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Corradin M, Schiavon R, Micaglio A, Pierantoni S, Luppi V, Canavese F. Simultaneous subtalar arthroeresis, midfoot soft tissue release, and talo-navicular arthrodesis in children with planovalgus neurologic foot. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2163-2170. [PMID: 38565784 DOI: 10.1007/s00590-024-03914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA). METHODS A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6-17). Mean follow-up was 7 ± 2.9 years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01. RESULTS Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing. CONCLUSIONS SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco Corradin
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy.
| | - Roberto Schiavon
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy
- Department of Paediatric Orthopaedic, Policlinic Abano Terme, 35031, Abano Terme, PD, Italy
| | - Andrea Micaglio
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy
| | - Silvia Pierantoni
- Department of Paediatric Orthopaedic, Policlinic Abano Terme, 35031, Abano Terme, PD, Italy
| | - Valentina Luppi
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy
| | - Federico Canavese
- Department of Pediatric Orthopedics, Faculty of Medicine, Jeanne de Flandre Hospital, Lille University Hospital, Rue Eugène Avinée, 59800, Lille, France
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Bilgili F, Demirel M, Koyuncu D. Preliminary Results of Calcaneal Lengthening Osteotomy Combined With Extra-articular Subtalar Arthrodesis for Severe Pes Planovalgus Deformity in Children With Cerebral Palsy: A New Surgical Technique. J Pediatr Orthop 2024:01241398-990000000-00541. [PMID: 38623033 DOI: 10.1097/bpo.0000000000002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Pes planovalgus is the most common foot deformity seen in patients with cerebral palsy (CP). There are several different treatment modalities to treat this condition. Single or double calcaneal osteotomies, extra-articular arthrodesis, calcaneo-cuboido-cuneiform osteotomy, intraarticular arthrodesis, and arthroereisis are some of these modalities. Currently, there is insufficient information to determine the most effective treatment approach for pes planovalgus in children with CP. The aim of this study is to show the short to mid-term results of the new technique which combines calcaneus lengthening osteotomy, extra-articular subtalar arthrodesis, and soft tissue reconstruction that aims to decrease recurrence and complication rates of pes planovalgus surgery for patients with ambulatory CP. METHODS Patients with CP who were treated with calcaneal lengthening surgery and extra-articular subtalar arthrodesis between 2018 and 2021 were investigated retrospectively. All patients were ambulatory and Gross Motor Function Classification System I-II-III. Functional levels of the patients were assessed with the American Orthopaedic Foot and Ankle Society, Ankle-Hindfoot Score, and the Foot and Ankle Ability Score (Foot and Ankle Ability Measure) in preoperative and postoperative periods. On anteroposterior x-rays, talus-first metatarsal, talocalcaneal, talonavicular coverage angle and on lateral x-rays talus-first metatarsal, talocalcaneal, calcaneal inclination angle and talar tilt angle were evaluated. RESULTS The mean follow-up was 46 (range: 36 to 60) months. The mean American Orthopaedic Foot and Ankle Society increased from 41 (20 to 79) to 74 (38 to 93; P < 0.001). The mean Foot and Ankle Ability Measure increased significantly from 35 (7 to 73) to 54 (29 to 96; P<0.001). Clinical results were "satisfactory" for 32 feet, while they were "unsatisfactory" for 2 feet. Significant deformity correction was observed in all radiologic parameters. CONCLUSION Our technique is found to be efficient for patients with Gross Motor Function Classification System I-II-III CP with pes planovalgus deformity. In short to mid-term follow-up, the technique achieved successful clinical and radiologic results with low complication rates. Superiority of this technique compared with the traditional ones can only be shown with randomized prospective studies. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Affiliation(s)
- Fuat Bilgili
- Department of Orthopaedics and Traumatology, İstanbul Medical School, İstanbul University, İstanbul, Turkey
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Lenhart RL, Goodbody CM. Symptomatic flatfoot in cerebral palsy. Curr Opin Pediatr 2024; 36:98-104. [PMID: 37872808 DOI: 10.1097/mop.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the current literature and best practices in the evaluation and treatment of symptomatic flatfoot in cerebral palsy. RECENT FINDINGS While techniques to reconstruct the neuromuscular flatfoot and reestablish bony levers have remained similar over time, the concept of surgical dosing has helped guide appropriate interventions based on the magnitude of disease and functional level of the child. Moreover, the utilization of multisegment foot modeling in motion analysis has allowed quantitative description of such deformities and their impact on gait. SUMMARY Future research should focus on refining operative indications and interventions with larger, multicenter, prospective cohorts to provide more robust evidence in surgical decision making. Long-term data are needed to confirm and compare efficacy of procedures. Radiographic data alone are not sufficient for describing functional foot position. Gait analysis with foot modeling and pedobarography along with patient-centered subjective outcomes will be needed in such investigations to make conclusive recommendations.
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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] [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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Elbarbary HM, Arafa AS, Said ABZ, Hegazy M, Reiad MW, Basha NY, Fahmy M. Clinical and Radiological Outcomes of Subtalar Arthroereisis for Management of Planovalgus Foot in Children With Cerebral Palsy: 3-Year Follow-up. Foot Ankle Spec 2022; 15:536-544. [PMID: 33345616 DOI: 10.1177/1938640020980911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Planovalgus deformity of the foot is common among cerebral palsy (CP) patients. It is an upcoming topic with debate and controversy that require further studies. Many clinical studies involving arthroereisis have shown acceptable results in short- and mid-term follow-up. The aim of this work was to evaluate the outcome of arthroereisis using a conventional screw placed percutaneously across the talocalcaneal articulation for the treatment of moderate planovalgus deformity in children with CP. METHODS Between 2015 and 2018, a prospective study was conducted including 23 CP patients with bilateral flexible planovalgus deformity with follow-up period ranging from 24 to 40 months (mean of 36.7 months). The radiological and clinical outcomes were assessed. The patient/parent outcome was evaluated using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). RESULTS The results showed statistically significant improvement in both radiological and clinical data as well as patient's symptoms and parent's satisfaction. CONCLUSION Results obtained from literature from the past decades after arthroereisis for the correction of moderate planovalgus deformity in CP patients are promising. The few studies reported on that procedure shared the same harmony with our study giving a chance to be a good alternative to joint destructive procedures. Our technique is simple, effective, economical, and minimally invasive if used in selected pediatric CP patients. LEVELS OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
| | - Amr Said Arafa
- Orthopaedic Surgery Department, Cairo University, Cairo, Egypt
| | | | - Mohamed Hegazy
- Orthopaedic Surgery Department, Cairo University, Cairo, Egypt
| | | | | | - Mahmoud Fahmy
- Orthopaedic Surgery Department, Cairo University, Cairo, Egypt
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MacInnes P, Lewis TL, Griffin C, Martinuzzi M, Shepherd KL, Kokkinakis M. Surgical management of pes planus in children with cerebral palsy: A systematic review. J Child Orthop 2022; 16:333-346. [PMID: 36238147 PMCID: PMC9550996 DOI: 10.1177/18632521221112496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Pes planus (or flatfoot) is the most common deformity in children with cerebral palsy. There are several surgical interventions used to treat it: single calcaneal osteotomies, extra-articular arthrodesis, double calcaneal osteotomy, calcaneo-cuboid-cuneiform osteotomy, intra-articular arthrodesis, and arthroereisis. There is currently no evidence on optimal treatment for flatfoot in children with cerebral palsy. Our purpose is to systematically review studies reporting complications, recurrence rates, and radiological outcomes of the surgical management of flatfoot in children with cerebral palsy. METHODS Five databases were searched to identify studies published from inception until July 2021, with keywords relating to flatfoot, cerebral palsy, and surgical interventions. We included prospective, retrospective, and comparative study designs in the English language. Data was extracted and tabulated in duplicate into Excel, and analysis was conducted using Python SciPy. RESULTS In total, 1220 studies were identified of which 44 met the inclusion criteria, comprising 2234 feet in 1364 patients with a mean age of 10.3 years and mean follow-up of 55.9 months. Radiographic outcomes showed improvement with all procedures; complications and recurrence rates were too poorly reported to compare. Only 6 (14%) studies were assessed as a low risk of bias. There was substantial heterogeneity of outcome measures. CONCLUSION There is a lack of high-quality, comparative studies assessing the radiological outcomes, complications, and recurrence rates of surgical alternatives to treat flatfoot in children with cerebral palsy. There is currently no clear evidence on optimal surgical treatment. LEVEL OF EVIDENCE IIa based on Oxford Centre for Evidence-based Medicine.
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Affiliation(s)
- Poppy MacInnes
- GKT School of Medical Education, King’s
College London, London, UK,Poppy MacInnes, GKT School of Medical
Education, King’s College London, Strand, London WC2R 2LS, UK.
| | - Thomas L Lewis
- Evelina Children’s Hospital, St Thomas’
Hospital, London, UK
| | - Cora Griffin
- GKT School of Medical Education, King’s
College London, London, UK
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Sees JP, Miller F. The Foot in Cerebral Palsy. Foot Ankle Clin 2021; 26:639-653. [PMID: 34752232 DOI: 10.1016/j.fcl.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Children with cerebral palsy frequently develop foot deformities, most commonly equinus contractures, which can be managed with orthotics up to age 5 to 7 years. Plantar flexor lengthening, typically around this age, should be restricted to the offending muscle only, usually with a fascia release of the gastrocnemius. Equinovarus, mainly a problem in children with unilateral cerebral palsy, often responds to plantar flexor lengthening. If further tendon transfers are needed, they should be done when the child is older to avoid overcorrection. Planovalgus mostly improves spontaneously up to age 5 years. Surgical correction is best done in adolescence.
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Affiliation(s)
- Julieanne P Sees
- Department of Orthopedics, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Freeman Miller
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, BOX 269, Wilmington, DE 19899, USA.
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Kim NT, Lee YT, Park MS, Lee KM, Kwon OS, Sung KH. Changes in the bony alignment of the foot after tendo-Achilles lengthening in patients with planovalgus deformity. J Orthop Surg Res 2021; 16:118. [PMID: 33557891 PMCID: PMC7869243 DOI: 10.1186/s13018-021-02272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study was performed to investigate the change in the bony alignment of the foot after tendo-Achilles lengthening (TAL) and the factors that affect these changes in patients with planovalgus foot deformity. Methods Consecutive 97 patients (150 feet; mean age 10 years; range 5.1–35.7) with Achilles tendon contracture (ATC) and planovalgus foot deformity who underwent TAL were included. All patients underwent preoperative and postoperative weight-bearing anteroposterior (AP) or lateral (LAT) foot radiographics. Changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, LAT talo-1st metatarsal angle, and calcaneal pitch angle and the factors affecting such changes after TAL were analyzed using lineal mixed model. Results There were no significant change in AP talo-1st metatarsal angle and AP talo-2nd metatarsal angle after TAL in patients with cerebral palsy (CP) (p = 0.236 and 0.212). However, LAT talo-1st metatarsal angle and calcaneal pitch angle were significantly improved after TAL (13.0°, p < 0.001 and 4.5°, p < 0.001). Age was significantly associated with the change in LAT talo-1st metatarsal angle after TAL (p = 0.028). The changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, and calcaneal pitch angle after TAL were not significantly associated with the diagnosis (p = 0.879, 0.903, and 0.056). However, patients with CP showed more improvement in LAT talo-1st metatarsal angle (− 5.0°, p = 0.034) than those with idiopathic cause. Conclusion This study showed that TAL can improve the bony alignment of the foot in patients with planovalgus and ATC. We recommend that physicians should consider this study’s findings when planning operative treatment for such patients.
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Affiliation(s)
- Nak Tscheol Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea
| | - Young Tae Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Oh Sang Kwon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea
| | - Ki Hyuk Sung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea. .,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Agashe MV, Sagade BS, Bansal AV. Functional and Radiological Outcomes Following Calcaneo-Cuboid-Cuneiform Osteotomy for the Treatment of Planovalgus Feet: A Short-Term Analysis. Indian J Orthop 2020; 55:119-127. [PMID: 34122764 PMCID: PMC8149568 DOI: 10.1007/s43465-020-00195-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/07/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Flexible flatfoot refers to the loss of the medial longitudinal arch of the foot on weight bearing and is associated with excessive heel eversion or forefoot abduction. Unless symptomatic, flexible flatfeet are best managed non-operatively. The calcaneo-cuboid-cuneiform osteotomy is a procedure that restores the anatomical shape of the foot without arthrodesis of the joints. Our study aims to evaluate the functional and radiological outcomes of patients treated with calcaneo-cuboid-cuneiform osteotomy in patients with planovalgus feet. METHODOLOGY A retrospective review of records and radiographs of patients with symptomatic flexible planovalgus feet, who were operated with the calcaneo-cuboid-cuneiform osteotomy by a single senior surgeon in a time period between April 2016 and July 2017 was done. The clinical and radiological outcomes were evaluated in 12 feet in 8 children. RESULTS A total of 12 feet in 8 children were operated (6 males and 2 females). Average age of patients was 11 ± 1.27 years; average follow up was 14.7 months ± 2.7 months. Two patients had planovalgus feet secondary to spastic diplegia and 6 had idiopathic planovalgus feet. There was a statistically significant improvement in the pain score as well as the radiographic parameters in all the operated patients. CONCLUSION The calcaneo-cuboid-cuneiform osteotomy has potential to give good results for symptomatic planovalgus feet with minimal complications.
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Affiliation(s)
- Mandar V. Agashe
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 India
| | - Bhushan S. Sagade
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 India
| | - Ankita V. Bansal
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 India
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Double hindfoot arthrodesis technique for the treatment of severe equino-plano-valgus foot deformity in cerebral palsy: long-term results and radiological evaluation. J Pediatr Orthop B 2019; 28:235-241. [PMID: 30839360 DOI: 10.1097/bpb.0000000000000616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the clinical and radiological results of a double arthrodesis technique for the treatment of equino-plano-valgus foot deformity in pediatric patients affected by cerebral palsy. A retrospective evaluation was performed on 175 feet surgically treated with a talonavicular and calcaneocuboid joint fusion technique. The average age at surgery was 14.7 years (range: 12-20 years). Visual analogue scale for pain score, Gross Motor Function Classification System scale, talonavicular angle, Costa-Bertani angle, and Kite's angle on standard weight bearing radiographs were evaluated preoperatively and postoperatively. The mean clinical follow-up was 62.4 months (range: 12-112 months). The mid Gross Motor Function Classification System scale value did not show a significant improvement in any of the subgroups considered. A significant improvement in the visual analogue scale for pain score value was evident 6 months after surgery. Radiological examination showed a statistically significant improvement in the talonavicular angle (average 7.4°) and the Costa-Bertani angle (average 128.5°). Complications occurred in 8.6% of cases. The described surgical technique is safe and efficacious, and could represent a useful option of treatment of equino-plano-valgus severe deformity in cerebral palsy patients older than 12 years of age.
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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] [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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Suh DH, Park JH, Lee SH, Kim HJ, Park YH, Jang WY, Baek JH, Sung HJ, Choi GW. Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review. INTERNATIONAL ORTHOPAEDICS 2019; 43:1179-1192. [PMID: 30701302 DOI: 10.1007/s00264-019-04303-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and arthroereisis (AR) for treating symptomatic flatfoot in children. METHODS We conducted a comprehensive search on MEDLINE, EMBASE, and Cochrane Library databases. Literature search, data extraction, and quality assessment were conducted by two independent reviewers. The outcomes analyzed included radiographic parameters, clinical scores, satisfaction, complications, and re-operations. RESULTS Twenty-one and 13 studies were included in the LCL and AR groups, respectively. The change in anteroposterior talo-first metatarsal angle was greater in the LCL (9.5° to 21.7°) than in the AR group (10.6° to 12.8°). The change in calcaneal pitch was greater in the LCL (2.1° to 26.53°) than in the AR group (- 1.3° to 3.23°). Improvements in the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were greater in the LCL (27.7 to 39.1) than in the AR group (17 to 22). The percentage of satisfaction was similar between the LCL (68% to 89%) and AR (78.5% to 96.4%) groups. The complication rate was higher in the LCL (0% to 86.9%) than in the AR group (3.5% to 45%). The most common complications were calcaneocuboid subluxation and persistent pain in the LCL and AR groups, respectively. The re-operation rate was similar between the LCL (0% to 27.3%) and AR (0% to 36.4%) groups. CONCLUSIONS The LCL group has achieved more radiographic corrections and more improvements in the AOFAS score than the AR group. Complications were more common in the LCL group than in the AR group, and the re-operation rates were similar between the two groups.
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Affiliation(s)
- Dong Hun Suh
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Jung Ho Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Soon Hyuck Lee
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Woo Young Jang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung Heum Baek
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Hyun Jae Sung
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea.
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13
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Relationship between Subtalar Joint Stiffness and Relaxed Calcaneal Stance Position in Cerebral Palsy Children with Valgus Deformities. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6576108. [PMID: 29854778 PMCID: PMC5952502 DOI: 10.1155/2018/6576108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/27/2018] [Accepted: 03/21/2018] [Indexed: 11/18/2022]
Abstract
Relaxed calcaneal stance position (RCSP) is an important index in the correctional treatment of foot valgus deformities for cerebral palsy (CP) children. However, patients with similar RCSP showed diverse outcomes when accepting similar treatment, as the corrective resistance of subtalar joint (STJ) could be quite different. This study aimed to investigate the relationship between STJ stiffness and RCSP in different loading conditions. 38 valgus feet of 19 CP subjects were included in the study. A reposition force was applied beneath the STJ and pushed the foot from pronated position to neutral position. The STJ stiffness was calculated as the slope of the line fitting the force-displacement data. Correlations between the STJ stiffness, RCSP, and composite spasticity index (CSI) were analyzed. The spearman correlation coefficient indicated that STJ stiffness had no correlation with RCSPs, yet it had negative correlation with the change of RCSP under difference loading conditions (ΔRCSP1w−0w and ΔRCSP0.5w−0w). STJ stiffness was also correlated with the composite spasticity index (CSI), implying that this index had an advantage in reflecting the mechanism of valgus deformity and should be considered as a necessary measurement of foot valgus in CP children. The present method for quantification of STJ stiffness could improve the accuracy in the diagnosis and classification of foot deformity and may help increase the understanding of the biomechanical factors in foot deformity rehabilitation.
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14
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Affiliation(s)
- Sheldon S Lin
- Department of Orthopaedics, Rutgers New Jersey School of Medicine, Newark, New Jersey
| | - Omkar Baxi
- Department of Orthopaedics, Rutgers New Jersey School of Medicine, Newark, New Jersey
| | - Michael Yeranosian
- Department of Orthopaedics, Rutgers New Jersey School of Medicine, Newark, New Jersey
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