital of Tangshan, Tangshan, Hebei, 063000, China
| | - Xinzhong Shao
- Orthopaedics Department, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| |
Collapse
|
6
|
Abstract
Subtalar arthroereisis has been reported as a minimally-invasive, effective and low-risk procedure in the treatment of flatfoot mainly in children but also in adults.It has been described as a standalone or adjunctive procedure, and is indicated in the treatment of flexible flatfoot, tibialis posterior tendon dysfunction, tarsal coalition and accessory navicular syndrome.Different devices for subtalar arthroereisis are currently used throughout the world associated with soft-tissue and bone procedures, depending on the surgeon rather than on standardised or validated protocols.Sinus tarsi pain is the most frequent complication, often requiring removal of the implant.To date, poor-quality evidence is available in the literature (Level IV and V), with only one comparative non-randomised study (Level II) not providing strong recommendations. Long-term outcome and complication rates (especially the onset of osteoarthritis) are still unclear. Cite this article: EFORT Open Rev 2017;2:438-446. DOI: 10.1302/2058-5241.2.170009.
Collapse
Affiliation(s)
- Alessio Bernasconi
- Orthopaedic and Traumatology Unit, Department of Public Health, "Federico II" Naples University, Naples, Italy
| | | | - Francesco Sadile
- Orthopaedic and Traumatology Unit, Department of Public Health, "Federico II" Naples University, Naples, Italy
| |
Collapse
|
7
|
Xu Y, Cao YX, Li XC, Zhu Y, Xu XY. Double calcaneal osteotomy for severe adolescent flexible flatfoot reconstruction. J Orthop Surg Res 2017; 12:153. [PMID: 29041945 PMCID: PMC5645836 DOI: 10.1186/s13018-017-0655-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/11/2017] [Indexed: 12/05/2022] Open
Abstract
Background The timing and strategy of treatment for flatfoot still remain controversial. It is a difficult problem when facing severe adolescent flexible flatfoot because a single procedure cannot realign flatfoot deformity effectively. Methods We reviewed 13 adolescent flexible flatfoot patients who underwent double calcaneal osteotomy during May 2012 to June 2015. The mean age of patients was 15.2 ± 1.8 (range, 10–18) years. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS-AH) scores and SF-36 score were adopted to evaluate the preoperative and postoperative functions of the foot. Changes of hindfoot valgus angles, talonavicular uncoverage angles on AP view and talo-first metatarsal angles, and talar pitch angles and calcaneal pitch angles on the lateral film before and after surgery were measured. Results All 13 patients (15 ft) were followed. The mean duration of follow-up was 34.5 ± 15.7 (range, 21–60) months. The hindfoot valgus angle improved from 16.5 ± 4.1 to 2.9 ± 1.6. On the foot AP view, the mean preoperative and postoperative talonavicular coverage angles were 24.9 ± 8.5 and 6.5 ± 3.6. On the lateral view of the foot, the average preoperative and postoperative talo-first metatarsal angles were 18.1 ± 5.5 and 4.9 ± 4.4. The mean preoperative and postoperative talar pitch angles were 36.4 ± 4.7 and 24.0 ± 5.6. The AOFAS-AH score improved from 68.9 ± 12.3 preoperatively to 94.6 ± 3.9 postoperatively. Conclusion With additional procedures, double calcaneal osteotomy was an effective method for severe adolescent flexible flatfoot.
Collapse
Affiliation(s)
- Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong-Xing Cao
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xing-Chen Li
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuan Zhu
- Department of orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xiang-Yang Xu
- Department of orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| |
Collapse
|