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Khorramroo F, Mousavi SH, Hijmans JM. Step width modification to change rearfoot eversion and medial longitudinal arch angle during walking and running in individuals with pronated feet. Gait Posture 2024; 113:366-373. [PMID: 39068870 DOI: 10.1016/j.gaitpost.2024.07.295] [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: 05/07/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Individuals with pronated feet often experience altered foot biomechanics, leading to increased risk of lower limb injuries. Step width modification has been proposed as a potential intervention to improve foot alignment during gait. RESEARCH QUESTION Does modifying step width influence rearfoot eversion and medial longitudinal arch angle (MLAA) in individuals with pronated feet during walking and running? METHODS Twenty individuals with pronated feet underwent analysis during walking and running on treadmill, maintaining increased or decreased step width using real-time visual feedback. Three-dimensional motion analysis measured rearfoot eversion and MLAA during the stance phase of gait. RESULTS Wide step width significantly reduced peak rearfoot eversion during waking (mean difference - with normal step width - (MD) = 3.6°, p < 0.001) and running (MD = 4.4°, p < 0.001), time to peak rearfoot eversion during walking (MD = 16.6 p < 0.001) and running (MD = 13.8°, p = 0.014), rearfoot eversion at touch down (TD) during walking (MD = 1.3°, p = 0.004), rearfoot eversion excursion during running (MD = 4.3°, p < 0.001), and peak MLAA during walking (MD = 2.9°, p = 0.006) and MLAA excursion during running (MD = 4.8°, p = 0.004). By contrast, during running, narrow condition significantly increased peak rearfoot eversion (MD = 3.4°, p < 0.001). During walking, time to peak rearfoot eversion (MD = 16.1, p < 0.001), rearfoot eversion at TD (MD = 1.4°, p = 0.008), rearfoot eversion excursion (MD = 5.9°, p < 0.001), and peak MLAA (MD = 3.4°, p < 0.001) were significantly increased. SIGNIFICANCE This study highlights the potential of step width modification as a simple yet effective intervention to improve foot biomechanics in pronated feet individuals during walking and running. Further research could lead to the development of personalized strategies for pronated feet individuals.
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Affiliation(s)
- Fateme Khorramroo
- Department of Sport Injuries and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Islamic Republic of Iran.
| | - Seyed Hamed Mousavi
- Department of Sport Injuries and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Islamic Republic of Iran.
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands.
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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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Agnew PS, Foster JD, Chariton J, Chariton AJ, Bresnahan PJ, Daniel EC, Fishman SA. Clinical Outcomes Following Treatment of Recurrent Talotarsal Joint Dislocation Using a Type II Extraosseous Talotarsal Stabilization Implant-A Long-Term Follow-Up Study. J Foot Ankle Surg 2023; 62:877-882. [PMID: 37348750 DOI: 10.1053/j.jfas.2023.06.001] [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: 12/22/2022] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
Collapsing foot deformity (CFD) and its resulting sequelae caused by recurring talotarsal joint dislocation (RTTJD) affects pediatric and adult patients. An extraosseous talotarsal stabilization (EOTTS) procedure, a subset of subtalar arthroereisis (SA) procedures, is recommended as a minimally invasive, first in-line surgical treatment option for CFD. The aim of this multicenter, retrospective study was to evaluate patient-reported outcomes measures in patients who were treated for RTTJD with Type II EOTTS implants. Sixty-seven cases having a median age of 38 years (range: 10-74) with more than 5 years of follow-up were included in this study. The mean postoperative visual analog scale and Maryland Foot Score was 1.0 ± 1.9 and 92.3 ± 11.3, respectively, indicating excellent clinical outcomes. Subjectively, 88% cases reported as being satisfied with the outcome, 94% cases said they would recommend EOTTS, and 93% said that, if necessary, they would repeat it on their contralateral foot. A subgroup analysis revealed that while not statistically significant, clinical outcomes were slightly better in pediatric patients compared to adults. Implant removal rate was 4.5% (3 cases), and these were in the adult group only. Rate of minor issues such as pain, stiffness, discomfort, etc. was 15%; however, no serious adverse effects or complications were observed in any patient. This study suggests that EOTTS is an effective surgical treatment option wherein successful long-term clinical outcomes with low failure rates can be achieved in a select patient population.
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Elbarbary HM, Arafa AS, Said ABZ, Hegazy M, Reiad MW, Basha NY, Fahmy M. Clinical and Radiological Outcomes of Subtalar Arthroereisis for Management of Planovalgus Foot in Children With Cerebral Palsy: 3-Year Follow-up. Foot Ankle Spec 2022; 15:536-544. [PMID: 33345616 DOI: 10.1177/1938640020980911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Planovalgus deformity of the foot is common among cerebral palsy (CP) patients. It is an upcoming topic with debate and controversy that require further studies. Many clinical studies involving arthroereisis have shown acceptable results in short- and mid-term follow-up. The aim of this work was to evaluate the outcome of arthroereisis using a conventional screw placed percutaneously across the talocalcaneal articulation for the treatment of moderate planovalgus deformity in children with CP. METHODS Between 2015 and 2018, a prospective study was conducted including 23 CP patients with bilateral flexible planovalgus deformity with follow-up period ranging from 24 to 40 months (mean of 36.7 months). The radiological and clinical outcomes were assessed. The patient/parent outcome was evaluated using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). RESULTS The results showed statistically significant improvement in both radiological and clinical data as well as patient's symptoms and parent's satisfaction. CONCLUSION Results obtained from literature from the past decades after arthroereisis for the correction of moderate planovalgus deformity in CP patients are promising. The few studies reported on that procedure shared the same harmony with our study giving a chance to be a good alternative to joint destructive procedures. Our technique is simple, effective, economical, and minimally invasive if used in selected pediatric CP patients. LEVELS OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
| | - Amr Said Arafa
- Orthopaedic Surgery Department, Cairo University, Cairo, Egypt
| | | | - Mohamed Hegazy
- Orthopaedic Surgery Department, Cairo University, Cairo, Egypt
| | | | | | - Mahmoud Fahmy
- Orthopaedic Surgery Department, Cairo University, Cairo, Egypt
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García Bistolfi M, Avanzi R, Buljubasich M, Bosio S, Puigdevall M. Subtalar arthroereisis in pediatric flexible flat foot: Functional and radiographic results with 5 years of average follow-up. Foot (Edinb) 2022; 52:101920. [PMID: 36030650 DOI: 10.1016/j.foot.2022.101920] [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: 11/16/2020] [Revised: 02/09/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
The aim of this retrospective study is to evaluate the clinical-functional and radiographic results in pediatric patients with painful and disabling Flexible Flat Foot (FFF) refractory to conservative treatment who underwent percutaneous subtalar arthroereisis with a Maxwell Brancheau Arthroereisis® (MBA) implant. Patients aged 8-14 years old with a minimum follow-up of 24 months were included. A pre and postoperative radiographic evaluation was carried out analyzing Meary's angle, internal Moreau-Costa-Bartani´s angle, Talar declination angle, Calcaneal Pitch, Kite's angle, Talar-1st metatarsal angle, and Talonavicular coverage angle. In those patients with more than 5 years of follow-up, the development of subtalar osteoarthritis was evaluated. A clinical-functional evaluation was carried out using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot rating scale. Pre and postoperative pain was evaluated using the visual analog scale (VAS). Postoperative complications were described. Fourteen patients (19 feet) met the inclusion criteria. The mean age at surgery was 12 years old with a mean follow-up of 68.26 months. All radiographic angles improved significantly. No signs of subtalar osteoarthritis were identified. The mean pre and postoperative pain according to VAS was 7.05 and 0.77 respectively. The mean pre and postoperative AOFAS was 75.42 and 97.05 respectively. One female patient had persistent pain in both feet (VAS = 4). However, she was able to do sports and daily life activities without restrictions. None of the implants needed to be removed due to intolerance or pain. Subtalar arthroereisis seems to be effective to improve the clinical-functional and radiographic parameters in moderate pediatric FFF.
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Affiliation(s)
- Mariano García Bistolfi
- Orthopaedic and Traumatology Department, Instituto de Ortopedia "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Argentina.
| | - Rocío Avanzi
- Orthopaedic and Traumatology Department, Instituto de Ortopedia "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Argentina.
| | - Martín Buljubasich
- Orthopaedic and Traumatology Department, Instituto de Ortopedia "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Argentina.
| | - Santiago Bosio
- Orthopaedic and Traumatology Department, Instituto de Ortopedia "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Argentina.
| | - Miguel Puigdevall
- Orthopaedic and Traumatology Department, Instituto de Ortopedia "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Argentina.
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Baryeh KW, Ismail H, Sobti A, Harb Z. Outcomes Following the Use of Subtalar Arthroereisis in the Correction of Adult Acquired Flatfoot: A Systematic Review. Foot Ankle Spec 2022; 15:384-393. [PMID: 33511862 DOI: 10.1177/1938640020987775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adult acquired flatfoot deformity (AAFD) is a condition affecting approximately 3% of the adult population. It can lead to severe morbidity, and therefore, prompt treatment is of the upmost importance in maintaining and restoring function. Recently, the use of subtalar arthroereisis has become more widespread in the treatment of AAFD. The purpose of this systematic review is to examine the clinical and radiological outcomes of AAFD when treated with subtalar arthroereisis. METHODS Studies involving the use of subtalar arthroereisis for the management of AAFD were reviewed, and appropriate studies selected based on inclusion and exclusion criteria. Studies were reviewed for both clinical and radiological outcomes following the use of subtalar arthroereisis as well as reported complications. RESULTS Nine studies met our inclusion criteria, with most of these involving stage II AAFD. A total of 190 subtalar arthroereisis procedures were performed with all studies demonstrating improvement in both clinical and radiological scores with a low rate of complications. CONCLUSION Subtalar arthroereisis may have benefits when used as an adjunct to treat stage II AAFD. However, more high-quality studies are needed to establish its best use. LEVELS OF EVIDENCE Level IV: Systematic review.
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Affiliation(s)
- Kwaku Wiredu Baryeh
- Royal Berkshire NHS Foundation Trust, Reading, UK.,Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK
| | - Hiba Ismail
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK
| | - Anshul Sobti
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK
| | - Ziad Harb
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK
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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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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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Irgit KS, Katsarov AZ. Flexible Progressive Collapsing Foot Deformity: Is There Any Role for Arthroereisis in the Adult Patient? Foot Ankle Clin 2021; 26:539-558. [PMID: 34332734 DOI: 10.1016/j.fcl.2021.06.004] [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] [Indexed: 02/02/2023]
Abstract
Over the last two decades there is a growing interest in the adult literature for subtalar joint arthroereisis. Parallel to this interest, there have been improvements in the design and biomechanics of the implant, although the main indication of subtalar joint arthroereisis in adults is not clear. Most studies show significant improvement in postoperative clinical scores and visual analog scores. Sinus tarsi pain, being the most common complication, is the main determinant of clinical satisfaction. This review focuses on the role and complications of subtalar joint arthroereisis in the adult population.
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Affiliation(s)
- Kaan Suleyman Irgit
- Orthopedics and Traumatology, Marmara School of Medicine, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad No 10, PK 34899, Pendik, İstanbul, Turkey.
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Vescio A, Testa G, Amico M, Lizzio C, Sapienza M, Pavone P, Pavone V. Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years. World J Orthop 2021; 12:433-444. [PMID: 34189081 PMCID: PMC8223720 DOI: 10.5312/wjo.v12.i6.433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/21/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Flexible flatfoot (FFF) is a very common condition in children, characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot. Arthroereisis (AR) procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop (CS).
AIM We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients. We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population, young athletes, and obese people according to material device.
METHODS Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6, 2020. The research string used was (pediatric OR children OR Juvenile NOT adult) AND (flexible NOT rigid) AND (flat foot OR pes planus) AND (calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal). The risk of bias assessment was performed using the Dutch checklist form for prognosis.
RESULTS A total of 47 articles were found. Ultimately, after reading the full text and checking reference lists, we selected 17 articles that met the inclusion and exclusion criteria. A total of 1864 FFFs were identified. Eight studies concerned the subtalar AR (47.1%) and nine concerning CS (52.9%). The average age of patients at start of treatment was 11.8 years, the average follow-up of the studies was 71.9 mo (range 29.1-130). Globally, complications occurred in 153 of the 1864 FFF treated, with a rate of 8.2%.
CONCLUSION Both AR procedures are valid surgical techniques for treating FFF. Surgeon experience, implant cost, and cosmetic correction are the most common considerations included in the orthopedic device decision-making process. In obese patients, the subtalar AR is not recommended. In adolescents who need to improve sports performance, the CS screw had better results compared with other implants.
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Affiliation(s)
- Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Mirko Amico
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Claudio Lizzio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania 95123, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
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11
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Hsu CM, Lin SC, Wu KW, Wang TM, Chang JF, Lee CC. Preliminary Results of Subtalar Arthroereisis with Vulpius Procedure for Symptomatic Flatfoot in Patients with Type I Osteogenesis Imperfecta. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010067. [PMID: 33374125 PMCID: PMC7796301 DOI: 10.3390/ijerph18010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
In this retrospective study, we aim to assess the safety and feasibility of adapting subtalar arthroereisis (SA) for type I osteogenesis imperfecta (OI) patients with symptomatic flatfoot. From December 2013 to January 2018, six type I OI patients (five girls and one boy, 12 feet) with symptomatic flexible flatfoot were treated with SA and the Vulpius procedure. All the patients were ambulatory and skeletally immature with failed conservative treatment and unsatisfactory life quality. The median age at the time of surgery was 10 years (range 5-11), and the median follow-up period was 55 months (range 33-83). All functional and radiographic parameters improved (p < 0.05) after the procedure at the latest follow-up. The median American Orthopaedic Foot and Ankle Society ankle-hindfoot scale improved from 68 (range 38-80) to 95 (range 71-97). All of the patients ambulated well without significant complications. The weight-bearing radiographs showed maintained correction of the tarsal bone alignment with intact bony surfaces adjacent to implants during the post-operative follow-up period. This is the very first study on symptomatic flatfoot in pediatric patients with type I OI. Our data suggest that SA is a potentially viable approach, as functional improvements and maintained radiographic correction without significant complication were observed.
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Affiliation(s)
- Cheng-Min Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan 333, Taiwan;
| | - Sheng-Chieh Lin
- Department of Orthopedic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Kuan-Wen Wu
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 100, Taiwan; (K.-W.W.); (T.-M.W.)
| | - Ting-Ming Wang
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 100, Taiwan; (K.-W.W.); (T.-M.W.)
| | - Jia-Feng Chang
- Department of Internal Medicine, Shuang Ho Hospital, New Taipei City 235, Taiwan;
- Department of Internal Medicine, En Chu Kong Hospital, New Taipei City 237, Taiwan
| | - Chia-Che Lee
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 100, Taiwan; (K.-W.W.); (T.-M.W.)
- Correspondence: ; Tel.: +886-2-23123456 (ext. 63987)
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Wang S, Chen L, Yu J, Zhang C, Huang JZ, Wang X, Ma X. Mid-term Results of Subtalar Arthroereisis with Talar-Fit Implant in Pediatric Flexible Flatfoot and Identifying the Effects of Adjunctive Procedures and Risk Factors for Sinus Tarsi Pain. Orthop Surg 2020; 13:175-184. [PMID: 33332772 PMCID: PMC7862150 DOI: 10.1111/os.12864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/23/2020] [Accepted: 10/18/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives To (i) report the mid‐term outcomes of subtalar arthroereisis using Talar‐Fit implant for the treatment of flexible flatfoot patients; (ii) compare clinical and radiographic outcomes between arthroereisis with and without adjunctive operative procedures to investigate the effects of adjuncts on the outcomes; and (iii) analyze the risk factors associated with sinus tarsi pain, which is the most common postoperative complication of arthroereisis. Methods Thirty‐one flexible flatfoot children and adolescents (46 feet) treated with subtalar arthroereisis using Talar‐Fit implant from June 2014 to May 2019 were retrospectively analyzed. The feet were divided into four treatment groups: (i) arthroereisis alone, (ii) arthroereisis with gastrocnemius recession, (iii) arthroereisis with Kidner procedure, and (iv) arthroereisis with gastrocnemius recession and Kidner procedure. Clinical function was evaluated based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score. The following angles were measured for radiographic evaluation: talar‐first metatarsal angle, calcaneal pitch angle, and talar declination angle on the lateral view; and talar‐first metatarsal angle, talocalcaneal angle, and anteroposterior talonavicular coverage angle on the anteroposterior (AP) view. The paired Student's t‐test was used to compare the pre‐ and postoperative angular measurements and AOFAS scores. The Wilcoxon rank‐sum test was undertaken to determine the outcome differences among four treatment groups. Multivariate logistic regression analysis was used to analyze risk factors for sinus tarsi pain. P value <0.05 is considered statistically significant. Results The mean follow‐up of the feet was 32.8 months (range, 10–71 months). The mean AOFAS score significantly improved from 55.5 ± 14.5 preoperatively to 86.3 ± 9.9 (P < 0.001). Comparison of radiographic outcomes showed that the lateral talar‐first metatarsal angle decreased by a mean of 19.1° ± 11.9° (P < 0.001), the calcaneal pitch angle increased by a mean of 5.4° ± 3.4° (P < 0.001), the talar declination angle decreased by a mean of 14.8° ± 9.9° (P < 0.001), the AP talar‐first metatarsal angle decreased by a mean of 15.6° ± 10.3° (P < 0.001), the AP talocalcaneal angle decreased by a mean of 7.2° ± 8.3° (P = 0.001), and the AP talonavicular coverage angle decreased by a mean of 20.4° ± 9.0° (P < 0.001). There were no statistically significant differences with regard to AOFAS score and all angle measurements on both the AP and lateral views among the four treatment groups. There was one dislocation case caused by a fall 6 weeks after surgery, which was treated nonoperatively. The incidence of sinus tarsi pain was 13% and logistic regression analysis indicated that patients with a longer distance from the tail end of the implant to the lateral calcaneal wall had 38.8% greater odds of developing sinus tarsi pain. Conclusions The mid‐term clinical and radiographic results were satisfactory in patients who underwent the subtalar arthroereisis procedure using Talar‐Fit implant, alone or in combination with other adjuncts, for the treatment of flexible flatfoot.
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Affiliation(s)
- Sen Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China.,Department of Orthopaedics, Huashan Hospital North, Fudan University, Shanghai, China
| | - Jian Yu
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Zhang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia-Zhang Huang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
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Radiographic and Functional Results following Subtalar Arthroereisis in Pediatric Flexible Flatfoot. Adv Orthop 2019; 2019:5061934. [PMID: 31467723 PMCID: PMC6699253 DOI: 10.1155/2019/5061934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Flexible flatfoot (FFF) is one of the most common skeletal disorders in children. In symptomatic patients who do not respond to conservative measures, surgery may be an option. Subtalar arthroereisis consists of limiting excessive eversion of the subtalar joint through different types of implants. Materials and Methods We carried out a retrospective study of 16 patients (32 feet) intervened for FFF with a subtalar device (arthroereisis), across the period of 2008-2015 with a minimum follow-up period of one year. Pre- and postoperative measures of the Moreau-Costa-Bartani angle, dorsoplantar (DP) and lateral (L) talocalcaneal angle, talonavicular coverage angle, and naviculocuboid overlap were used to evaluate correction of the deformity. Two expert surgeons from the Pediatric Orthopedics Unit took separate measurements of these angles for subsequent analysis purposes and to obtain the interobserver correlation coefficient for quantitative variables. Pre- and postoperative differences in the measurement of angles were ascertained using Student's t-test for paired samples; and a functional evaluation of the patients intervened was carried out pre- and postoperatively by administering the parent version of the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) during a clinical interview. All statistical analyses were performed using the SPSS v. 19.0 program (SPSS, Chicago, IL), with values being deemed statistically significant at p<0.05. Results A breakdown of the study population showed 81.25% (13 patients) males and 18.75% (3 patients) females, with mean age of 9 years (7-11). The interobserver coefficient for quantitative variables displayed a very high degree of concordance (0.7-0.9), indicating that the validity of the measures was adequate. Pre- and postoperative analysis of differences in the measurement of angles was statistically significant (p<0.005). In terms of functional evaluation, the postoperative results were positive, with statistical significance for the “school and play”, “emotional”, and “footwear” domains of the OxAFQ-C scale and no differences in the “physical” domain. Conclusion Subtalar arthroereisis is a valid option for the treatment of symptomatic pediatric flatfoot, with good postoperative functional and radiographic results.
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Elvan A, Simsek IE, Cakiroglu MA, Angin S. Association of quadriceps angle with plantar pressure distribution, navicular height and calcaneo-tibial angle. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:145-149. [PMID: 30638781 PMCID: PMC6506805 DOI: 10.1016/j.aott.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 10/02/2018] [Accepted: 12/21/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of study was to analyze the association between Quadriceps Angle (QA) and plantar pressure, navicular height (NH), and calcaneo-tibial angle (CTA). METHODS A total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19-33)) participated in this cross sectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamic plantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneus and the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground was measured while the subject was standing on both feet for NH. QA was measured while the subject was standing in a relaxed posture where both feet bearing equal weight. RESULTS There were significant negative correlations between QA and maximum force (MxF) under the 4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral (FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head (MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 and MH5 were found to be significantly negatively correlated with QA. A significant correlation was also found between QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regression analysis showed that NH was appeared as the major contributor for the QA (β = -0.49, p < 0.001) in the dynamic condition, followed by BT-FTI (β = 0.37, p < 0.001) and MH5-MxF (β = -0.21, p < 0.037). CONCLUSION These findings may imply that the NH which can at least be controlled by appropriate shoe inserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity may be altered. LEVEL OF EVIDENCE Level III, Diagnostic Study.
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Affiliation(s)
- Ata Elvan
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.
| | - Ibrahim Engin Simsek
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | | | - Salih Angin
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
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Caravaggi P, Sforza C, Leardini A, Portinaro N, Panou A. Effect of plano-valgus foot posture on midfoot kinematics during barefoot walking in an adolescent population. J Foot Ankle Res 2018; 11:55. [PMID: 30302128 PMCID: PMC6167855 DOI: 10.1186/s13047-018-0297-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Plano-valgus is a common alteration of the paediatric foot, characterized by valgus hindfoot, foot pronation and drop of the medial longitudinal arch. Despite their importance in the diagnosis and classification of plano-valgus foot condition, little information is available on functional alterations of the major joints spanning the medial longitudinal arch – i.e. midtarsal and tarso-metatarsal. Aim of the study was to provide objective description of the alterations in plano-valgus midfoot joints with respect to those in an age-matched normally-developed feet population. Methods Twenty adolescents (13.3 ± 0.8 years) with bilateral plano-valgus feet underwent clinical examination and were gait-analysed via a validated 4-segment foot model. This allowed to measure static foot posture, kinematics of the main foot joints, and medial longitudinal arch deformation during walking at comfortable speed. Range of motion and temporal profiles of joint rotations were compared to those from a control population of age-matched adolescents with normally-developed feet. Results The plano-valgus midtarsal joint was more dorsiflexed, everted and abducted than that in the control group, and showed reduced sagittal-plane RoM (plano-valgus = 15.9 degrees; control = 22.2 degrees; P < 0.01). The tarso-metarsal joint was more plantarflexed and adducted, and showed larger frontal-plane RoM. The MLA showed larger RoM and was lower throughout the stance phase of the gait cycle. Conclusion Significant postural and kinematic alterations are present at the midtarsal and tarso-metarsal joints of adolescents with plano-valgus feet. Objective identification and quantification of plano-valgus foot alterations, via non-invasive gait-analysis, is relevant to improving the diagnosis of this condition and to evaluating the effect of conservative treatments and of surgical corrections by different techniques.
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Affiliation(s)
- Paolo Caravaggi
- 1Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Chiarella Sforza
- 2Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133 Milan, Italy
| | - Alberto Leardini
- 1Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Nicola Portinaro
- 3Department of Pediatric Orthopedics and Neuro-orthopedics, Humanitas Research Hospital, University of Milan, Via Manzoni 56, 20089 Rozzano, MI Italy.,4Department of Translational Medicine, Orthopaedic and Traumatology Clinic, Humanitas Research Hospital, University of Milan, Rozzano, Milan Italy
| | - Artemisia Panou
- 2Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133 Milan, Italy.,3Department of Pediatric Orthopedics and Neuro-orthopedics, Humanitas Research Hospital, University of Milan, Via Manzoni 56, 20089 Rozzano, MI Italy
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Martinelli N, Bianchi A, Martinkevich P, Sartorelli E, Romeo G, Bonifacini C, Malerba F. Return to sport activities after subtalar arthroereisis for correction of pediatric flexible flatfoot. J Pediatr Orthop B 2018; 27:82-87. [PMID: 28263247 DOI: 10.1097/bpb.0000000000000449] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to establish whether children treated with subtalar arthroereisis for flexible flatfoot were able to return to sport activities. We reviewed 49 patients with a mean age at the time of surgery of 10.7 years. The type of sport activities, the number of sessions per week, the time dedicated to each session, and the level achieved were assessed preoperatively and at the last follow-up. Overall, 45 patients returned to sports after surgery. Surgery did not alter the duration, frequency, and type of sporting activities, but the participation in physical activities as well as the emotional status and footwear issues improved.
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Affiliation(s)
- Nicolò Martinelli
- Department of Foot and Ankle Surgery, Galeazzi Hospital, Milan, Italy
| | - Alberto Bianchi
- Department of Foot and Ankle Surgery, Galeazzi Hospital, Milan, Italy
| | - Polina Martinkevich
- Department of Children's Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Elena Sartorelli
- Department of Foot and Ankle Surgery, Galeazzi Hospital, Milan, Italy
| | - Giovanni Romeo
- Department of Foot and Ankle Surgery, Galeazzi Hospital, Milan, Italy
| | - Carlo Bonifacini
- Department of Foot and Ankle Surgery, Galeazzi Hospital, Milan, Italy
| | - Francesco Malerba
- Department of Foot and Ankle Surgery, Galeazzi Hospital, Milan, Italy
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Arthroereisis: physiologic blocking of the subtalar joint. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Calvo Calvo S, Marti Ciruelos R, Rasero Ponferrada M, González de Orbe G, Viña Fernández R. More than 10 years of follow up of the stop screw technique. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Calvo Calvo S, Marti Ciruelos R, Rasero Ponferrada M, González de Orbe G, Viña Fernández R. [More than 10 years of follow up of the stop screw technique]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 60:75-80. [PMID: 26059741 DOI: 10.1016/j.recot.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Infantile flexible flatfoot does not require treatment in most cases. Symptomatic flexible flat feet are treated orthopaedically and surgery is only indicated when orthosis fails. MATERIAL AND METHODS Cases who underwent surgical treatment with the stop screw technique at the 12 de Octubre Hospital between 1995 and 2002 are reported. Patient progress is also analysed. Six angles are measured on the x-ray prior to surgery and those same x-ray angles are measured again before material extraction. They are then compared to see if the correction achieved is statistically significant. A more reduced sample is currently being assessed with the same radiological measurements and two clinical assessment scales: Lickert, and Smith and Millar. The latest x-rays are analysed by two radiologists to determine if there is subtalar arthrosis. RESULTS In the short term, statistically significant differences are observed in all angles. The comparison between the post-surgery angles and the current angles does not show differences, except for the Giannestras angle, which has statistically significantly worsened. Clinical results and patient satisfaction is good. Incipient subtalar arthrosis is present in 68.5% of current patient x-rays. CONCLUSIONS Stop screw method is a cheap, simple and effective technique to correct symptomatic flexible flatfoot that has not improved with conservative treatment. This technique provides short-term foot correction which can be maintained over time.
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Affiliation(s)
- S Calvo Calvo
- Servicio de Traumatología Infantil, Hospital Universitario 12 de Octubre, Madrid, España.
| | - R Marti Ciruelos
- Servicio de Traumatología Infantil, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Rasero Ponferrada
- Servicio de Radiología Infantil, Hospital Universitario 12 de Octubre, Madrid, España
| | - G González de Orbe
- Servicio de Radiología Infantil, Hospital Universitario 12 de Octubre, Madrid, España
| | - R Viña Fernández
- Servicio de Traumatología Infantil, Hospital Universitario 12 de Octubre, Madrid, España
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Tarissi N, Vallée A, Dujardin F, Duparc F, Roussignol X. Reducible valgus flat-foot: assessment of posterior subtalar joint surface displacement by posterior arthroscopy during sinus tarsi expansion screwing. Orthop Traumatol Surg Res 2014; 100:S395-9. [PMID: 25454334 DOI: 10.1016/j.otsr.2014.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Subtalar arthroereisis corrects childhood and adult reducible valgus flat-foot in certain indications. Inserting an expansion screw in the sinus tarsi simultaneously corrects the calcaneal valgus of the talocalcaneal divergence and first-ray pronation if these are reducible. The displacement induced in the posterior subtalar joint (decoaptation, translation, rotation) is, however, poorly known. The present study involved arthroscopic assessment of posterior subtalar joint surface displacement during insertion of a talocalcaneal arthroereisis screw, with the hypothesis that displacement varies in three dimensions according to screw size. MATERIAL AND METHOD Eight specimens were used for the study. All ankles were supple, taken from adult subjects. A 4.5-mm arthroscope was used and measurements were taken with a graduated palpator in the posterior subtalar joint. Three sinus tarsi expansion screws of incremental diameter were assessed. Before and after insertion measurements were made of posterolateral and posteromedial talar exposure on the calcaneus, anteroposterior and lateromedial translation, and talocalcaneal joint-line opening. RESULTS Medial rotation, varization and anterior translation of the calcaneus were comparable in all cases. Mean lateral opening of the posterior subtalar joint was 0.88 mm with 8-mm screws and 1.25 mm with 16-mm screws. Significant differences between 8 and 16 mm screws were found for lateral subtalar joint opening (P=0.028) and for lateromedial translation (P=0.004). CONCLUSION Sinus tarsi expansion screwing corrects hindfoot valgus and talocalcaneal divergence by inducing medial translation of the calcaneus under the talus and talar medial rotation and varization, proportional to screw size (medial translation and lateral opening of the subtalar joint). LEVEL OF EVIDENCE III.
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Affiliation(s)
- N Tarissi
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - A Vallée
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - F Dujardin
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - F Duparc
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - X Roussignol
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France.
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Nakhostin-Roohi B, Hedayati S, Aghayari A. The effect of flexible flat-footedness on selected physical fitness factors in female students aged 14 to 17 years. JOURNAL OF HUMAN SPORT AND EXERCISE 2013. [DOI: 10.4100/jhse.2013.83.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yen-Douangmala D, Vartivarian M, Choung JD. Subtalar arthroereisis and its role in pediatric and adult population. Clin Podiatr Med Surg 2012; 29:383-90. [PMID: 22727379 DOI: 10.1016/j.cpm.2012.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Subtalar joint arthroereisis is a surgical procedure that addresses symptomatic flexible flatfoot deformities using an extraarticular implant within the sinus tarsi. Three groups of implants have been developed for this procedure: self-locking wedges, axis-altering devices, and impact-blocking devices. The self-locking wedge implants are the focus of this article, relative to its use, limitations, and controversies in the pediatric and adult population.
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Affiliation(s)
- Daphne Yen-Douangmala
- Department of Podiatric Surgery, Kaiser Foundation Hospital, 99 Montecillo Road, San Rafael, CA 94903, USA
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Shih YF, Chen CY, Chen WY, Lin HC. Lower extremity kinematics in children with and without flexible flatfoot: a comparative study. BMC Musculoskelet Disord 2012; 13:31. [PMID: 22381254 PMCID: PMC3359242 DOI: 10.1186/1471-2474-13-31] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 03/02/2012] [Indexed: 11/13/2022] Open
Abstract
Background A high percentage of young children present with flatfeet. Although the percentage of those with flatfeet declines with age, about 15% of the population maintains a flat arch. A reduction in longitudinal arch height usually combines with excessive subtalar joint pronation and may be related to other musculoskeletal problems of the lower extremity kinetic chain. The purpose of this study is to describe and compare the lower extremity kinematics between children with normal arches and those with flexible flatfeet, with the intent of providing practical information for decision making when treating children with flexible flatfeet. Methods Twenty children with flexible flatfeet (years age mean (SD), 9.7 (0.9) years) and 10 children with normal arches (yeas age mean (SD), 9.6 (1.2) years) were included. Kinematic data (maximum and minimum angles, and movement range, velocity, and excursion) of the hip, knee and rearfoot were collected during walking using Liberty Electromagnetic Tracking System. Kinematic variables were compared between the normal arches and flexible flatfeet groups using repeated measures mixed effects ANOVA. Results Movement patterns at the hip, knee and ankle joints were similar between children with flexible flatfeet and with normal arches. The results of ANOVA showed no significant main effect or interaction in any of the kinematic variables (P ≥ 0.05). Conclusions This study identified no kinematic adaptation during walking in children with flexible flatfoot. We suggested that future research should take the influence of the mid-foot and forefoot into consideration when examining lower extremity kinematics in children with flexible flatfoot.
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Affiliation(s)
- Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155 LiNong Street Section 2, Pei-Tou District, Taipei, Taiwan 112.
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