Correction of the pronated foot

Flatfoot in Indian population

PURPOSE

To compare outcomes of different conservative treatments for flatfoot using the foot print index and valgus index.

METHODS

150 symptomatic flatfoot patients and 50 controls (without any flatfoot or lower limb deformity) aged older than 8 years were evaluated. The diagnosis was based on pain during walking a distance, the great toe extension test, the valgus index, the foot print index (FPI), as well as eversion/ inversion and dorsiflexion at the ankle. The patients were unequally randomised into 4 treatment groups: (1) foot exercises (n=60), (2) use of the Thomas crooked and elongated heel with or without arch support (n=45), (3) use of the Rose Schwartz insoles (n=18), and (4) foot exercises combined with both footwear modifications (n=27).

RESULTS

Of the 150 symptomatic flatfoot patients, 96 had severe flatfoot (FPI, >75) and 54 had incipient flatfoot (FPI, 45-74). The great toe extension test was positive in all 50 controls and 144 patients, and negative in 6 patients (p=0.1734, one-tailed test), which yielded a sensitivity of 96% and a positive predictive value of 74%. Symptoms correlated with the FPI (Chi squared=9.7, p=0.0213). Combining foot exercises and foot wear modifications achieved best outcome in terms of pain relief, gait improvement, and decrease in the FPI and valgus index.

CONCLUSION

The great toe extension test was the best screening tool. The FPI was a good tool for diagnosing and grading of flatfoot and evaluating treatment progress. Combining foot exercises and foot wear modifications achieved the best outcome.

Flexible flatfoot in children and adolescents

Flexible flatfoot is a normal foot shape that is present in most infants and many adults. The arch elevates spontaneously in most children during the first decade of life. There is no evidence that a longitudinal arch can be created in a child's foot by any external forces or devices. Flexible flatfoot with a short Achilles tendon, in contrast to simple flexible flatfoot, is known to cause pain and disability in some adolescents and adults. Joint-preserving, deformity-correcting surgery is indicated in flexible flatfeet with short Achilles tendons when conservative measurements fail to relieve pain under the head of the plantar flexed talus or in the sinus tarsi area. Osteotomy is the fundamental and central procedure of choice. In almost all cases, Achilles tendon lengthening is required. In some cases, rigid supination deformity of the forefoot is present, requiring identification and concurrent treatment.

Talar neck osteotomy for flatfoot reconstruction: a 27-year follow-up study

The talar neck osteotomy is done at the junction of the head and neck of the talus, frequently in conjunction with desmoplasty and posterior tibial tendon advancement. This is done effectively to correct severe deformities involving the talus. The correction produces a structural realignment of the talar head. Adjunctive procedures are also done when these are deformities involving the posterior column, lateral column, and/or medial column. A 27-year follow-up study is presented containing data from 215 procedures on 117 patients with a minimum of one year follow-up.

Biomechanical foot orthotics: a retrospective study

Foot orthotics are becoming recognized as an important consideration in the correction of lower extremity alignment and mechanical dysfunctions. There are many different foot orthotics on the market today claiming to relieve pain and enhance foot function. Unfortunately, minimal research has been conducted investigating the effectiveness of foot orthotics in adult patient populations. The purpose of this study was to determine the degree of pain relief experienced by patients, the ability of patients to return to their previous levels of activity associated with the duration of use of the orthotics, and patient compliance. This study also discusses the specific deformity for which the orthotic was prescribed and the degree of posting necessary to compensate for the deformity. Fifty-three subjects, 20 males and 33 females, responded to a questionnaire survey. The type of foot deformity and the orthotic prescription are also presented for each subject. The responses to the questions were correlated with an individual patient chart review. In addition, chi-square analysis was used to determine the level of significance between the specific deformity and the age and weight of the patients. The level of significance was determined between the patient's ability to adjust to the orthotics and their continued use of the orthotics. Finally, the significance of the orthotic treatment was compared to four other treatment interventions. Ninety-six percent of the patients reported relief from pain with the use of the prescribed foot orthotic. Ninety-four percent of the patients were still wearing the orthotic, and 52% reported that they would not leave home without them in their shoes at the time the survey was conducted. Seventy percent of the patients reported that they were able to return to their previous level of activity with the use of the foot orthotics.J Orthop Sports Phys Ther 1988;10(6):205-212.

Pes planus: radiographic changes with foot orthoses and shoes

Radiographic evaluation of 10 children with bilateral pes planus was performed. Radiographs taken barefoot, with a Thomas heel, with an over-the-counter insert, with two specially molded plastic foot orthoses were used. No significant change was seen after the donning of these appliances in their comparison to barefoot evaluation. The conclusion is that there was not a significant change radiographically of these feet by the utilization of any of the appliances.