Role of surgery in the management of lesions of the medial collateral ligament of the ankle

Medial ankle instability is likely underestimated. Three types of medial collateral ligament (MCL) lesion exist: isolated lesions, in case of valgus sprain in external rotation; lesions associated with chronic lateral instability, in case of rotational instability; and lesions associated with medial insufficiency and valgus flat-foot. Diagnostic confirmation and treatment of MCL lesions, isolated or associated with chronic lateral instability, by ligament suture is at present largely arthroscopic. Chronic MCL lesions with valgus flat-foot are probably irreversible: ligament reconstruction is unreliable, and bone surgery (osteotomy, fusion) is required.

Effect of plano-valgus foot posture on midfoot kinematics during barefoot walking in an adolescent population

Background

Plano-valgus is a common alteration of the paediatric foot, characterized by valgus hindfoot, foot pronation and drop of the medial longitudinal arch. Despite their importance in the diagnosis and classification of plano-valgus foot condition, little information is available on functional alterations of the major joints spanning the medial longitudinal arch – i.e. midtarsal and tarso-metatarsal. Aim of the study was to provide objective description of the alterations in plano-valgus midfoot joints with respect to those in an age-matched normally-developed feet population.

Methods

Twenty adolescents (13.3 ± 0.8 years) with bilateral plano-valgus feet underwent clinical examination and were gait-analysed via a validated 4-segment foot model. This allowed to measure static foot posture, kinematics of the main foot joints, and medial longitudinal arch deformation during walking at comfortable speed. Range of motion and temporal profiles of joint rotations were compared to those from a control population of age-matched adolescents with normally-developed feet.

Results

The plano-valgus midtarsal joint was more dorsiflexed, everted and abducted than that in the control group, and showed reduced sagittal-plane RoM (plano-valgus = 15.9 degrees; control = 22.2 degrees; P <  0.01). The tarso-metarsal joint was more plantarflexed and adducted, and showed larger frontal-plane RoM. The MLA showed larger RoM and was lower throughout the stance phase of the gait cycle.

Conclusion

Significant postural and kinematic alterations are present at the midtarsal and tarso-metarsal joints of adolescents with plano-valgus feet. Objective identification and quantification of plano-valgus foot alterations, via non-invasive gait-analysis, is relevant to improving the diagnosis of this condition and to evaluating the effect of conservative treatments and of surgical corrections by different techniques.

Impact of wearing a functional foot orthotic on the ankle joint angle of frontal surface of young adults with flatfoot

[Purpose] This study investigated the effects of proprietary foot orthotics in young adults with flatfoot to determine changes in the ankle joint angle in the coronal plane during the midstance phase. [Subjects and Methods] The subjects were 15 college students diagnosed with flatfoot. Changes in the ankle joint angle in the coronal plane in the midstance phase were measured using the Vicon Motion System before and after use of the orthotic. The data were analyzed using Statistical Package for the Social Sciences Win 16.0. [Results] The subjects showed significant increases in left and right ankle joint angles in the coronal plane during the midstance phase of the gait cycle after use of the orthotics. However, the difference between the left and right ankle joint angles showed no significant change, even though the difference increased after use of the orthotics. [Conclusion] Young adults with flatfoot showed increased ankle joint angles after use of the orthotics. This suggests that orthotic footwear can shape the plantar arch and affect the ankle joint, and that constant use of orthotics would cause a dynamic change in normal walking.

Effects of wearing functional foot orthotic on pelvic angle among college students in their 20s with flatfoot

[Purpose] This study examined the impact of wearing a functional foot orthotic on the pelvic angle of young adults who have flatfoot. [Subjects and Methods] A total of 15 college students diagnosed with flatfoot were included in the study. Changes in the pelvic angle in the stance period during walking before and after orthotic use were measured using a VICON Motion System (VICON, Hansung, Korea). The data were analyzed using SPSS 12.0 for Windows. [Results] In the experimental group, the pelvic angle during the mid-stance and mid-swing periods of the gait cycle significantly decreased on the left and right sides after wearing the orthotic, compared to the measurements taken before orthotic usage. The pelvic angle change on the left and right sides also decreased after wearing the orthotic, though this difference was not significant. [Conclusion] The pelvic angle of college students with flatfoot decreased after they wore orthotics. This implies that wearing orthotic shoes can greatly benefit individuals during normal walking by promoting passive changes that decrease the pelvic angle.

Reducible valgus flat-foot: assessment of posterior subtalar joint surface displacement by posterior arthroscopy during sinus tarsi expansion screwing

INTRODUCTION

Subtalar arthroereisis corrects childhood and adult reducible valgus flat-foot in certain indications. Inserting an expansion screw in the sinus tarsi simultaneously corrects the calcaneal valgus of the talocalcaneal divergence and first-ray pronation if these are reducible. The displacement induced in the posterior subtalar joint (decoaptation, translation, rotation) is, however, poorly known. The present study involved arthroscopic assessment of posterior subtalar joint surface displacement during insertion of a talocalcaneal arthroereisis screw, with the hypothesis that displacement varies in three dimensions according to screw size.

MATERIAL AND METHOD

Eight specimens were used for the study. All ankles were supple, taken from adult subjects. A 4.5-mm arthroscope was used and measurements were taken with a graduated palpator in the posterior subtalar joint. Three sinus tarsi expansion screws of incremental diameter were assessed. Before and after insertion measurements were made of posterolateral and posteromedial talar exposure on the calcaneus, anteroposterior and lateromedial translation, and talocalcaneal joint-line opening.

RESULTS

Medial rotation, varization and anterior translation of the calcaneus were comparable in all cases. Mean lateral opening of the posterior subtalar joint was 0.88 mm with 8-mm screws and 1.25 mm with 16-mm screws. Significant differences between 8 and 16 mm screws were found for lateral subtalar joint opening (P=0.028) and for lateromedial translation (P=0.004).

CONCLUSION

Sinus tarsi expansion screwing corrects hindfoot valgus and talocalcaneal divergence by inducing medial translation of the calcaneus under the talus and talar medial rotation and varization, proportional to screw size (medial translation and lateral opening of the subtalar joint).

LEVEL OF EVIDENCE

III.