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Yamashita T, Sato M, Ata S, Yamashita K. Predictors of flatfoot in 11-12-year olds: a longitudinal cohort study. Biomed Eng Online 2024; 23:83. [PMID: 39169367 PMCID: PMC11337572 DOI: 10.1186/s12938-024-01282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND The structures around the navicular bones, which constitute the medial longitudinal arch, develop by 10 years of age. While navicular bone height is often emphasized in the assessment of flatfoot, three-dimensional (3D) evaluations, including those of structural parameters during inversion, have rarely been investigated. If the development of flatfoot during the growth process could be predicted, appropriate interventions could be implemented. Therefore, in this longitudinal cohort study, we developed a system, utilizing smartphones, to measure the 3D structure of the foot, performed a longitudinal analysis of changes in midfoot structures in 124 children aged 9-12 years, and identified factors influencing the height of the navicular bone. The foot skeletal structure was measured using a 3D system. RESULTS Over 2 years, foot length and instep height increased during development, while navicular height decreased. The 25th percentile of the instep height ratio and navicular height ratio at ages 9-10 years did not exceed those at ages 11-12 years, with percentages of 17.9% and 71.6%, respectively, for boys, and 15.8% and 49.1%, respectively, for girls. As the quartiles of the second toe-heel-navicular angle (SHN angle) increased at ages 9-10 years, the axis of the bone distance (ABD) and SHN angles at ages 11-12 years also increased, resulting in a decrease in the navicular height ratio. A significant inverse correlation was found between changes in SHN angle and navicular height ratio. These findings indicate that the navicular bone rotation of the midfoot is a predictor of the descent of the navicular bone. CONCLUSIONS This study revealed that some children exhibit decreases in navicular bone height with growth. As a distinct feature, the inversion of the navicular bone promotes flattening of the midfoot. Thus, this study provides insights into changes in midfoot development in children and provides an effective evaluation index.
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Affiliation(s)
- Tomoko Yamashita
- Department of Clinical Engineering, Faculty of Human Care at Makuhari, Tohto University, 1-1 Hibino, Mihama-Ku, Chiba, 261-0021, Japan.
- Department of core informatics, Graduate School of Informatics, Osaka Metropolitan University, Osaka, Japan.
| | - Mitsuru Sato
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Gunma, Japan
| | - Shingo Ata
- Department of core informatics, Graduate School of Informatics, Osaka Metropolitan University, Osaka, Japan
| | - Kazuhiko Yamashita
- Department of Clinical Engineering, Faculty of Human Care at Makuhari, Tohto University, 1-1 Hibino, Mihama-Ku, Chiba, 261-0021, Japan
- Department of Information Systems, Graduate School of Engineering, Saitama Institute of Technology, Saitama, Japan
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Liu C, Zhang H, Li J, Li S, Li G, Jiang X. The effects of foot orthoses on radiological parameters and pain in children with flexible flat feet: a systematic review and meta-analysis. Front Pediatr 2024; 12:1388248. [PMID: 39156020 PMCID: PMC11327157 DOI: 10.3389/fped.2024.1388248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/11/2024] [Indexed: 08/20/2024] Open
Abstract
Objective This study aimed to investigate the impact of foot orthoses on foot radiological parameters and pain in children diagnosed with flexible flatfoot. Methods A comprehensive search was conducted across several databases, including PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO, covering publications from the inception of each database up to 8 June 2024. The study focused on randomized controlled trials investigating the use of foot orthoses for treating flexible flat feet in children. Four researchers independently reviewed the identified literature, extracted relevant data, assessed the quality of the studies, and performed statistical analyses using RevMan 5.4 software. Results Six studies involving 297 participants were included. The methodological quality of the included literature ranged from moderate to high. Radiological parameters of the foot improved significantly in older children with flexible flat feet following foot orthotic intervention compared to controls, particularly in the lateral talar-first metatarsal angle [mean difference (MD) = -2.76, 95% confidence interval (95% CI) -4.30 to -1.21, p = 0.0005], lateral talo-heel angle (MD = -5.14, 95% CI -7.76 to -2.52, p = 0.0001) and calcaneal pitch angle (MD = 1.79, 95% CI 0.88-2.69, p = 0.0001). These differences were statistically significant. Additionally, foot orthoses significantly improved the ankle internal rotation angle and reduced foot pain in children with symptomatic flexible flatfoot (MD = -2.51, 95% CI -4.94 to -0.07, p = 0.04). Conclusion The use of foot orthoses positively impacts the improvement of radiological parameters of the foot and reduces pain in older children with flexible flat feet. However, in younger children with flexible flat feet, the improvement from foot orthoses was not significant, likely due to challenges in radiological measurements caused by the underdevelopment of the ossification centers in the foot. Further studies are needed. Consequently, the results of this meta-analysis support the implementation of an early intervention strategy using foot orthoses for the management of symptomatic flat feet in older children. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO [CRD42023441229].
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Affiliation(s)
| | | | | | | | - GuQiang Li
- Department of Special Education and Rehabilitation, Binzhou Medical University, Yantai, Shandong, China
| | - XiangZhan Jiang
- Department of Special Education and Rehabilitation, Binzhou Medical University, Yantai, Shandong, China
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Naili JE, Åström E, Löwing J, Reimeringer M, Löwing K. The impact of foot orthoses on gait in children with Osteogenesis Imperfecta type I, III and IV - a cross-sectional study. BMC Musculoskelet Disord 2024; 25:560. [PMID: 39026247 PMCID: PMC11256494 DOI: 10.1186/s12891-024-07672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND For children with Osteogenesis Imperfecta (OI), a rare genetic bone disease, walking can be difficult to carry out due to a combination of bone fragility and deformity, muscle weakness, joint hypermobility, and pain. Bisphosphonate treatment has facilitated more children being able to walk, but for many, foot and ankle hypermobility is a limiting factor. Current evidence on foot orthoses in children with OI is sparse. This study aimed to evaluate gait characteristics in children with OI walking barefoot as compared to walking with foot orthoses. METHODS Twenty-three children with OI and hypermobility (mean age 8.3 ± 3.0 years) were included in this cross-sectional study. Children conducted three-dimensional gait analysis barefoot, and with foot orthoses and appropriate foot wear (stable yet light-weight), respectively. Walking speed, step length, lower limb kinematics and kinetics were collected. Differences in gait characteristics between test conditions were evaluated using paired sample t-tests. RESULTS When walking with foot orthoses, the external foot progression angle was reduced, peak ankle dorsiflexion angle increased, and peak plantarflexion moment increased as compared to barefoot. No difference was found in walking speed between test conditions, however, children with OI walked with longer steps with foot orthoses as compared to barefoot. CONCLUSION The observed gait alterations suggest that foot orthoses, aiming to support the foot and ankle joint, contributed to reduced overall foot rotation as measured by external foot progression, increased peak plantarflexion moment, and increased step length. In a wider perspective, the ability to walk provides the opportunity to be physically active, and thereby increase skeletal loading and prevent fractures, thus, foot orthoses may be an important treatment option to consider in children with OI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Josefine E Naili
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Vägen 37 A, QA 02:07, 171 76, Stockholm, Sweden.
- Motion Analysis Lab, Karolinska University Hospital, Stockholm, Sweden.
| | - Eva Åström
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Vägen 37 A, QA 02:07, 171 76, Stockholm, Sweden
- Department of Neuropediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Josefin Löwing
- Department of Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Gävlegatan 55, NB0:01, 171 76, Stockholm, Sweden
| | - Mikael Reimeringer
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Vägen 37 A, QA 02:07, 171 76, Stockholm, Sweden
| | - Kristina Löwing
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Vägen 37 A, QA 02:07, 171 76, Stockholm, Sweden
- Department of Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Gävlegatan 55, NB0:01, 171 76, Stockholm, Sweden
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Alhassan MS, Park BK, Shah M, Park KB, Park H, Rhee I, Kim HW. Surgical management of severe planovalgus foot deformity in children with generalised joint hypermobility. Foot Ankle Surg 2024:S1268-7731(24)00154-1. [PMID: 39013737 DOI: 10.1016/j.fas.2024.07.004] [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: 01/30/2024] [Revised: 06/21/2024] [Accepted: 07/09/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND This study aimed to evaluate the outcomes of calcaneal lengthening osteotomy (CLO) and double arthrodesis of the talonavicular and calcaneocuboid joints (DA) for correcting planovalgus foot deformity exclusively in patients with generalised joint hypermobility. METHODS We retrospectively reviewed 29 feet in 17 consecutive patients who underwent either CLO or DA. The mean age at surgery was 11.3 ± 2.3 years, and the mean follow-up duration was 7.7 ± 3.2 years. Preoperative and final follow-up radiographs and dynamic foot-pressure measurements were analysed. RESULTS Both operations significantly improved the radiographic parameters, except for the lateral talocalcaneal angle in the CLO group. Pedobarographic study demonstrated an elevation of the medial longitudinal arch and an improved foot-pressure distribution after both surgeries. The plantar pressure in the lateral forefoot significantly increased only in the DA group, while the pressures exerted on the medial forefoot and hindfoot and the arch index improved only in the CLO group. CONCLUSIONS Both CLO and DA effectively improve the foot alignments of the deformity in patients with generalised joint hypermobility. However, differences were observed in the changes in the lateral talocalcaneal angle and plantar pressure distribution between the two procedures. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
| | - Byoung Kyu Park
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan 48108, Republic of Korea.
| | - Mudit Shah
- Department of Orthopaedic Surgery, Surya hospital, Mumbai 400054, India.
| | - Kun-Bo Park
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
| | - Hoon Park
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea.
| | - Isaac Rhee
- Department of Orthopaedics, Eastern Health, Melbourne, VIC 3128, Australia.
| | - Hyun Woo Kim
- Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
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Moraca G, Martinelli N, Bianchi A, Filardo G, Sansone V. Subtalar arthroereisis with metallic implant is a safe and effective treatment for pediatric patients with symptomatic flexible flatfeet. A 10-year clinical and radiographic follow-up. Foot Ankle Surg 2024:S1268-7731(24)00143-7. [PMID: 38972783 DOI: 10.1016/j.fas.2024.06.004] [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: 02/26/2024] [Revised: 05/13/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Subtalar arthroereisis (SA) is an increasingly applied minimally invasive approach for flexible flat foot (FFF) not responsive to conservative treatment. This study aimed at evaluating the long-term clinical and radiographic outcomes of SA in pediatric patients with symptomatic FFF. METHODS Thirty-seven patients (11.9 ± 1.6yy) underwent SA (74 feet), with outcomes assessed after a mean 10-year follow-up. Pain, quality of life, foot functionality, and alignment were evaluated using validated tools and radiographic parameters, calculated on weightbearing x-rays pre- and post-operatively. RESULTS Clinical outcomes reached excellent postoperative results (FFI: 9.1, AOFAS: 94.5) with a low 0.9 NRS pain (p < 0.01) and a 92 % satisfaction. All radiographic parameters improved significantly towards normal values: CP 17.5 ± 3.9, MA 4.3 ± 5.8, TCA 42.8 ± 6.2, TNCA 21.1 ± 8.5, TNU% 26.6 ± 8.4 (all p < 0.01). CONCLUSIONS SA with a metallic endosinotarsal device provided significant long-term clinical and radiographic improvements, with low complication rates and high patient satisfaction, supporting its efficacy as a treatment option for pediatric symptomatic FFF. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Giacomo Moraca
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900 Lugano, Switzerland.
| | - Nicolò Martinelli
- IRCCS Galeazzi - Sant'Ambrogio Institute, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Alberto Bianchi
- IRCCS Galeazzi - Sant'Ambrogio Institute, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900 Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Via La Santa 1, 6962 Lugano, Switzerland
| | - Valerio Sansone
- IRCCS Galeazzi - Sant'Ambrogio Institute, Via Cristina Belgioioso 173, 20157 Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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Elshenawy A, AlzamIl TH, Alkuwaykibi HM, Alruwaili RH, Alruwaili SM, Alruwaili HF, Alruwaili SA, Alruwaili AS. Knowledge and Attitudes Regarding Flatfoot in the Al-Jouf Region, Saudi Arabia. Cureus 2024; 16:e61842. [PMID: 38975496 PMCID: PMC11227372 DOI: 10.7759/cureus.61842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Background Flatfoot is a syndrome that includes multiple static and dynamic deformities, characterized by the flattening of the medial arch. It is a common disorder that may affect any age group, causing foot malalignment, pain, and loss of function. Community awareness about flatfoot is essential for the prevention and control of flatfoot complications, ultimately improving the quality of life. The current study aimed to assess community knowledge and attitudes about flatfoot in the Al-Jouf region, Saudi Arabia. Methods The study enrolled 315 participants from different sectors of the Saudi population in the Al-Jouf region. An online questionnaire was distributed to them. Answers were scored on a scale of five (never "1", rarely "2", sometimes "3", often "4", always "5"). The level of their knowledge was determined by calculating the scores. Results There were significant disparities in the answers, with the majority of participants denying the effect of flatfoot on walking (135, 42.9%), running (123, 39%), standing for long periods (186, 59%), or causing tripping. More than half of the participants agreed that flatfoot never affects school activities or participation in clubs or activities after school. However, most participants showed a good attitude toward individuals with flatfoot, as they were not bothered by their way of walking (199, 63.2%) or how their foot or ankle looks (255, 80.9%), and never embarrassed them because of their foot or ankle (266, 84.5%). Most participants agreed that no one has the right to be unkind to them because of their foot or ankle (276, 87.5%). These positive attitudes are likely due to the cultural norms of the community. Conclusion There is a decreased level of awareness about the effects of flatfoot on daily physical activities among the Saudi population in the Al-Jouf region. However, their attitude toward people suffering from flatfoot is highly appreciated. Health education programs are recommended.
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Affiliation(s)
- Amany Elshenawy
- Microbiology, College of Medicine, Jouf University, Sakaka, SAU
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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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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.
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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
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Böhm H, Stebbins J, Kothari A, Dussa CU. Dynamic Gait Analysis in Paediatric Flatfeet: Unveiling Biomechanical Insights for Diagnosis and Treatment. CHILDREN (BASEL, SWITZERLAND) 2024; 11:604. [PMID: 38790599 PMCID: PMC11119624 DOI: 10.3390/children11050604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Flatfeet in children are common, causing concern for parents due to potential symptoms. Technological advances, like 3D foot kinematic analysis, have revolutionized assessment. This review examined 3D assessments in paediatric idiopathic flexible flat feet (FFF). METHODS Searches focused on paediatric idiopathic FFF in PubMed, Web of Science, and SCOPUS. Inclusion criteria required 3D kinematic and/or kinetic analysis during posture or locomotion, excluding non-idiopathic cases, adult feet, and studies solely on pedobarography or radiographs. RESULTS Twenty-four studies met the criteria. Kinematic and kinetic differences between FFF and typical feet during gait were outlined, with frontal plane deviations like hindfoot eversion and forefoot supination, alongside decreased second peak vertical GRF. Dynamic foot classification surpassed static assessments, revealing varied movement patterns within FFF. Associations between gait characteristics and clinical measures like pain symptoms and quality of life were explored. Interventions varied, with orthoses reducing ankle eversion and knee and hip abductor moments during gait, while arthroereisis normalized calcaneal alignment and hindfoot eversion. CONCLUSIONS This review synthesises research on 3D kinematics and kinetics in paediatric idiopathic FFF, offering insights for intervention strategies and further research.
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Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, Treatment Center Aschau im Chiemgau, 83229 Aschau im Chiemgau, Germany
- Faculty of Engineering and Health Göttingen, University of Applied Sciences and Arts, 37077 Göttingen, Germany
| | - Julie Stebbins
- Oxford University Hospitals NHSFT, Oxford OX3 9DU, UK; (J.S.); (A.K.)
| | - Alpesh Kothari
- Oxford University Hospitals NHSFT, Oxford OX3 9DU, UK; (J.S.); (A.K.)
| | - Chakravarthy Ughandar Dussa
- Department of Orthopaedic Trauma and Surgery, Friedrich-Alexander University Erlangen, 91054 Erlangen, Germany;
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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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Galán-Olleros M, Del Baño Barragán L, Figueroa MJ, Prato de Lima CH, Fraga-Collarte M, Torres-Izquierdo B, Hosseinzadeh P, Martínez-Caballero I. Outcomes of the "Calcaneo-stop" procedure for treating symptomatic flexible flatfoot in children: A systematic review and meta-analysis of 2394 feet. Foot Ankle Surg 2024:S1268-7731(24)00084-5. [PMID: 38714453 DOI: 10.1016/j.fas.2024.04.011] [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: 01/19/2024] [Revised: 03/23/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND This study evaluates the efficacy of the calcaneo-stop (C-Stop) procedure's effectiveness in treating symptomatic flexible flatfoot (FFF) in children. METHODS A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane databases to identify studies until 2023 on the outcomes of the C-Stop procedure in children with FFF. The risk of bias was assessed using MINORS criteria. RESULTS Of 85 studies screened, 20 involving 2394 feet from 1415 patients (mean age 11.2 ± 1.3 years) were included. Post-procedure, significant improvements were noted in pain reduction (93.5%), heel alignment (95.21%), and radiological measures, including reductions in Kite (7.32º), Meary (11.65º), Costa-Bartani angles (17.11º), talar declination (12.63º) and increase in Calcaneal Pitch Angle (5.92º). AOFAS scores increased by 22.32 points on average, with 94.83% reporting high satisfaction. Complication rate was low (7.8%). CONCLUSIONS The C-Stop procedure is effective for treating FFF in children, offering significant clinical, radiological, and functional improvements with high patient satisfaction and a low complication rate. LEVEL OF EVIDENCE Level IV, Systematic review of Level-IV studies.
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Affiliation(s)
- María Galán-Olleros
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Laura Del Baño Barragán
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - María Jesús Figueroa
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos H Prato de Lima
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Manuel Fraga-Collarte
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Beltran Torres-Izquierdo
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Pooya Hosseinzadeh
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ignacio Martínez-Caballero
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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12
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Behling AV, Rainbow MJ, Welte L, Kelly L. Chasing footprints in time - reframing our understanding of human foot function in the context of current evidence and emerging insights. Biol Rev Camb Philos Soc 2023; 98:2136-2151. [PMID: 37489055 DOI: 10.1111/brv.12999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
In this narrative review we evaluate foundational biomechanical theories of human foot function in light of new data acquired with technology that was not available to early researchers. The formulation and perpetuation of early theories about foot function largely involved scientists who were medically trained with an interest in palaeoanthropology, driven by a desire to understand human foot pathologies. Early observations of people with flat feet and foot pain were analogized to those of our primate ancestors, with the concept of flat feet being a primitive trait, which was a driving influence in early foot biomechanics research. We describe the early emergence of the mobile adaptor-rigid lever theory, which was central to most biomechanical theories of human foot function. Many of these theories attempt to explain how a presumed stiffening behaviour of the foot enables forward propulsion. Interestingly, none of the subsequent theories have been able to explain how the foot stiffens for propulsion. Within this review we highlight the key omission that the mobile adaptor-rigid lever paradigm was never experimentally tested. We show based on current evidence that foot (quasi-)stiffness does not actually increase prior to, nor during propulsion. Based on current evidence, it is clear that the mechanical function of the foot is highly versatile. This function is adaptively controlled by the central nervous system to allow the foot to meet the wide variety of demands necessary for human locomotion. Importantly, it seems that substantial joint mobility is essential for this function. We suggest refraining from using simple, mechanical analogies to explain holistic foot function. We urge the scientific community to abandon the long-held mobile adaptor-rigid lever paradigm, and instead to acknowledge the versatile and non-linear mechanical behaviour of a foot that is adapted to meet constantly varying locomotory demands.
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Affiliation(s)
- Anja-Verena Behling
- School of Human Movement and Nutrition Science, The University of Queensland, Union Rd, St Lucia, Queensland, 4067, Australia
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Lauren Welte
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Luke Kelly
- School of Human Movement and Nutrition Science, The University of Queensland, Union Rd, St Lucia, Queensland, 4067, Australia
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13
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Tippabhatla A, Torres-Izquierdo B, William M, Pereira D, Meyer Z, Hosseinzadeh P. Is There a Benefit to Rigid Fixation in Calcaneal Lengthening Osteotomy in Painful Pediatric Idiopathic Flatfoot Deformity? Comparing Results of Kirschner Wire Versus Plate Fixation. J Pediatr Orthop 2023; 43:e823-e827. [PMID: 37694614 DOI: 10.1097/bpo.0000000000002514] [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: 09/12/2023]
Abstract
INTRODUCTION Flexible flatfoot (FF) is a common pediatric condition that is mostly asymptomatic, and surgical intervention is only considered when painful FF is refractory to conservative treatment. Calcaneal lengthening osteotomy (CLO) is one of the most commonly used procedures to address painful FF. Traditionally, Kirschner wires (K-wires) were used for fixation, but there has been a recent increase in the use of plates. We compared the clinical and radiographic outcomes of these 2 fixation methods. METHODS This single-center retrospective study included children aged 8 to 18 years with symptomatic FF that received CLO using K-wire or plate fixation. Primary outcomes include weight-bearing radiographic measurements and complications after surgery. Secondary outcomes included patient-reported outcomes. Statistical significance was held at 0.05. RESULTS Among 102 feet (65 patients), 42 feet (41.2%) underwent K-wire and 60 feet (58.8%) underwent plate fixation. No differences in casting duration ( P =0.525) and time-to-radiographic healing ( P =0.17) were noted. Total complications were higher in the plate cohort (12 vs. 2, P =0.04) due to a higher rate of reoperations (16.7%) for hardware-related pain [10 vs. 0; odds ratio 17.74, 95% CI (1.01, 310.54), P <0.05], and infection rates were similar. Both interventions significantly improved ( P ≤ 0.001) aneteroposterior (AP) Talo-first metatarsal and calcaneal pitch angles. Irrespective of intervention, CLO significantly improved pain at 6 months and mobility scores at 12 months. Neither modality demonstrated superior pain or mobility scores at final follow-up. CONCLUSION Both K-wire and plate fixations lead to similar radiographic and functional outcomes after CLO in painful, pediatric flatfeet. Compared with K-wire fixation, plates cause a 17.7-fold increased risk of reoperations for painful hardware, with 16.7% of plated cases requiring reoperation. Noting this, along with the higher costs associated with using plates, our study advocates for K-wire fixation for children undergoing CLO. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Abhishek Tippabhatla
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, MO
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Sorrentino R, Carlson KJ, Orr CM, Pietrobelli A, Figus C, Li S, Conconi M, Sancisi N, Belvedere C, Zhu M, Fiorenza L, Hublin JJ, Jashashvili T, Novak M, Patel BA, Prang TC, Williams SA, Saers JPP, Stock JT, Ryan T, Myerson M, Leardini A, DeSilva J, Marchi D, Belcastro MG, Benazzi S. Morphological and evolutionary insights into the keystone element of the human foot's medial longitudinal arch. Commun Biol 2023; 6:1061. [PMID: 37857853 PMCID: PMC10587292 DOI: 10.1038/s42003-023-05431-8] [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] [Received: 04/08/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
The evolution of the medial longitudinal arch (MLA) is one of the most impactful adaptations in the hominin foot that emerged with bipedalism. When and how it evolved in the human lineage is still unresolved. Complicating the issue, clinical definitions of flatfoot in living Homo sapiens have not reached a consensus. Here we digitally investigate the navicular morphology of H. sapiens (living, archaeological, and fossil), great apes, and fossil hominins and its correlation with the MLA. A distinctive navicular shape characterises living H. sapiens with adult acquired flexible flatfoot, while the congenital flexible flatfoot exhibits a 'normal' navicular shape. All H. sapiens groups differentiate from great apes independently from variations in the MLA, likely because of bipedalism. Most australopith, H. naledi, and H. floresiensis navicular shapes are closer to those of great apes, which is inconsistent with a human-like MLA and instead might suggest a certain degree of arboreality. Navicular shape of OH 8 and fossil H. sapiens falls within the normal living H. sapiens spectrum of variation of the MLA (including congenital flexible flatfoot and individuals with a well-developed MLA). At the same time, H. neanderthalensis seem to be characterised by a different expression of the MLA.
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Affiliation(s)
- Rita Sorrentino
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, 40126, Italy.
| | - Kristian J Carlson
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, WITS 2050, South Africa
| | - Caley M Orr
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Department of Anthropology, University of Colorado Denver, Denver, CO, 80217, USA
| | - Annalisa Pietrobelli
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, 40126, Italy
| | - Carla Figus
- Department of Cultural Heritage, University of Bologna, Ravenna, 48121, Italy
| | - Shuyuan Li
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA
| | - Michele Conconi
- Department of Industrial Engineering, Health Sciences and Technologies, Interdepartmental Centre for Industrial Research (HST-ICIR), University of Bologna, Bologna, 40136, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering, Health Sciences and Technologies, Interdepartmental Centre for Industrial Research (HST-ICIR), University of Bologna, Bologna, 40136, Italy
| | - Claudio Belvedere
- Laboratory of Movement Analysis and Functional Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mingjie Zhu
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA
| | - Luca Fiorenza
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC, 3800, Australia
| | - Jean-Jacques Hublin
- Chaire Internationale de Paléoanthropologie, CIRB (UMR 7241-U1050), Collège de France, Paris, France
- Max Planck Institute for Evolutionary Anthropology, Leipzig, 04103, Germany
| | - Tea Jashashvili
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
- Department of Geology and Paleontology, Georgian National Museum, Tbilisi, 0105, Georgia
| | - Mario Novak
- Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, 10000, Croatia
| | - Biren A Patel
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, 90089, USA
| | - Thomas C Prang
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Scott A Williams
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, WITS 2050, South Africa
- Center for the Study of Human Origins, Department of Anthropology, New York University, New York, 10003, USA
- Centre for the Exploration of the Deep Human Journey, University of the Witwatersrand, Johannesburg, Wits, 2050, South Africa
| | - Jaap P P Saers
- Naturalis Biodiversity Center, 2333, CR, Leiden, the Netherlands
| | - Jay T Stock
- Department of Anthropology, Western University, London, Ontario, N6A 3K7, Canada
| | - Timothy Ryan
- Department of Anthropology, The Pennsylvania State University, State College, PA, 16802, USA
| | - Mark Myerson
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA
| | - Alberto Leardini
- Laboratory of Movement Analysis and Functional Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jeremy DeSilva
- Department of Anthropology, Dartmouth College, Hanover, NH, 03755, USA
| | - Damiano Marchi
- Centre for the Exploration of the Deep Human Journey, University of the Witwatersrand, Johannesburg, Wits, 2050, South Africa
- Department of Biology, University of Pisa, Pisa, 56126, Italy
| | - Maria Giovanna Belcastro
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, 40126, Italy
| | - Stefano Benazzi
- Department of Cultural Heritage, University of Bologna, Ravenna, 48121, Italy
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Xie HG, Chen L, Geng X, Wang C, Zhang C, Wang X, Huang J, Ma X. Mid-term assessment of subtalar arthroereisis with Talar-Fit implant in pediatric patients with flexible flatfoot and comparing the difference between different sizes and exploring the position of the inserted implant. Front Pediatr 2023; 11:1258835. [PMID: 37849498 PMCID: PMC10577167 DOI: 10.3389/fped.2023.1258835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Background Subtalar arthroereisis (STA) has gained growing acceptance as a viable approach solution for the management of pediatric flexible flatfoot. However, STA still remains controversial. The purpose of this study is to assess the effect of STA using the Talar-Fit implant for treating pediatric flexible flatfoot. Specifically, the aims of the study are as follows: first, to present the mid-term outcomes of STA using the Talar-Fit implant; second, to compare the radiographic and clinical outcomes associated with varying sizes of Talar-Fit implant; and third, to analyze the optimal position of the inserted implants. Methods A retrospective analysis was conducted on a cohort of 57 pediatric patients diagnosed with flexible flatfoot (77 feet) who underwent STA utilizing Talar-Fit between January 2014 and December 2021. The participants were categorized into five groups according to the size of the implant: Group 8, Group 9, Group 10, Group 11, and Group 12. The evaluation included the assessment of clinical function using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, as well as the assessment of radiographic data such as the calcaneal pitch angle (CPA), lateral Meary angle (LMA), talar declination angle (TDA), and medial longitudinal arch angle (MLAA) were evaluated. Furthermore, the position of the inserted implants was also recorded, including angle, depth, and distance. The comparison of pre- and postoperation was conducted using the paired Student's t-test, whereas the analysis of differences among subgroups was performed using the Wilcoxon rank-sum test. A P-value < 0.05 is considered statistically significant. Results In total, 57 pediatric patients (77 feet) were successfully followed-up for an average period of 26.8 months. The overall AOFAS score significantly improved from 58.6 ± 10.9 to 85.2 ± 8.6 (P < 0.001). Furthermore, the LMA decreased from 20.3° ± 3.6° to 4.5° ± 1.3°, the CPA increased from 14.8° ± 1.6° to 23.6° ± 2.7°(P < 0.05), the TDA decreased from 40.2° ± 2.3° to 25.5° ± 3.2°(P < 0.05), and the MLAA decreased from 140.1° ± 2.8° to 121.4° ± 3.9°(P < 0.05). No statistically significant differences were observed among subgroups regarding the final outcomes. The improvements of CPA, TDA, and MLAA among different groups were significantly different; however, the adjusted P-values were all greater than 0.05. The implant were inserted at a mean angle of 89.5° ± 2.4°, a mean depth of 0.9 mm ± 2.1 mm, and a mean distance of 9.9 mm ± 0.9 mm. Eight patients experienced complications, including six cases of pain occurrence and two cases of implant dislocation. Conclusion STA with Talar-Fit has demonstrated satisfactory mid-term outcomes. A Talar-Fit with a larger size may demonstrate a superior effect when compared with that of a smaller size. The implants were inserted in a similar position, indicating that the medial edge of the implant may be possible to transcend the midline of the talus neck.
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Affiliation(s)
| | | | | | | | | | | | | | - Xin Ma
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Biz C, Cerchiaro M, Mori F, Rossin A, Ponticiello M, Crimì A, Ruggieri P. Flatfoot over the centuries: the background of current conservative and operative treatments. INTERNATIONAL ORTHOPAEDICS 2023; 47:2357-2368. [PMID: 37222816 PMCID: PMC10439239 DOI: 10.1007/s00264-023-05837-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE Although flatfoot is a widespread human condition, historical medical texts and ancient illustrations on this deformity are extremely rare. Nowadays, doubts regarding its management remain unsolved. This historical review aims to identify the presence of pes planus since the prehistoric era and examine the treatments proposed over the centuries up to the present. METHOD For this propose, we performed an extensive electronic search of the relevant literature, complemented by a manual search of additional sources from archaeological to artistic, literary, historical, and scientific accounts, describing flatfoot and its treatment in different eras. RESULTS Flatfoot accompanied the evolutionary timeline of human species: from Lucy Australopithecus to Homo Sapiens. It was described among various diseases suffered by Tutankhamun (1343-1324 B.C.), while the first anatomical description dates to Emperor Trajan (53-117 A.D.) and the medical studies of Galen (129-201 A.D.). It was also represented in the anatomical drawings of Leonardo da Vinci (1452-1519) and Girolamo Fabrici d'Acquapendente (1533-1619). Historically, the conservative treatment by insoles was the only one proposed until the nineteenth century. Since then, the most popular surgical procedures performed for correction have been osteotomies, arthrodesis, arthrorisis, and tendon lengthening and transfer. CONCLUSION During the centuries, conservative therapeutic strategies have not radically changed in their substance, while operative ones have become the protagonists during the twentieth century up to the present. Nevertheless, after more than 2000 years of history, there is no consensus regarding the best indication for the flatfoot and if it really needs to be treated.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Mariachiara Cerchiaro
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Fabiana Mori
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Alessandro Rossin
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Mattia Ponticiello
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Alberto Crimì
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Via Giustiniani 2, 35128 Padua, Italy
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Karatekin YS, Altinayak H, Karatekin Ş, Karadağ H, Usta E, Karaismailoğlu B, Seker A. Exploration of Flexible Pes Planus as a Potential Risk Factor for Cardiac Pathologies in Pediatric Cases. Cureus 2023; 15:e46139. [PMID: 37779679 PMCID: PMC10538805 DOI: 10.7759/cureus.46139] [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: 09/28/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE The aim of this study is to investigate the relationship between flexible pes planus (FPP) and cardiac pathologies in pediatric patients, with a particular emphasis on hypermobility status. METHODS Between January and June 2022, a retrospective screening was conducted on a total of 68 patients aged between 6 and 18 years who had been diagnosed with FPP. Eight patients were excluded from the study due to suspicion of connective tissue or neuromuscular diseases following systemic examinations conducted by a pediatric specialist. The included 60 patients underwent comprehensive cardiac examinations conducted by pediatric cardiology specialists and were evaluated through echocardiography (ECHO) as part of the study. Simultaneously, a control group of healthy individuals aged 6 to 18, without a diagnosis of pes planus (PP), was selected from those who applied for health reports for the purpose of obtaining sports licenses. Patients diagnosed with FPP were compared to a control group in terms of the presence of cardiac pathology. Furthermore, the Beighton Hypermobility Scores (BHSs) of patients diagnosed with FPP were compared based on the presence of cardiac pathology. RESULTS A total of 60 patients (40 males, 20 females) diagnosed with FPP were included in the study, and a control group consisting of 453 healthy individuals (287 males, 166 females) was selected. The incidence of cardiac pathology in patients diagnosed with FPP (23.3%) was found to be significantly higher compared to the control group (7%) (p <0.01). The risk of cardiac pathology in patients diagnosed with FPP was determined to be four times higher compared to the control group (Odds ratio: 4 (1.993-8.046), p<0.01). Among patients with FPP, individuals who were found to have cardiac pathology had statistically significantly higher average BHSs compared to those without cardiac pathology (p: 0.043). CONCLUSIONS Our study suggested that there may be a significant relationship between FPP and high cardiac pathology risk in pediatric patients. We observed a significant increase in the incidence of cardiac pathologies among patients diagnosed with FPP. Additionally, the presence of higher hypermobility scores among patients diagnosed with FPP suggests a potential connection between the two. In the evaluation of FPP in the pediatric population, it should be considered as a potential risk factor for cardiac pathologies and its potential association with hypermobility.
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Affiliation(s)
| | - Harun Altinayak
- Orthopaedics and Traumatology, Samsun Training and Research Hospital, Samsun, TUR
| | - Şeyma Karatekin
- Pediatrics, Faculty of Medicine, Samsun University, Samsun, TUR
| | - Hüseyin Karadağ
- Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Emre Usta
- Pediatric Cardiology, Faculty of Medicine, Samsun University, Samsun, TUR
| | - Bedri Karaismailoğlu
- Orthopaedics and Traumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, TUR
| | - Ali Seker
- Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, TUR
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18
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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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Silva BAMDA, Silva NADA, Vasconcelos JB. MODIFIED MUBARAK TECHNIQUE FOR FLEXIBLE FLATFOOT CORRECTION IN CHILDREN AND ADOLESCENTS. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e265045. [PMID: 37547233 PMCID: PMC10399999 DOI: 10.1590/1413-785220233104e265045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/19/2022] [Indexed: 08/08/2023]
Abstract
Objective To describe the technique, analyze possible radiographic correction and evaluate the clinical result of medial and plantar calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy for flexible flatfoot correction. Methods 23 patients (30 feet) diagnosed with flexible flat foot treated with plantar and medial calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy were evaluated retrospectively. In the lateral radiographs calcaneal pitch and Meary's angle were the radiographic parameters evaluated; while the talonavicular coverage angle was evaluated in the anteroposterior radiographs. To assess the clinical outcome of the surgical procedure, the American Orthopedic Foot and Ankle Society Score (AOFAS) for the ankle and hindfoot was adopted. Results The mean values of the evaluated angles and AOFAS score for ankle and hindfoot significantly improved when comparing pre- and postoperative values. Conclusion Plantar and medial calcaneal displacement osteotomy associated with an opening wedge cuboid osteotomy is able to improve radiological and clinical parameters of child patients with flexible flatfoot. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
- Bruno Air Machado DA Silva
- Hospital de Urgencias de Aparecida de Goiania, Goiania, GO, Brazil
- Instituto Ortopedico de Goiania, Goiania, GO, Brazil
| | - Nilzio Antônio DA Silva
- Universidade Federal de Goiania, Escola de Medicina, Departamento de Reumatologia, Goiania, GO, Brazil
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Sakr SAH, Zayda AI, Mesregah MK, Abosalem AA. Tibialis anterior rerouting combined with calcaneal lengthening osteotomy as a single-stage reconstruction of symptomatic flexible flatfoot in children and adolescents. J Orthop Surg Res 2023; 18:429. [PMID: 37312166 PMCID: PMC10262376 DOI: 10.1186/s13018-023-03890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Symptomatic flexible flatfoot in children and adolescents should be surgically managed only if conservative measures have failed. The aim of this study was to assess functional and radiological results of tibialis anterior rerouting combined with calcaneal lengthening osteotomy as s single-stage reconstruction of symptomatic flexible flatfoot. METHODS The current study was a prospective study of patients with symptomatic flexible flatfoot treated by single-stage reconstruction in the form of tibialis anterior tendon rerouting combined with calcaneal lengthening osteotomy. The American Orthopaedic Foot and Ankle Society score (AOFAS) was utilized to evaluate the functional outcomes. The evaluated radiological parameters included the standing anteroposterior (AP) and lateral talo-first metatarsal angle, talar head coverage angle, and calcaneal pitch angle. RESULTS The current study included 16 patients (28 feet) with a mean age of 11.6 ± 2.1 years. There was a statistically significant improvement in the mean AOFAS score from 51.6 ± 5.5 preoperatively to 85.3 ± 10.2 at final follow-up. Postoperatively, there was a statistically significant reduction in the mean AP talar head coverage angle from 13.6 ± 4.4° to 3.9 ± 3°, the mean AP talo-first metatarsal angle from 16.9 ± 4.4° to 4.5 ± 3.6°, and the mean lateral talo-first metatarsal angle from 19.2 ± 4.9° to 4.6 ± 3.2°, P < 0.001. Additionally, the mean calcaneal pitch angle increased significantly from 9.6 ± 1.9° to 23.8 ± 4.8°, P < 0.001. Superficial wound infection occurred in three feet and was treated adequately by dressing and antibiotics. CONCLUSION Symptomatic flexible flatfoot in children and adolescents can be treated with combined lateral column lengthening and tibialis anterior rerouting with satisfactory radiological and clinical outcomes. Level of evidence Level IV.
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Affiliation(s)
- Samy Abdel-Hady Sakr
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Ahmed Ibrahim Zayda
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt.
| | - Ahmed Abdelazim Abosalem
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
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Vergillos Luna M, Khal AA, Milliken KA, Solla F, Rampal V. Pediatric Flatfoot: Is There a Need for Surgical Referral? J Clin Med 2023; 12:jcm12113809. [PMID: 37298004 DOI: 10.3390/jcm12113809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Pediatric foot deformities are a common finding, concerning up to 44% of preschool aged children. The absence of accepted international guidelines, as well as heterogeneity in definitions and measurements, makes management of pediatric flatfoot a challenge, and decisions surrounding specialized care referral confusing and biased. The objective of this narrative review is to provide guidance to primary care physicians treating these patients. A non-systematic review of the literature regarding the development, etiology, and clinical and radiographic assessment of flatfeet using the PubMed and Cochrane Library databases was performed. The exclusion criteria for the review were adult populations, papers detailing the outcome of a specific surgical procedure, and publications prior to 2001. The included articles showed great heterogeneity in definition and proposed management, which makes the study of pediatric flatfoot challenging. Flatfoot is a common finding in children under 10 years old, and should not be considered pathological unless stiffness or functional limitation are present. Surgical referral should be reserved to children with stiff or painful flatfoot, while simple observation is indicated for flexible, asymptomatic flatfeet.
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Affiliation(s)
- Manuel Vergillos Luna
- Department of Orthopedics, Regina Montis Regalis Hospital, 12084 Mondovì, Italy
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Adyb-Adrian Khal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Kara A Milliken
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Federico Solla
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Virginie Rampal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
- Laboratoire Motricité Humaine Expertise Sport Santé, Unité de Formation et Recherche Sciences et Techniques des Activités Physiques et Sportives, 06205 Nice, France
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Inarejos Clemente EJ, Aparisi Gómez MP, Catala March J, Restrepo R. Ankle and Foot Deformities in Children. Semin Musculoskelet Radiol 2023; 27:367-377. [PMID: 37230135 DOI: 10.1055/s-0043-1766099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Ankle and foot deformity is one of the most common musculoskeletal disorders in children and a leading cause of functional impairment and diminished quality of life when not treated. A spectrum of conditions may produce foot and ankle deformities, with congenital disorders the most frequent cause, followed by acquired conditions. Congenital disorders include congenital talipes equinovarus or congenital clubfoot, metatarsus adductus, skewfoot, congenital vertical talus, and tarsal coalition.Some of these deformities are frequent and easily diagnosed based on clinical features, but clinical overlap between pathologies can be challenging. Thus imaging plays a paramount role in evaluating these patients. Radiographs are the first imaging modality of choice, but they may not be sufficient in infants due to the lack of ossification of the tarsal bones. Ultrasonography allows not only a detailed visualization of the cartilaginous structures but also permits a dynamic study of the foot and ankle. Computed tomography may be necessary in certain conditions such as tarsal coalitions.
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Affiliation(s)
| | | | | | - Ricardo Restrepo
- Department of Diagnostic Imaging, Nicklaus Children's Hospital, Miami, Florida
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Ali AA, Mohammed Ibrahim AEM, Ismail MA. Comparativestudy between the calcaneo stop procedure and endorthesis in the management of pediatric symptomatic flexible flatfoot. EGYPTIAN ORTHOPAEDIC JOURNAL 2023; 57:314-325. [DOI: 10.4103/eoj.eoj_53_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Kim JY, Kim SA, Kim Y, Hwang I, Heo NH. Radiologic changes of long term foot insole use in symptomatic pediatric flatfoot. Medicine (Baltimore) 2023; 102:e33152. [PMID: 36897708 PMCID: PMC9997835 DOI: 10.1097/md.0000000000033152] [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: 07/17/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
Clinically, flatfoot, known as pes planus, is quite prevalent. It is classified into 2 types: flexible and rigid, both of which may or may not have symptoms. If a flexible flatfoot is symptomatic, it must be treated to prevent subsequent complications. In principle, most physicians initially use conservative methods, such as foot insoles. This study aimed to demonstrate the effect of long term use of a foot insole using plain radiography as an objective measurement in children with symptomatic flexible flatfoot (SFFF) in large samples. This study analyzed the medical records of 292 children aged < 18 years who were diagnosed with SFFF. Of these, 200 children (62 boys and 138 girls, mean age: 6.49 ± 2.96 years) were selected and conservatively treated with foot insoles. They were periodically followed up within 3 to 4 months to modify the foot insole and perform radiologic evaluations, such as foot radiography. The calcaneal pitch angle (CPA) and talo first metatarsal angle were measured and compared individually using foot lateral radiographs, which were pictured in a bilateral barefoot state. The treatment was terminated by repeating the same procedure until the symptoms disappeared. A significant improvement (P < .001) was observed in the radiological indicators, both CPA and talo first metatarsal angle, regardless of age, after the application of soft foot insoles. However, the right foot CPA in the group with valgus deformity was an exception (P = .078). This study showed that in children diagnosed with SFFF under 18 years of age, wearing a periodically revised foot insole as conservative treatment could not only decrease the symptoms, but also improve the radiologic indices.
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Affiliation(s)
- Joon Yeop Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Soo A Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Yuntae Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Insu Hwang
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
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Böhm H, Dussa CU. Clinical, Radiographic and Gait Parameters Associated with Medial Arch Pain in the Flexible Pediatric Flatfoot. J Foot Ankle Surg 2023:S1067-2516(23)00013-3. [PMID: 36822970 DOI: 10.1053/j.jfas.2023.01.008] [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: 08/14/2020] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 02/25/2023]
Abstract
Pain in the flexible flatfoot is a common complaint, if present it is important to find its exact location and causes Therefore, the study aimed to find differences between children with and without medial arch pain and relate them to the reduction of pain following surgical treatment. Children with idiopathic flexible flatfeet were retrospectively included in the study. All children underwent a clinical, radiographic, and gait examination. The feet were subdivided into 2 groups: asymptomatic and those with medial arch pain. Factors associated with medial arch pain were identified via t test. Significant radiological and gait parameters were correlated to the change in medial arch pain score following surgery. Included were 322 feet belonging to 177 children, with the mean age of 11.8 (SD = 2.2) years. The pain was perceived in 52% of the feet, of these, 74% in the medial arch. In the group with pain, 31 feet received a gait analysis following surgery. The radiological parameters, talus-1 and -2 metatarsal angles and the gait parameter, calcaneal lateral shift during walking showed a significant difference (p ≤ .004) between the no pain and pain groups and were associated (R2 ≥0.14, p ≤ .04) with the reduction in pain following surgery. The increased talus-1 and -2 metatarsal angles and the calcaneal lateral shift may cause increased tension on the soft-tissues along the medial side of the foot and may produce pain. Therapies aiming at improving the medial arch pain should be directed to normalize the talus-1 or -2 metatarsal angles and the calcaneal lateral shift.
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Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, KIZ Chiemgau GmbH, Aschau im Chiemgau, Germany; Centre for Healthcare Technology, PFH- Private University Göttingen, Göttingen, Germany.
| | - Chakravarthy U Dussa
- Orthopaedic Hospital for Children, KIZ Chiemgau GmbH, Aschau im Chiemgau, Germany; Department of Orthopaedic Trauma and Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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Blümel S, Stephan A, Stadelmann VA, Manner HM, Velasco R. Percutaneous minimal invasive Achilles tendon lengthening improves clinical and radiographic outcomes in severe flexible flatfeet with shortened triceps sureae complex in early childhood: A retrospective study. Foot Ankle Surg 2023; 29:158-164. [PMID: 36566121 DOI: 10.1016/j.fas.2022.12.009] [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: 08/02/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Severe flexible flatfeet with triceps surae complex shortening are prognostically unfavorable in early childhood and may compromise normal foot development. METHODS This retrospective, IRB-approved study included 20 children (38 feet) under 6 years with severe flexible flatfeet and triceps surae complex shortening. Treatment included minimally invasive percutaneous achilles tendon lengthening followed by a 4-week cast fixation and corrective orthotic therapy under talo-navicular reposition for at least 6-months. Preoperative weightbearing x-rays and at the last available follow-up included anteroposterior talus-first metatarsal angle and lateral talus pitch, Meary's and talocalcaneal angle and were compared to reference values. ROM, surgeon-rated clinical outcomes and complications/re-interventions were evaluated. RESULTS Age at surgery was 3.7 years (1.3-5.9 y) and follow-up time was 4.3 years (1.1-8.9 y). No complications occurred. Clinical outcome was good (68 %) to very good (26 %). Ratio of normal angles increased significantly for three angles. Dorsiflexion ROM improved from -5.0 ± 6.8° at baseline to 15.7 ± 7.6°. CONCLUSIONS With significant improvements in clinical and radiographic outcomes, minimal-invasive percutaneous Achilles tendon lengthening followed by orthotic therapy seems to be a valuable treatment option for selected preschool-aged patients with severe, flexible flatfeet with significantly shortened triceps surae. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stefan Blümel
- Department of Pediatric Orthopaedics, Schulthess Klinik, Zürich, Switzerland.
| | - Anika Stephan
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland.
| | - Vincent A Stadelmann
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland.
| | - Hans M Manner
- Department of Pediatric Orthopaedics, Schulthess Klinik, Zürich, Switzerland.
| | - Rafael Velasco
- Department of Pediatric Orthopaedics, Schulthess Klinik, Zürich, Switzerland.
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Impact of night orthotic managements on gastroc-soleus complex tightness in pediatric with flexible flatfoot: Systematic review. Prosthet Orthot Int 2023; 47:112-116. [PMID: 36791382 DOI: 10.1097/pxr.0000000000000150] [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] [Received: 08/06/2021] [Accepted: 03/14/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Equinus generally is linked to many foot and ankle pathologies. A reasonably convincing relationship was found between isolated gastrocnemius or Achilles contracture and the flatfoot deformity. Achilles' tightness in flatfoot children can lead to future pain and disability, which makes it more important than other types of flatfeet. Findings in the literature suggest stretching and orthotic management as a conservative treatment for this compound disorder. OBJECTIVE This review aimed to examine the impact of orthotic managements on gastroc-soleus complex tightness in pediatric with flexible flatfoot. STUDY DESIGN Systematic review. METHODS A systematic search of electronic databases (PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science) was performed to find relevant articles. The level of evidence and quality was identified using Downs and Black (1998). This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS Three hundred fifty-seven studies were found by searching electronic databases. After removing duplicate documents, 190 documents remained. Three other articles were identified from the screened of related references. During title/abstract screening, 193 studies were excluded and no study was selected for full consideration for the present review. CONCLUSIONS In conclusion, no study assessed the impact of orthotic management on gastroc-soleus complex tightness in children with flexible flatfoot. These devices have been proposed in spastic and nonspastic patients. Hence, researches that show whether these devices can be effective on gastrocnemius or Achilles tendon tightness in flatfoot children or not will be worthwhile.
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Ikuta Y, Nakasa T, Sumii J, Nekomoto A, Adachi N. Radiographic foot alignment and morphological features of deltoid ligament in pediatric patients with medial osteochondral lesions of the talus. J Pediatr Orthop B 2023; 32:39-46. [PMID: 36445374 DOI: 10.1097/bpb.0000000000001027] [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: 11/30/2022]
Abstract
The cause of osteochondral lesions of the talus (OLT) in patients without a history of trauma remains unclear, and almost all nontraumatic lesions appear to involve the medial talar dome. This study aimed to investigate the relationship between foot alignment, deltoid morphology, and medial OLT in pediatric patients. In total, 28 patients (31 feet) with medial OLT (17 boys, 11 girls, mean age: 14.9 years), and 50 patients without OLT (50 feet, 31 boys, 19 girls, mean age: 14.5 years) were included in this study. The OLT patients were subdivided into traumatic and nontraumatic groups. Radiographic parameters of the foot arch were measured on weight-bearing lateral images. The extent of the OLT was measured on computed tomographic images. The ratio of deep deltoid attachment length of the talus to talar height was examined as deltoid ligament position index (DPI) on coronal magnetic resonance imaging. Nontraumatic medial lesions were frequently observed in pediatric patients (54.8%) compared to traumatic lesions. The depression of the foot arch was commonly identified in pediatric patients with resistant medial lesions. The lesion size was moderately correlated with DPI (rho = 0.48; P = 0.0086). The attachment of the deep deltoid ligament to the medial talar dome was located more proximally in nontraumatic lesions than in traumatic lesions and the control group. Our findings suggest that a combination of foot alignment and the anatomic variations in the attachment of the deep deltoid ligament contributes to the incidence of nontraumatic medial OLT in the pediatric population. Level of evidence: level IV.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
- Sports Medical Center, Hiroshima University Hospital
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
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ÜNVER B, TAŞKIRAN H, AKGÖL AC. Foot Muscle Strength, Muscle Shortness, Balance, and Shoe Preferences in Different Foot Postures. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.714950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: The aim of this study was to investigate the foot muscle strength, muscle shortness, tibialis posterior endurance, balance, and the shoe preference differences between the neutral and pronated foot posture.
Methods: Forty-nine participants consisting of 23 women and 26 men, and age of between 18 and 45 years were participated in the study. Foot posture, medial longitudinal arch height, height, gastrocnemius and hamstring muscle shortness, foot and ankle muscle strength, tibialis
posterior muscle endurance, static balance, and shoe preferences of the participants were evaluated. Subjects were recruited into two groups according to their foot posture evaluated with Foot Posture Index: as those with neutral and pronated foot posture.
Results: Navicular drop, gastrocnemius, and hamstring muscle shortness were significantly higher in participants with pronated foot posture compared to those with neutral foot (p0.05).
Conclusion: Flexibility of gastrocnemius and hamstring muscles were reduced, but foot muscle strength, tibialis posterior muscle endurance, and balance remained unaffected in young individuals with excessive foot pronation. Moreover, shoe preferences may not affect the foot posture in young people. Although all age-related biomechanical effects of foot pronation are not well known yet, muscle shortness seems to arise earlier than muscle weakness and reduced balance in pronated foot posture
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Aparisi Gómez MP, Bazzocchi A, Simoni P, Inarejos Clemente EJ. Postsurgical Evaluation of the Pediatric Foot and Ankle. Semin Musculoskelet Radiol 2022; 26:755-776. [PMID: 36791743 DOI: 10.1055/s-0042-1760244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This article reviews situations in which surgical treatment is required in the context of different types of pathology in the foot and ankle of children, focusing on the role of imaging in surgical planning and postsurgical assessment. The types of pathology analyzed from this perspective are congenital pathology, neuromuscular disorders, osteochondral lesions, fractures and infection, ligament injuries, and tumors.We address the most common pitfalls of postsurgical imaging of the ankle and foot in children. With some exceptions, postsurgical follow-up focuses on clinical assessment, with imaging follow-up only needed in patients where complications are suspected or symptoms recur. Postoperative assessment of the foot and ankle in children and adolescents requires knowing the indications for surgery and the most common types of interventions, along with their imaging characteristics. The radiologist needs to be aware of the normal sequence of development of structures and how to select adequate imaging techniques to assess anatomy at various stages or in different postsurgical scenarios.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology. IMSKE, València, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Simoni
- Diagnostic Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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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.
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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.
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Torrez TW, Kothari EA, Andrews N, Seidenstein AH, Strom S, McGwin G, Gilbert SR, Shah A, Doyle JS, Conklin MJ. Analysis of risk factors for nonunion in pediatric lateral column lengthening. J Pediatr Orthop B 2022:01202412-990000000-00057. [PMID: 36445378 DOI: 10.1097/bpb.0000000000001026] [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: 11/30/2022]
Abstract
The lateral column lengthening procedure is a commonly used osteotomy for correction of pes planus performed by inserting a graft in the anterior aspect of the calcaneus through a transverse osteotomy. Though nonunion and calcaneo-cuboid subluxation have been previously reported, these complications have not been extensively studied in pediatric patients. After IRB approval, 111 patients (151 feet) who underwent lateral column lengthening at a single institution were identified. Fifty-three females (70 feet) and 58 males (81 feet) with an average age of 11.4 years (2.6 SD; range 5-17) were analyzed. The primary outcome was nonunion defined as a lack of radiographic evidence of osteotomy healing by 9 months. Underlying diagnosis, pre and postoperative radiographic measurements, age, operative technique, fixation, calcaneo-cuboid subluxation, graft material and concomitant procedures were analyzed for their relationship to nonunion. Nonunion occurred in 7 of 151 feet (4.6%). Patient age at the time of surgery and calcaneo-cuboid subluxation trended toward a significant association with nonunion ( P = 0.053, 0.054, respectively). The degree of surgical correction, as determined by radiographic analysis, and the use of calcaneo-cuboid fixation were not significantly associated with nonunion. None of the other factors evaluated were significantly associated with nonunion. There were three cases of postoperative infections (2.0%), two were superficial and 1 (0.7%) was deep. Thirty-five of 151 feet disclosed radiographic evidence of subluxation. Excluding subluxation, the overall complication rate was 8.6%. Nonunion occurred in 4.6% of pediatric feet undergoing lateral column lengthening. Fixation type was not significantly associated with nonunion. Older age at the time of surgery and calcaneocuboid subluxation trended towards significance. The placement of a calcaneo-cuboid pin was not found to be a significant factor in preventing calcaneo-cuboid subluxation or nonunion.
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Affiliation(s)
- Timothy W Torrez
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Ezan A Kothari
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicholas Andrews
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | | | - Shane Strom
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald McGwin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shawn R Gilbert
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - John S Doyle
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J Conklin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Li J, Yang Z, Rai S, Li X, Jiang G, Pan X, Tang X. Effect of Insoles Treatment on School-Age Children with Symptomatic Flexible Flatfoot: A 2-Year Follow-Up Study. Indian J Orthop 2022; 56:1985-1991. [PMID: 36310549 PMCID: PMC9561439 DOI: 10.1007/s43465-022-00698-1] [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: 11/28/2021] [Accepted: 07/02/2022] [Indexed: 02/04/2023]
Abstract
Background Flatfoot is common among children. Symptomatic flexible flatfoot is one of the various types which needs treatment. Wearing insoles is considered one of the conservative therapies, but its effects are still uncertain. This study aims to provide evidence for the efficacy of insoles treatment among school-aged children with symptomatic flexible flatfoot. Methods Patient who were Children who were diagnosed with symptomatic flexible flatfoot and received insoles treatment in authors' institute were retrospectively included. Their ages, body mass index, pain positions, pain frequency, valgus angle, arch index and visual analogue scale (VAS) score were collected before and after insole treatment. Results A total of 32 children were included in this study. The results showed that wearing insoles for 2 years caused a significant improvement in pain frequency, valgus angle, arch index and VAS score. Conclusions This study indicated that pediatric symptomatic flexible flatfoot could be relieved by wearing insoles for 2 years. Insole treatment might be a workable option for pediatric symptomatic flexible flatfoot in children older than 6 years old.
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Affiliation(s)
- Jin Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Zimo Yang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, National Academy of Medical Sciences, Mahankal, Kathmandu, 44600 Nepal
| | - Xiangrui Li
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Guoyong Jiang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Xiaofei Pan
- Shafeile Rehabilitation Devices Co Ltd, Wuhan, 430000 China
| | - Xin Tang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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Tian F, Wang J, Liu C, Li Y, Liang X, Wang X. Medial column reinforcement for the correction of flatfoot deformity with accessory navicular bone. Am J Transl Res 2022; 14:6368-6374. [PMID: 36247284 PMCID: PMC9556485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical effects of reinforcement of the medial column in the treatment of flatfoot deformity with accessory navicular bone. METHODS A retrospective analysis of 32 patients (46 feet) of flatfoot deformity with accessory navicular bone were reviewed. All patients underwent the reinforcement of their medial column in the midfoot, mainly including spring ligament repair, posterior tibial tendon reconstruction, and cotton osteotomy. Clinical evaluation adopted American Orthopaedic Foot and Ankle Society (AOFAS) score and pain visual analogue scale (VAS) was used to evaluate foot function and pain. Radiographic evaluation was performed, and Meary's angle, calcaneal pitch angle, talonavicular coverage angle (TCA), talar 2th metatarsal angle (T2MT) and calcaneal valgus angle (CVA) were measured. RESULTS All patients were followed up for an average duration of 24.3±3.6 months. At the final follow-up, the patient's foot pain was relieved and the foot deformity was improved. The data indicated that the mean functional AOFAS score was significantly improved and the mean VAS score was significantly decreased postoperatively at final follow-up. Additionally, Meary's angle, TCA, T2MT and CVA were all significantly decreased, and calcaneal pitch angle was significantly increased after surgery. CONCLUSION We found that reinforcement of the medial column can effectively maintain medial longitudinal arch, correct flatfoot deformity with accessory navicular bone.
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Affiliation(s)
- Feng Tian
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Junhu Wang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Cheng Liu
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Yi Li
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Xiaojun Liang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Xinwen Wang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
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Herdea A, Neculai AG, Ulici A. The Role of Arthroereisis in Improving Sports Performance, Foot Aesthetics and Quality of Life in Children and Adolescents with Flexible Flatfoot. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070973. [PMID: 35883957 PMCID: PMC9323989 DOI: 10.3390/children9070973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
Abstract
Flexible flatfoot represents one of the most common deformities of the lower limb, affecting children and adolescents. Aesthetic aspect, abnormal gait, pain and fatigue are by far the most important symptoms which determine parents to bring their children to the orthopedist. We set out to conduct a prospective study, case-controlled, including patients with symptomatic flexible flatfeet operated on by arthroereisis surgery and comparing them to a normal feet group of children age- and sex-matched (control group). Minimum follow-up time was 2 years. In total, 33 patients with bilateral arthroereisis were included and 36 patients formed the control group (12.12 +/− 1.85 years vs. 11.81 ± 2.40 years, p = 0.54). Quality of life improved postoperatively (p = 0.18) and was not different from the control group. Median running time improved postoperatively by 2.25 s (p < 0.0001) and got closer to the median running time from the control group (22.30 s compared to 20.94 s, p = 0.01). All radiological angles improved (p < 0.0001), but quality of life improvement was correlated with talonavicular coverage angle and Meary angle measurements. Flatfoot in children and adolescents may be a condition in which the quality of life and sports performance are decreased, compared to healthy children. Arthroereisis is a minimally invasive surgical procedure with a short recovery time and a short period before resumption of sport activities, which can be useful in certain types of flexible flatfoot due to its effectiveness on symptom reduction.
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Affiliation(s)
- Alexandru Herdea
- 11th Department of Pediatric Orthopedics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Pediatric Orthopedics Department, Grigore Alexandrescu Children’s Emergency Hospital, 011743 Bucharest, Romania;
| | - Adrian-Gabriel Neculai
- Pediatric Orthopedics Department, Grigore Alexandrescu Children’s Emergency Hospital, 011743 Bucharest, Romania;
| | - Alexandru Ulici
- 11th Department of Pediatric Orthopedics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Pediatric Orthopedics Department, Grigore Alexandrescu Children’s Emergency Hospital, 011743 Bucharest, Romania;
- Correspondence: ; Tel.: +40-0723188988
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Squibb M, Sheerin K, Francis P. Measurement of the Developing Foot in Shod and Barefoot Paediatric Populations: A Narrative Review. CHILDREN 2022; 9:children9050750. [PMID: 35626927 PMCID: PMC9139892 DOI: 10.3390/children9050750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022]
Abstract
The theory that footwear may change foot shape dates back 100 years. Since this period, research has revealed the anatomical and functional consequences that footwear can cause to the foot. Children’s feet remain malleable as they undergo developmental changes until adolescence, which is why childhood is arguably a crucial period to understand how footwear can affect natural foot development. This review explored the development of the foot in children and adolescents and the methods used to measure the different foot structures; it comments on the key issues with some of these methods and gives direction for future research. Various internal and external factors can affect foot development; the main factors are age, gender, ethnicity, body mass index (BMI) and footwear habits. Research on how footwear can affect foot development has increased over the years and the final section of this review aimed to unpick the findings. Studies investigating the influence of footwear habits on foot length and width have established inconsistent findings. Many of the studies in the review did not control for internal and external factors that can affect foot development. There was also a limited number of studies that investigated hallux valgus angle and muscle strength differences in those with different footwear habits. Moreover, multiple studies in the final section of this review did not successfully examine the footwear habits of the participants and instead used observations or self-assessments, which is a major limitation. Future research should examine footwear behaviors and other confounding factors when investigating the development of the foot in children and adolescents. Moreover, researchers should critically evaluate the methods used to quantify the different structures of the foot to ensure valid and reliable parameters are being used.
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Affiliation(s)
- Maisie Squibb
- Department of Science and Health, South East Technological University, Kilkenny Road, Moanacurragh, R93 V960 Carlow, Ireland;
- Correspondence:
| | - Kelly Sheerin
- Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, 1010 Auckland, New Zealand;
| | - Peter Francis
- Department of Science and Health, South East Technological University, Kilkenny Road, Moanacurragh, R93 V960 Carlow, Ireland;
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Ikuta Y, Nakasa T, Fujishita H, Obayashi H, Fukuhara K, Sakamitsu T, Ushio K, Adachi N. An association between excessive valgus hindfoot alignment and postural stability during single-leg standing in adolescent athletes. BMC Sports Sci Med Rehabil 2022; 14:64. [PMID: 35410244 PMCID: PMC9004062 DOI: 10.1186/s13102-022-00457-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diminished balance is associated with the incidence of ankle and lower extremity injuries in adolescents. Although flexible flatfoot is a common foot condition in pediatric and adolescent populations, the association between balance control and foot morphology remain unclear in adolescent athletes. METHODS Rearfoot angle in the double-limb standing position, body mass index (BMI), and isometric muscle strength related to the knee joint were retrospectively reviewed in 101 adolescent athletes (75 boys and 26 girls) with a mean age of 14.0 years (range 12-17). Postural stability during single-leg standing on static and dynamic platforms was investigated using Balance System SD in 119 feet without functional ankle instability. The participants were divided according to their rearfoot angle into control (less than 7°) and valgus (greater than or equal to 7°) groups. The measured parameters were compared between the control and valgus groups using Welch's t-test, and P values < 0.05 were considered statistically significant. Multiple regression analysis was conducted to identify the factors that significantly influenced postural control. RESULTS The average rearfoot angle was 4.6° in all participants. An excessive valgus rearfoot angle was detected in 53 feet (26.2%). No significant difference was found between the groups in terms of BMI and isometric knee muscle strength. Although no statistical differences were observed in postural stability on the static platform between the control and valgus groups, the valgus group demonstrated poorer postural stability for single-leg standing on the dynamic platform. Multiple regression analysis revealed that BMI and rearfoot angle were significantly associated with a poor postural control on the dynamic platform. CONCLUSIONS Our findings suggest that excessive rearfoot valgus specifically contributes to the deterioration of postural stability in adolescent athletes, and that rearfoot alignment should be evaluated for the adolescent population to prevent sports-related lower extremity injury.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan. .,Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan.
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan.,Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Hiromune Obayashi
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Kouki Fukuhara
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Kai Ushio
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan.,Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan
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Smolle MA, Svehlik M, Regvar K, Leithner A, Kraus T. Long-term clinical and radiological outcomes following surgical treatment for symptomatic pediatric flexible flat feet: a systematic review. Acta Orthop 2022; 93:367-374. [PMID: 35347339 PMCID: PMC8958850 DOI: 10.2340/17453674.2022.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Albeit pediatric flexible flat foot (FFF) is a common condition, only a minority of patients become symptomatic. Long-term outcomes of surgically treated pediatric patients with symptomatic FFF are largely unknown. In this systematic review, studies providing outcomes at a mean follow-up of at least 4 years after the procedure in these patients were analyzed. MATERIAL AND METHODS A PubMed search was undertaken involving original articles published up to July 2021 on outcome in children aged 6 to 14 with surgically treated FFF and mean (or minimum) follow-up of at least 4 years. Radiographic and clinical outcomes were analyzed. RESULTS Of initially 541 entries, 10 could be included in the systematic review (all level IV), involving 846 pediatric patients with 1,536 symptomatic FFF. Pooled mean radiological (n = 8) and clinical follow-up (n = 10) was 5.3 (range 0.5-15) and 7.0 (range 4.1-15) years, respectively. Surgical procedures included arthroereisis (n = 8), lateral column lengthening (n = 1), and Horseman procedure (n = 1). Overall relative frequency of implant-associated complications and wound-healing problems was 3.2% and 1.3%, as well as 2.8% and 1.6% following subtalar arthroereisis only. From preoperative to latest radiological assessment following subtalar arthroereisis (including 3 studies with radiological follow-up < 48 months), pooled median decrease in talonavicular coverage angle (TNCA; -9.2°), anteroposterior talocalcaneal angle (A-TCA; -6.5°), lateral talocalcaneal angle (L-TCA; -3.5°), talar declination angle (TDA; -14°), Moreau Costa Bertani angle (MCB; -13°), and talo-firstmetatarsal angle (L-T1MA; -10°) was observed, as was an increase in calcaneal pitch (4.5°). INTERPRETATION In symptomatic pediatric FFF patients, surgery is associated with a manageable complication profile, and results in satisfactory long-term clinical as well as radiological outcome. Yet scientific evidence is low, warranting larger scaled studies in the future.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
| | - Martin Svehlik
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
| | - Katharina Regvar
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
| | - Tanja Kraus
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz.
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Eysel LO, Lüders KA, Braunschweig L, Lorenz HM, Dörner J, Hell AK, Stinus H. Foot Typology, Dynamic and Static Weight Distribution, and Radiographic Changes After Subtalar Arthroereisis in Juvenile Symptomatic Flexible Flat Feet. J Foot Ankle Surg 2022; 61:272-278. [PMID: 34420796 DOI: 10.1053/j.jfas.2021.07.021] [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: 02/04/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 02/03/2023]
Abstract
Flexible flatfoot is among the most common skeletal disorders in childhood. This study describes the dynamic and static correction effects of subtalar arthroereisis in adolescents with flexible symptomatic flatfeet in comparison to normal subjects as well as to results before and after removal of metal. Eighteen adolescents with 25 symptomatic flexible flatfeet were treated surgically with a subtalar arthroereisis at a mean of 12.5 (10-16) years. At follow-up (mean 3.9 years, range 0.4-8), patients filled out the American Orthopaedic Foot and Ankle Society questionnaire, received radiographs and were examined using dynamic and static pedobarography as well as static hindfoot axis examination. Results were compared to healthy controls (n = 13; 26 feet). Surgically treated feet (n = 25) had better questionnaire results after surgery than before, but lower scores than healthy feet. Radiological parameters improved significantly after surgery. Removal of metal did not influence post-surgical results (follow-up 2.8 years). Surgically treated feet had larger contact areas than normal feet with predominance to the midfoot region. The relative maximum force, relative peak pressure and contact time were higher in the midfoot of treated feet compared to controls. When comparing pedobarography data of treated versus untreated feet of the same patients (subgroup n = 11 feet), there were no differences. Subtalar arthroereisis was able to effectively treat symptomatic flexible flatfeet in this population. Results improved significantly evaluating a questionnaire, radiographs, dynamic and static weight distribution, but were still worse than results of healthy feet. There was no relapse after removal of metal.
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Affiliation(s)
- Lara O Eysel
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Katja A Lüders
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Lena Braunschweig
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Heiko M Lorenz
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Anna K Hell
- Pediatric Orthopaedics, Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany.
| | - Hartmut Stinus
- Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
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40
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Longo UG, Papalia R, De Salvatore S, Ruzzini L, Candela V, Piergentili I, Oggiano L, Costici PF, Denaro V. Trends in hospitalization for paediatric flatfoot: an Italian nationwide study from 2001 to 2016. BMC Pediatr 2022; 22:83. [PMID: 35135510 PMCID: PMC8822862 DOI: 10.1186/s12887-022-03145-0] [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: 12/02/2021] [Accepted: 01/29/2022] [Indexed: 01/14/2023] Open
Abstract
Background Flatfoot is a common condition in young patients, but usually resolves by adolescence. This study aimed to estimate annual trend hospitalizations for flatfoot in Italian paediatric population from 2001 to 2016. Methods Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper (2001–2016). The yearly number of hospital admission for flatfoot, the percentage of males and females, the average age, the average days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. Results 109,300 hospitalizations for flatfoot of young patients were performed during this period. 59.3% of patients were male and 40.7% female of the 10–14 years-old age class. The average days of hospitalization stay were 1.73 ± 1.27 days. The data highlights that the burden of flatfoot surgery is growing and affecting the healthcare system. The mean rate of hospital admissions in Italy for flatfoot in the young population was 82.14 for 100,000 inhabitants of the same age class. Conclusions The data highlights that the cases of flatfoot surgery increased from 2001 to 2016. The most common treatment was the “Internal Fixation Of Bone Without Fracture Reduction, Tarsals And Metatarsals followed by Subtalar Fusion and Arthroereisis. Further prospective studies on this topic may be conducted to improve the evidence of the results.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy. .,Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy. .,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 , Roma, Italy.
| | - Rocco Papalia
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 , Roma, Italy
| | - Sergio De Salvatore
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 , Roma, Italy
| | - Laura Ruzzini
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 , Roma, Italy
| | - Ilaria Piergentili
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 , Roma, Italy
| | - Leonardo Oggiano
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Vincenzo Denaro
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 , Roma, Italy
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41
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Longo UG, Papalia R, De Salvatore S, Ruzzini L, Piergentili I, Oggiano L, Costici PF, Denaro V. Trends in hospitalisation of Subtalar Joint Arthroereisis in Italy from 2009 to 2016. Foot Ankle Surg 2022; 28:258-262. [PMID: 33875391 DOI: 10.1016/j.fas.2021.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Subtalar Joint Arthroereisis (SJA) is the most used technique for the treatment of flexible flatfoot. Limited data are reported to trends of hospitalisation for SJA. This study aimed to estimate annual admissions and the geographical distribution of SJA in young Italian patients from 2009 to 2016. METHODS Data of this study were collected from the National Hospital Discharge Reports reported at the Italian Ministry of Health. The yearly number of SJA, sex, age and days of hospitalisation were calculated. Public and Private hospitalisations have been analysed individually. RESULTS 1.6762 hospitalisations for SJA were performed in Italy during the study period, and the incidence increased from 8.22 to 117.08 (cases/100,000 inhabitants). Men represented the majority of young patients treated by SJA. The mean length of stay was 1.55 ± 0.818 days. CONCLUSIONS The prevalence of admissions of young patients for SJA increases from 2009 to 2016. The majority of the procedure was performed in public hospitals, but a shorter length of stay was reported in patients treated in private hospitals (p < 0.001). This study highlighted the limits of ICD-9; in fact, difficulties in procedure codification and heterogeneity in diagnosis and procedures performed were reported.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Rocco Papalia
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Ruzzini
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Ilaria Piergentili
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Leonardo Oggiano
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Vincenzo Denaro
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Abstract
BACKGROUND Paediatric flat feet are a common presentation in primary care; reported prevalence approximates 15%. A minority of flat feet can hurt and limit gait. There is no optimal strategy, nor consensus, for using foot orthoses (FOs) to treat paediatric flat feet. OBJECTIVES To assess the benefits and harms of foot orthoses for treating paediatric flat feet. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase to 01 September 2021, and two clinical trials registers on 07 August 2020. SELECTION CRITERIA We identified all randomised controlled trials (RCTs) of FOs as an intervention for paediatric flat feet. The outcomes included in this review were pain, function, quality of life, treatment success, and adverse events. Intended comparisons were: any FOs versus sham, any FOs versus shoes, customised FOs (CFOs) versus prefabricated FOs (PFOs). DATA COLLECTION AND ANALYSIS We followed standard methods recommended by Cochrane. MAIN RESULTS We included 16 trials with 1058 children, aged 11 months to 19 years, with flexible flat feet. Distinct flat foot presentations included asymptomatic, juvenile idiopathic arthritis (JIA), symptomatic and developmental co-ordination disorder (DCD). The trial interventions were FOs, footwear, foot and rehabilitative exercises, and neuromuscular electrical stimulation (NMES). Due to heterogeneity, we did not pool the data. Most trials had potential for selection, performance, detection, and selective reporting bias. No trial blinded participants. We present the results separately for asymptomatic (healthy children) and symptomatic (children with JIA) flat feet. The certainty of evidence was very low to low, downgraded for bias, imprecision, and indirectness. Three comparisons were evaluated across trials: CFO versus shoes; PFO versus shoes; CFO versus PFO. Asymptomatic flat feet 1. CFOs versus shoes (1 trial, 106 participants): low-quality evidence showed that CFOs result in little or no difference in the proportion without pain (10-point visual analogue scale (VAS)) at one year (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.67 to 1.07); absolute decrease (11.8%, 95% CI 4.7% fewer to 15.8% more); or on withdrawals due to adverse events (RR 1.05, 95% CI 0.94 to 1.19); absolute effect (3.4% more, 95% CI 4.1% fewer to 13.1% more). 2. PFOs versus shoes (1 trial, 106 participants): low to very-low quality evidence showed that PFOs result in little or no difference in the proportion without pain (10-point VAS) at one year (RR 0.94, 95% CI 0.76 to 1.16); absolute effect (4.7% fewer, 95% CI 18.9% fewer to 12.6% more); or on withdrawals due to adverse events (RR 0.99, 95% CI 0.79 to 1.23). 3. CFOs versus PFOs (1 trial, 108 participants): low-quality evidence found no difference in the proportion without pain at one year (RR 0.93, 95% CI 0.73 to 1.18); absolute effect (7.4% fewer, 95% CI 22.2% fewer to 11.1% more); or on withdrawal due to adverse events (RR 1.00, 95% CI 0.90 to 1.12). Function and quality of life (QoL) were not assessed. Symptomatic (JIA) flat feet 1. CFOs versus shoes (1 trial, 28 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain (0 to 10 scale, 0 no pain) between groups (MD -1.5, 95% CI -2.78 to -0.22). Low-quality evidence showed improvements in function with CFOs (Foot Function Index - FFI disability, 0 to 100, 0 best function; MD -18.55, 95% CI -34.42 to -2.68), child-rated QoL (PedsQL, 0 to 100, 100 best quality; MD 12.1, 95% CI -1.6 to 25.8) and parent-rated QoL (PedsQL MD 9, 95% CI -4.1 to 22.1) and little or no difference between groups in treatment success (timed walking; MD -1.33 seconds, 95% CI -2.77 to 0.11), or withdrawals due to adverse events (RR 0.58, 95% CI 0.11 to 2.94); absolute difference (9.7% fewer, 20.5 % fewer to 44.8% more). 2. PFOs versus shoes (1 trial, 25 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain between groups (MD 0.02, 95% CI -1.94 to 1.98). Low-quality evidence showed no difference between groups in function (FFI-disability MD -4.17, 95% CI -24.4 to 16.06), child-rated QoL (PedsQL MD -3.84, 95% CI -19 to 11.33), or parent-rated QoL (PedsQL MD -0.64, 95% CI -13.22 to 11.94). 3. CFOs versus PFOs (2 trials, 87 participants): low-quality evidence showed little or no difference between groups in pain (0 to 10 scale, 0 no pain) at 3 months (MD -1.48, 95% CI -3.23 to 0.26), function (FFI-disability MD -7.28, 95% CI -15.47 to 0.92), child-rated QoL (PedsQL MD 8.6, 95% CI -3.9 to 21.2), or parent-rated QoL (PedsQL MD 2.9, 95% CI -11 to 16.8). AUTHORS' CONCLUSIONS Low to very low-certainty evidence shows that the effect of CFOs (high cost) or PFOs (low cost) versus shoes, and CFOs versus PFOs on pain, function and HRQoL is uncertain. This is pertinent for clinical practice, given the economic disparity between CFOs and PFOs. FOs may improve pain and function, versus shoes in children with JIA, with minimal delineation between costly CFOs and generic PFOs. This review updates that from 2010, confirming that in the absence of pain, the use of high-cost CFOs for healthy children with flexible flat feet has no supporting evidence, and draws very limited conclusions about FOs for treating paediatric flat feet. The availability of normative and prospective foot development data, dismisses most flat foot concerns, and negates continued attention to this topic. Attention should be re-directed to relevant paediatric foot conditions, which cause pain, limit function, or reduce quality of life. The agenda for researching asymptomatic flat feet in healthy children must be relegated to history, and replaced by a targeted research rationale, addressing children with indisputable foot pathology from discrete diagnoses, namely JIA, cerebral palsy, congenital talipes equino varus, trisomy 21 and Charcot Marie Tooth. Whether research resources should continue to be wasted on studying flat feet in healthy children that do not hurt, is questionable. Future updates of this review will address only relevant paediatric foot conditions.
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Affiliation(s)
- Angela M Evans
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Keith Rome
- Division of Rehabilitation & Occupation Studies, AUT University, Auckland 1020, New Zealand
| | - Matthew Carroll
- Department of Podiatry, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Fiona Hawke
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia
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Bac A, Kaczor S, Pasiut S, Ścisłowska-Czarnecka A, Jankowicz-Szymańska A, Filar-Mierzwa K. The influence of myofascial release on pain and selected indicators of flat foot in adults: a controlled randomized trial. Sci Rep 2022; 12:1414. [PMID: 35082352 PMCID: PMC8791964 DOI: 10.1038/s41598-022-05401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Flat foot pain is a common complaint that requires therapeutic intervention. Currently, myofascial release techniques are often used in the therapy of musculoskeletal disorders. A group of 60 people suffering from flat feet with associated pain. Patients were assigned to four groups (15 people each): MF-myofascial release, E-the exercise program, MFE-myofascial release and the exercise program, C-no intervention. The rehabilitation program lasted 4 weeks. The NRS scale was used to examine pain intensity and FreeMed ground reaction force platform was used to examine selected static and dynamic foot indicators. Statistically significant pain reduction was obtained in all research. A static test of foot load distribution produced statistically significant changes only for selected indicators. In the dynamic test, statistically significant changes were observed for selected indicators, only in the groups subjected to therapeutic intervention. Most such changes were observed in the MF group. In the dynamic test which assessed the support phase of the foot, statistically significant changes were observed only for selected subphases. Most such changes were observed in the MFE group. Both exercise and exercise combined with myofascial release techniques, and especially myofascial release techniques alone, significantly reduce pain in a flat foot. This study shows a limited influence of both exercises and myofascial release techniques on selected static and dynamic indicators of a flat foot.
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Affiliation(s)
- Aneta Bac
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland.
| | - Sabina Kaczor
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland
| | - Szymon Pasiut
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland
| | - Anna Ścisłowska-Czarnecka
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland
| | | | - Katarzyna Filar-Mierzwa
- Faculty of Motor Rehabilitation, The Bronisław Czech, University of Physical Education, al. Jana Pawła II 78, 31-571, Krakow, Poland
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Stevens P, Lancaster A, Khwaja A. Talar-tarsal Stabilisation: Goals and Initial Outcomes. Strategies Trauma Limb Reconstr 2022; 16:168-171. [PMID: 35111256 PMCID: PMC8778731 DOI: 10.5005/jp-journals-10080-1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Peter Stevens
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
- Peter Stevens, Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States, of America Phone: +801 330-3656, e-mail:
| | - Alex Lancaster
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
| | - Ansab Khwaja
- Department of Orthopedics, University of Arizona, Phoenix, Arizona, United States of America
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45
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Abstract
BACKGROUND Paediatric flat feet are a common presentation in primary care; reported prevalence approximates 15%. A minority of flat feet can hurt and limit gait. There is no optimal strategy, nor consensus, for using foot orthoses (FOs) to treat paediatric flat feet. OBJECTIVES To assess the benefits and harms of foot orthoses for treating paediatric flat feet. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase to 01 September 2021, and two clinical trials registers on 07 August 2020. SELECTION CRITERIA We identified all randomised controlled trials (RCTs) of FOs as an intervention for paediatric flat feet. The outcomes included in this review were pain, function, quality of life, treatment success, and adverse events. Intended comparisons were: any FOs versus sham, any FOs versus shoes, customised FOs (CFOs) versus prefabricated FOs (PFOs). DATA COLLECTION AND ANALYSIS We followed standard methods recommended by Cochrane. MAIN RESULTS We included 16 trials with 1058 children, aged 11 months to 19 years, with flexible flat feet. Distinct flat foot presentations included asymptomatic, juvenile idiopathic arthritis (JIA), symptomatic and developmental co-ordination disorder (DCD). The trial interventions were FOs, footwear, foot and rehabilitative exercises, and neuromuscular electrical stimulation (NMES). Due to heterogeneity, we did not pool the data. Most trials had potential for selection, performance, detection, and selective reporting bias. No trial blinded participants. We present the results separately for asymptomatic (healthy children) and symptomatic (children with JIA) flat feet. The certainty of evidence was very low to low, downgraded for bias, imprecision, and indirectness. Three comparisons were evaluated across trials: CFO versus shoes; PFO versus shoes; CFO versus PFO. Asymptomatic flat feet 1. CFOs versus shoes (1 trial, 106 participants): low-quality evidence showed that CFOs result in little or no difference in the proportion without pain (10-point visual analogue scale (VAS)) at one year (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.67 to 1.07); absolute decrease (11.8%, 95% CI 4.7% fewer to 15.8% more); or on withdrawals due to adverse events (RR 1.05, 95% CI 0.94 to 1.19); absolute effect (3.4% more, 95% CI 4.1% fewer to 13.1% more). 2. PFOs versus shoes (1 trial, 106 participants): low to very-low quality evidence showed that PFOs result in little or no difference in the proportion without pain (10-point VAS) at one year (RR 0.94, 95% CI 0.76 to 1.16); absolute effect (4.7% fewer, 95% CI 18.9% fewer to 12.6% more); or on withdrawals due to adverse events (RR 0.99, 95% CI 0.79 to 1.23). 3. CFOs versus PFOs (1 trial, 108 participants): low-quality evidence found no difference in the proportion without pain at one year (RR 0.93, 95% CI 0.73 to 1.18); absolute effect (7.4% fewer, 95% CI 22.2% fewer to 11.1% more); or on withdrawal due to adverse events (RR 1.00, 95% CI 0.90 to 1.12). Function and quality of life (QoL) were not assessed. Symptomatic (JIA) flat feet 1. CFOs versus shoes (1 trial, 28 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain (0 to 10 scale, 0 no pain) between groups (MD -1.5, 95% CI -2.78 to -0.22). Low-quality evidence showed improvements in function with CFOs (Foot Function Index - FFI disability, 0 to 100, 0 best function; MD -18.55, 95% CI -34.42 to -2.68), child-rated QoL (PedsQL, 0 to 100, 100 best quality; MD 12.1, 95% CI -1.6 to 25.8) and parent-rated QoL (PedsQL MD 9, 95% CI -4.1 to 22.1) and little or no difference between groups in treatment success (timed walking; MD -1.33 seconds, 95% CI -2.77 to 0.11), or withdrawals due to adverse events (RR 0.58, 95% CI 0.11 to 2.94); absolute difference (9.7% fewer, 20.5 % fewer to 44.8% more). 2. PFOs versus shoes (1 trial, 25 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain between groups (MD 0.02, 95% CI -1.94 to 1.98). Low-quality evidence showed no difference between groups in function (FFI-disability MD -4.17, 95% CI -24.4 to 16.06), child-rated QoL (PedsQL MD -3.84, 95% CI -19 to 11.33), or parent-rated QoL (PedsQL MD -0.64, 95% CI -13.22 to 11.94). 3. CFOs versus PFsO (2 trials, 87 participants): low-quality evidence showed little or no difference between groups in pain (0 to scale, 0 no pain) at 3 months (MD -1.48, 95% CI -3.23 to 0.26), function (FFI-disability MD -7.28, 95% CI -15.47 to 0.92), child-rated QoL (PedsQL MD 8.6, 95% CI -3.9 to 21.2), or parent-rated QoL (PedsQL MD 2.9, 95% CI -11 to 16.8). AUTHORS' CONCLUSIONS Low to very low-certainty evidence shows that the effect of CFOs (high cost) or PFOs (low cost) versus shoes, and CFOs versus PFOs on pain, function and HRQoL is uncertain. This is pertinent for clinical practice, given the economic disparity between CFOs and PFOs. FOs may improve pain and function, versus shoes in children with JIA, with minimal delineation between costly CFOs and generic PFOs. This review updates that from 2010, confirming that in the absence of pain, the use of high-cost CFOs for healthy children with flexible flat feet has no supporting evidence, and draws very limited conclusions about FOs for treating paediatric flat feet. The availability of normative and prospective foot development data, dismisses most flat foot concerns, and negates continued attention to this topic. Attention should be re-directed to relevant paediatric foot conditions, which cause pain, limit function, or reduce quality of life. The agenda for researching asymptomatic flat feet in healthy children must be relegated to history, and replaced by a targeted research rationale, addressing children with indisputable foot pathology from discrete diagnoses, namely JIA, cerebral palsy, congenital talipes equino varus, trisomy 21 and Charcot Marie Tooth. Whether research resources should continue to be wasted on studying flat feet in healthy children that do not hurt, is questionable. Future updates of this review will address only relevant paediatric foot conditions.
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Affiliation(s)
- Angela M Evans
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Keith Rome
- Division of Rehabilitation & Occupation Studies, AUT University, Auckland 1020, New Zealand
| | - Matthew Carroll
- Department of Podiatry, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Fiona Hawke
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia
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Cho DJ, Ahn SY, Bok SK. Effect of Foot Orthoses in Children With Symptomatic Flexible Flatfoot Based on Ultrasonography of the Ankle Invertor and Evertor Muscles. Ann Rehabil Med 2022; 45:459-470. [PMID: 35000371 PMCID: PMC8743848 DOI: 10.5535/arm.21137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the changes in the cross-sectional area (CSA) ratio of the ankle invertors and evertors following rigid foot orthosis (RFO) application in children with symptomatic flexible flatfoot and to determine the correlation between the degree of change in CSA ratio and pain-severity after RFO application. Methods We included 24 children with symptomatic flexible flatfoot without comorbidities and measured the CSAs of tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) using ultrasonography, resting calcaneal stance position (RCSP) angle, calcaneal pitch (CP), Meary’s angle, talonavicular coverage angle, and talocalcaneal angle using radiography, and foot function index (FFI) at baseline and 12 months after RFO application. We analyzed 48 data by measuring both feet of 24 children. The CSA ratios, the ratio of CSA of each muscle to the sum of CSA of TA, TP, and PL, were also compared. Correlations between the degree of change in FFI, each muscle’s CSA ratio, RCSP angle, and radiographic measurements were investigated. Results Following RFO application, significant increase in the PL ratio and CP and significant decrease in the RCSP angle, FFI total, pain, and disability scores were observed. The degree of change in the total score, pain, and disability score of FFI were significantly correlated with the degree of change in the PL ratio and RCSP angle. Conclusion RFOs applied to children with symptomatic flexible flatfoot might reduce the compensatory activities of the ankle invertors, thereby increasing the PL ratio, and pain decreases as the PL ratio increases.
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Affiliation(s)
- Dong Joon Cho
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - So Young Ahn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
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47
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Yamashita T, Yamashita K, Sato M, Ata S. Differences in Foot Features Between Children and Older Adults Assessed using a Three-Dimensional Foot Scanning System: A Cross-Sectional Observational Study. ADVANCED BIOMEDICAL ENGINEERING 2022. [DOI: 10.14326/abe.11.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Kazuhiko Yamashita
- Department of Clinical Engineering, Faculty of Human Care at Makuhari, Tohto University
| | - Mitsuru Sato
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University
| | - Shingo Ata
- Graduate School of Engineering, Osaka City University
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48
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Dadfar M, Sheikhhoseini R, Jafarian M, Esmaeili A. Lower extremity kinematic coupling during single and double leg landing and gait in female junior athletes with dynamic knee valgus. BMC Sports Sci Med Rehabil 2021; 13:152. [PMID: 34886878 PMCID: PMC8662875 DOI: 10.1186/s13102-021-00385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dynamic knee valgus (DKV) is a common lower extremity movement disorder among females. This study aimed to investigate kinematic couplings between lower extremity joints in female junior athletes with DKV during single and double-leg landing and gait. METHODS Twenty-six physically active female junior athletes (10-14 years old) with DKV were recruited. Kinematic couplings between rearfoot, tibia, knee, and hip were extracted using eight Vicon motion capture cameras and two force plates. Zero-lag cross-correlation coefficient and vector coding were used to calculate kinematic couplings between joints during physical tasks. Paired t-test and Wilcoxon tests were run to find significant couplings between joint motions and coupling strengths. Bonferroni posthoc was used to determine significance with α ≤ 0.05. RESULTS The results showed that the strongest kinematic relationship existed between rearfoot eversion/inversion and tibial internal/external rotation during all three tasks. Correlations of the rearfoot supination/pronation with tibial rotations, knee, and hip motions in sagittal, frontal, and transverse planes were very strong to strong during double-leg landing and moderate to weak during gait. A weak correlation was observed between rearfoot supination/pronation and hip adduction/abduction during single-leg landing. CONCLUSIONS Coupling relationships between rearfoot, knee, and hip vary by the task intensity and alignment profiles in female juniors with DKV.
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Affiliation(s)
- Mahdis Dadfar
- Department of Corrective Exercise and Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba’i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Rahman Sheikhhoseini
- Department of Corrective Exercise and Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba’i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Mohadeseh Jafarian
- Department of Electrical Engineering, Faculty of Electrical Engineering, Sharif University of Technology, Tehran, Iran
| | - Alireza Esmaeili
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Football League (AFL), Melbourne, Australia
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49
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Bouchard M, Ross TD. Bony Procedures for Correction of the Flexible Pediatric Flatfoot Deformity. Foot Ankle Clin 2021; 26:915-939. [PMID: 34752244 DOI: 10.1016/j.fcl.2021.09.001] [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
The pediatric flexible flatfoot is a common foot shape that is most often asymptomatic and may be a physiologic variant of normal. Surgery is only indicated when nonoperative interventions have failed to resolve symptoms. The goal of surgery is to alleviate symptoms by improving hindfoot alignment and restoring the medial arch while preserving joint mobility. This article focuses on the common bony techniques for surgical correction of the pediatric flexible flatfoot that has failed nonoperative management, including calcaneal, midfoot, and supramalleolar osteotomies and distal tibial hemiepiphyseodesis.
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Affiliation(s)
- Maryse Bouchard
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada; Division of Orthopaedic Surgery, The University of Toronto, Toronto, Canada.
| | - Tayler Declan Ross
- Division of Orthopaedic Surgery, The University of Toronto, 500 University Avenue #602, Toronto, Ontario M5G 1V7, Canada
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50
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De Pellegrin M, Moharamzadeh D. Subtalar Arthroereisis for Surgical Treatment of Flexible Flatfoot. Foot Ankle Clin 2021; 26:765-805. [PMID: 34752238 DOI: 10.1016/j.fcl.2021.07.007] [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
Various surgical techniques are known for the treatment of flexible flatfoot in children after failure of nonsurgical attempts. Data collected in a review of the last 10-year period (2010-2020) show that among the 691 feet undergoing subtalar arthroereisis with endorthesis, average age at surgery was 11.40 years and in the 1856 feet that underwent subtalar arthroereisis with calcaneo-stop 11.69 years, while the complications rate was 9.00% and 6.38%, respectively. These data confirm that subtalar arthroereisis with calcaneo-stop may have an advantage over subtalar arthroereisis with endorthesis as the screw is not placed across the subtalar joint but instead into the calcaneus.
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Affiliation(s)
- Maurizio De Pellegrin
- Pediatric Orthopedic and Traumatology Unit, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy
| | - Désirée Moharamzadeh
- Orthopedic and Traumatology Unit, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy.
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