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İncesoy MA, Uzer G. Tibialis spastic varus foot without tarsal coalition: a case report. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:698-702. [PMID: 39160373 DOI: 10.1007/s00132-024-04536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/21/2024]
Abstract
Tibialis spastic varus foot (TSVF) is an uncommon clinical entity primarily associated with tarsal coalition. This case report presents a rare instance of TSVF without tarsal coalition in an 8‑year-old male patient. Successful treatment was achieved through a conservative approach involving botulinum toxin injections and a plaster cast, highlighting the potential of nonsurgical interventions for this rare condition.
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Affiliation(s)
- Mustafa Alper İncesoy
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Iskender Pasa District Adnan Menderes Boulevard, 34093, Fatih/Istanbul, Turkey.
| | - Gokcer Uzer
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Iskender Pasa District Adnan Menderes Boulevard, 34093, Fatih/Istanbul, Turkey
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2
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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. INTERNATIONAL ORTHOPAEDICS 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] [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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Hadano Y, Kimura T, Kubota M, Saito M. Refractory peroneal spastic flat foot successfully treated with a cast in a girl. BMJ Case Rep 2022; 15:e248979. [PMID: 35264394 PMCID: PMC8915361 DOI: 10.1136/bcr-2022-248979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/03/2022] Open
Abstract
An 11-year-old girl presented with pain in the sinus tarsi and a foot deformity after spraining her left foot. She had flat foot due to spasticity of the peroneal tendon, which was difficult to correct manually. An imaging study revealed an accessory anterolateral talar facet (AALTF) and bone marrow oedema at the lateral aspect of the posterior talocalcaneal joint. We diagnosed peroneal spastic flat foot with possible involvement of sinus tarsi syndrome and AALTF. When conservative therapy failed, we applied a cast with the foot in full plantar flexion and an inverted position. After 4 weeks, the patient had a normal range of motion in the foot, the pain had resolved completely and the peroneal spasticity had disappeared. Orthopaedic treatment with a cast may be worth attempting before surgery in such cases.
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Affiliation(s)
- Yuka Hadano
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi Kimura
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Kubota
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
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Golshteyn G, Schneider HP. Tarsal Coalitions. Clin Podiatr Med Surg 2022; 39:129-142. [PMID: 34809791 DOI: 10.1016/j.cpm.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Tarsal coalitions are recognized as a congenital anomaly whereby the two or more bones of the hindfoot and midfoot are fused resulting in limitation of foot motion and pain. Tarsal coalitions were found to be the cause of painful flatfeet in adolescents and young adults. Developing a clinical understanding of tarsal coalitions as well as developing a step-wise conservative and surgical approach for their treatment can alleviate patient symptomatology and provide excellent long-term benefits. Conservative treatment consists of immobilization, NSAIDs, and casting for symptomatic patients, and surgical treatment for symptomatic tarsal coalition consists of resection and/or arthrodesis.
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Affiliation(s)
- Gan Golshteyn
- The Pediatric Orthopedic Center, Cedar Knolls, NJ, USA.
| | - Harry P Schneider
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139, USA
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Berkeley R, Tennant S, Saifuddin A. Multimodality imaging of the paediatric flatfoot. Skeletal Radiol 2021; 50:2133-2149. [PMID: 34002241 DOI: 10.1007/s00256-021-03806-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 02/02/2023]
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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Cho BK, Park JK. Realignment Calcaneal Osteotomy for Bilateral Complete Talocalcaneal Synostosis: A Case Report. J Foot Ankle Surg 2019; 58:599-603. [PMID: 30914151 DOI: 10.1053/j.jfas.2018.11.002] [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] [Received: 06/14/2016] [Indexed: 02/03/2023]
Abstract
Talocalcaneal synostosis is a congenital failure of the segmentation between tarsal bones. It may be very difficult to differentiate from talocalcaneal coalition, known as the most common tarsal coalition, especially in cases with a large bone bridge. Complete talocalcaneal synostosis is very rare, and there are few references in the literature about the clinical outcomes and operative methods for symptomatic synostosis. We report a case of a 15-year-old female with bilateral complete talocalcaneal synostosis and heel varus deformity who has experienced good clinical results after lateral sliding calcaneal osteotomy for hindfoot realignment.
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Affiliation(s)
- Byung-Ki Cho
- Professor, Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
| | - Ji-Kang Park
- Professor, Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
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Kılıçoğlu Öİ, Salduz A, Birişik F, Bilgili F, Polat G, Kaya İ, Süleyman F, Coşkun M. High Rates of Psychiatric Disorders and Below Normal Mental Capacity Associated With Spastic Peroneal Flatfoot: A New Relationship. J Foot Ankle Surg 2018; 57:501-504. [PMID: 29685560 DOI: 10.1053/j.jfas.2017.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Indexed: 02/03/2023]
Abstract
Spastic peroneal flatfoot (SPFF) is a rare hindfoot pathology usually seen in the adolescent age group that is characterized by painful spasms in the peroneal muscles. We have clinically observed that patients with SPFF also have some behavioral and emotional difficulties and problems in their academic achievements. Because of these observations, we investigated the prevalence and patterns of psychiatric disorders and intellectual disability among young subjects with SPFF. Our cohort consisted of 16 patients with SPFF. Their mean age at presentation was 21 (range 13 to 31) years. Only 6 patients had a tarsal coalition as an underlying condition. The psychometric evaluation was conducted using validated instruments (Wechsler Intelligence Scale for Children-revised form, Stanford Binet intelligence quotient [IQ] test, and Cattell IQ test). Psychiatric disorders were assessed using a semistructured diagnostic instrument (Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version). The testers and psychiatrists were unaware of the orthopedic condition and the preliminary psychiatric diagnoses. The ethical committee approved the study protocol. The mean follow-up period was 41 (range 12 to 97) months. The mean IQ score of the patients was 75.1 ± 17.9 (range 52 to 107). Compared with the general population, the rate of intellectual disability was significantly greater (p = .0001) and the rate of normal intelligence significantly lower (p = .0015) in our patient group. Furthermore, according to the community schooling ratio, our cohort also had lower junior high and secondary education rates compared with the general population. The rate of most psychiatric disorders diagnosed in the SPFF patients was greater than that in the normal population. The most commonly identified psychiatric disorders were social phobia and attention deficit and hyperactivity disorder (75%). Timely interventions of the psychosocial and academic problems of patients with SPFF might increase their compliance with orthopedic treatment and help with their psychological well-being and academic achievement. In addition, this relationship might be a clue for uncovering the etiology of this disease, which has not yet been clarified.
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Affiliation(s)
- Önder İsmet Kılıçoğlu
- Attending Surgeon, Orthopedic and Traumatology Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Ahmet Salduz
- Attending Surgeon, Orthopedic and Traumatology Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fevzi Birişik
- Attending Surgeon, Orthopedic and Traumatology Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fuat Bilgili
- Attending Surgeon, Orthopedic and Traumatology Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gökhan Polat
- Attending Surgeon, Orthopedic and Traumatology Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - İlyas Kaya
- Attending Physician, Department of Child and Adolescent Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Funda Süleyman
- Attending Physician, Department of Child and Adolescent Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Coşkun
- Attending Physician, Department of Child and Adolescent Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Xu J, Muhammad H, Wang X, Ma X. Botulinum Toxin Type A Injection Combined With Cast Immobilization for Treating Recurrent Peroneal Spastic Flatfoot Without Bone Coalitions: A Case Report and Review of the Literature. J Foot Ankle Surg 2014; 54:697-700. [PMID: 24774990 DOI: 10.1053/j.jfas.2014.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Indexed: 02/03/2023]
Abstract
Peroneal spastic flatfoot is an uncommon condition. It often presents as a rigid and usually painful valgus deformity in the hindfoot with peroneal muscles spasms. Although tarsal coalition is an important cause, a few patients have not undergone bone coalitions. We describe a 27-year-old female who experienced recurrent peroneal spastic flatfoot after an injury. She was treated successfully with a combination of botulinum toxin type A and immobilization of the foot in a neutral position with a cast. After 3 years, the condition had not recurred, and she was pain free and walked normally, with no increase in muscle tone. This unique treatment could be of potential use to treat many patients with such conditions.
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Affiliation(s)
- Jian Xu
- Resident, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Hassan Muhammad
- Resident, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Wang
- Associate Professor, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Ma
- Professor, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
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Cass AD, Camasta CA. A review of tarsal coalition and pes planovalgus: clinical examination, diagnostic imaging, and surgical planning. J Foot Ankle Surg 2010; 49:274-93. [PMID: 20356770 DOI: 10.1053/j.jfas.2010.02.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Indexed: 02/03/2023]
Abstract
Pediatric pes planovalgus deformity may be classified as flexible or rigid. The rigid pes planovalgus is often a result of a tarsal coalition, which is typically characterized as a painful unilateral or bilateral deformity, frequently associated with peroneal spasm. However, many tarsal coalitions are asymptomatic and demonstrate no peroneal spasm or pes planovalgus deformity. Likewise, the severe pes planovalgus foot type can demonstrate some of the same clinical and radiographic features of a tarsal coalition, especially in the obese adolescent patient. Also, peroneal spasm may occur in the noncoalesced foot, making diagnosis and etiology more difficult to elucidate. The authors believe that many patients with a pes planovalgus deformity lie in this "gray zone": somewhere between the frank osseous coalition and the flexible pes planovalgus. The "step-forward Hubscher maneuver" is introduced as an effective means of evaluating the flexibility of a pes planovalgus foot by negating the effects of a gastrocnemius or gastrocnemius-soleus equinus. This article focuses on the clinical examination and findings of specific imaging studies to assist in an accurate diagnosis of these complicated patients. This will also help to reveal the various surgical options that are appropriate for the individual patient. Emphasis is placed on computerized tomography (CT) imaging and offers enhanced methods for ordering this test to specifically evaluate middle facet coalitions of the subtalar joint. The authors also introduce "lateral tarsal wedging," an image finding associated with severe deformities, the implications of this finding, as well as its impact on surgical planning.
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Rodriguez N, Choung DJ, Dobbs MB. Rigid pediatric pes planovalgus: conservative and surgical treatment options. Clin Podiatr Med Surg 2010; 27:79-92. [PMID: 19963171 DOI: 10.1016/j.cpm.2009.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Rigid pediatric pes planovalgus refers to a condition of the foot in which the medial longitudinal arch height is abnormally decreased along with a significant loss of midfoot and hindfoot motion in the pediatric patient. Known causes for this condition are well documented and consist of congenital vertical talus, tarsal coalitions, and peroneal spastic flatfoot without coalition. This article outlines conservative and surgical treatment of rigid pediatric pes planovalgus.
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Affiliation(s)
- Nitza Rodriguez
- Northern California Foot and Ankle Center, San Francisco, CA 94114, USA.
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Rodriguez N, Volpe RG. Clinical diagnosis and assessment of the pediatric pes planovalgus deformity. Clin Podiatr Med Surg 2010; 27:43-58. [PMID: 19963169 DOI: 10.1016/j.cpm.2009.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The careful evaluation of the pediatric flatfoot begins with a detailed history and is followed by a thorough physical examination. Flatfeet may be congenital or acquired, and flexible or rigid. It is important to classify and evaluate a flatfoot, as the treatment recommendations depend on the assessment and proper diagnosis. The entire lower limb should be evaluated as a unit as one considers the suprapedal influences affecting foot position. The rigid flatfoot results in a fixed foot position that causes suprapedal compensation. On the other hand, most children presenting for evaluation of an acquired, flexible pes valgus deformity, with or without symptoms, will have abnormal, faulty biomechanical alignment of the lower extremity as the primary cause for an acquired, compensatory deformity of the foot.
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Affiliation(s)
- Nitza Rodriguez
- Northern California Foot and Ankle Center, San Francisco, CA 94114, USA.
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Abstract
The frequent occurrence of flexible flatfoot raises the question of its pathologic status. There may be cultural overtones resulting in the consideration that flat feet are always pathologic. Parents may believe that their own flat feet were successfully treated when they were children and wish the same for their offspring. Few studies attempt to answer the question of the natural history of this condition. This article reviews the available literature dealing with the natural history, comorbidities, recommendations for treatment, expansion of biomechanical theory, and classification of flatfoot. Issues associated with imaging of flatfoot and the design of studies to validate the effects of treatment are also reviewed.
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Nabeshima Y, Fujii H, Ozaki A, Nishiyama T, Takakura Y. Tibialis spastic varus foot with tarsal coalition: a report of five cases. Foot Ankle Int 2007; 28:731-4. [PMID: 17592705 DOI: 10.3113/fai.2007.0731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Y Nabeshima
- Department of Orthopaedic Surgery, Himeji St. Mary's Hospital, Hyogo, 670-0801, Japan.
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Harris EJ, Vanore JV, Thomas JL, Kravitz SR, Mendelson SA, Mendicino RW, Silvani SH, Gassen SC. Diagnosis and treatment of pediatric flatfoot. J Foot Ankle Surg 2004; 43:341-73. [PMID: 15605048 DOI: 10.1053/j.jfas.2004.09.013] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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