1
|
Stellar D, Lyons SR, Ramdass R, Meyr AJ. The Role of Equinus in Flatfoot Deformity. Clin Podiatr Med Surg 2023; 40:247-260. [PMID: 36841577 DOI: 10.1016/j.cpm.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Equinus plays an important role in flatfoot deformity. Proper evaluation and surgical management are critical to comprehensively treat and successfully resolved patients' symptoms. We have discussed the cause, evaluation, and some of the common surgical options. Each procedure has its inherent benefits and risks. It is imperative that the foot and ankle surgeon identify and include these procedures as part of the complete reconstructive surgery.
Collapse
Affiliation(s)
- Devrie Stellar
- Inova Fairfax Medical Campus, 3300 Gallows Road, Fairfax, VA 22031, USA.
| | - Sean R Lyons
- Inova Fairfax Medical Campus, 3300 Gallows Road, Fairfax, VA 22031, USA
| | - Roland Ramdass
- Foot & Ankle Center, P.C., 912 South Pleasant Valley Road, Winchester, VA 22601, USA; Residency Training Committee Inova Fairfax Medical Campus
| | - Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, 2nd Floor, 148 North 8th Street, Philadelphia, PA 19107, USA
| |
Collapse
|
2
|
Comparison between Malerba osteotomy and combined Evans/medial displacement calcaneal osteotomies for the management of flexible pes planus in young adults: a prospective randomised control trial, three years follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:2579-2588. [PMID: 34414486 DOI: 10.1007/s00264-021-05172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of the current study is to evaluate the functional and radiological outcomes of Malerba osteotomy in comparison to the standardized combined Evans/Medial Displacement Calcaneal Osteotomy (MDCO) in the management of symptomatic flexible pes planus in young adults. METHODS Prospective randomized control trial included 34 feet (33 patients), 17 cases in each group. Functionally, patients were assessed by AOFAS and FADI scores. Radiographic evaluation included calcaneal pitch, lateral talo-1st metatarsal, AP talo-first metatarsal, AP talo-calcaneal angles, and the talar coverage percentage. RESULTS Pre-operative and three years follow-up scores and angles were compared between both groups. No statistically significant difference could be detected between both groups (P value 0.87). However, the data showed statistically significant difference in each group when comparing (pre-operative and third year follow-up scores and angles) (P value < 0.001). The mean union rate was eight weeks in Malerba group and nine weeks in Evans/MDCO group. No incidence of nonunion. Complications like calcaneocuboid subluxation, calcaneal anterior process fracture, and lateral column pain were exclusively reported in Evans/MDCO group. CONCLUSION Malerba osteotomy is a strong valid option for the operative management of flexible pes planus in young adults. Authors recommend Malerba osteotomy in all mild and moderate deformities due to lower complication rate while the combined Evans/MDCO is preferred in severe deformity due to relatively higher corrective power with consideration of possible complications.
Collapse
|
3
|
Catani O, Cautiero G, Sergio F, Cattolico A, Calafiore D, de Sire A, Zanchini F. Medial Displacement Calcaneal Osteotomy for Unilateral Adult Acquired Flatfoot: Effects of Minimally Invasive Surgery on Pain, Alignment, Functioning, and Quality of Life. J Foot Ankle Surg 2021; 60:358-361. [PMID: 33472755 DOI: 10.1053/j.jfas.2020.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/18/2020] [Accepted: 11/22/2020] [Indexed: 02/03/2023]
Abstract
We aimed to assess the effects of medial displacement calcaneal osteotomy (MDCO) through a minimal skin incision in terms of pain, function, and alignment in patients with unilateral adult acquired flatfoot. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale and Numeric Pain Rating Scale (NPRS) were assessed as outcomes at the baseline (T0), at 6 months (T1), and at 1 year (T2) from surgery. We analyzed data of 20 patients (7 male and 13 female), mean aged 46.6 ± 5.34 years, showed significant differences after 6 months in terms of AOFAS total score (44.30 ± 7.39 vs 96.50 ± 4.89; p = .0001), AOFAS subitems (p < .001), and pain (NPRS: 7.95 ± 1.36 vs 1.05 ± 1.05; p = .0001). At 1 year after surgery (T2), all outcome measures still significantly differ from baseline (p < 01). Therefore, percutaneous MDCO through a minimal skin incision seemed to be safe and effective in the middle and long term in reducing pain and improving function and alignment in patients with unilateral adult acquired flatfoot.
Collapse
Affiliation(s)
- Ottorino Catani
- Foot and Ankle Surgeon, Department of Orthopaedic and Traumatology, Casa di Cura S. Maria della Salute, Santa Maria Capua Vetere, Caserta, Italy
| | - Giovanni Cautiero
- Foot and Ankle Surgeon, Department of Orthopaedic and Traumatology, Casa di Cura S. Maria della Salute, Santa Maria Capua Vetere, Caserta, Italy
| | - Fabrizio Sergio
- Foot and Ankle Surgeon, Department of Orthopaedic and Traumatology, Casa di Cura S. Maria della Salute, Santa Maria Capua Vetere, Caserta, Italy
| | - Alessandro Cattolico
- Resident in Orthopaedics, Clinical Orthopaedics, Department of Medical and Surgical Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dario Calafiore
- Physiatrist, Neuromotor Rehabilitation Unit, Neuroscience Department, Azienda Socio Sanitaria Territoriale di Mantova, Bozzolo, Mantova, Italy
| | - Alessandro de Sire
- Assistant Professor of Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy; Physiatrist, Rehabilitation Unit, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy.
| | - Fabio Zanchini
- Assistant Professor of Orthopaedics, Clinical Orthopaedics, Department of Medical and Surgical Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
4
|
Espinosa N, Klammer G. The Failed Deltoid Ligament in the Valgus Misaligned Ankle-How to Treat? Foot Ankle Clin 2021; 26:391-405. [PMID: 33990260 DOI: 10.1016/j.fcl.2021.03.011] [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] [Indexed: 02/02/2023]
Abstract
This article deals with the treatment of a chronically failed deltoid ligament complex in the valgus misaligned ankle. This is a challenging task in every orthopedic foot and ankle surgery. Before embarking on any surgery that relates to the deltoid ligament complex, it is mandatory to analyze any underlying cause that could promote the impairment. Once this is done, it might be of value in considering anatomic reconstructions. The article provides an anatomic reconstruction technique, which should help address the problem.
Collapse
Affiliation(s)
- Norman Espinosa
- Institute for Foot and Ankle Reconstruction, Beethovenstrasse 3, Zurich 8002, Switzerland.
| | - Georg Klammer
- Institute for Foot and Ankle Reconstruction, Beethovenstrasse 3, Zurich 8002, Switzerland
| |
Collapse
|
5
|
Persaud S, Hentges MJ, Catanzariti AR. Occurrence of Lateral Ankle Ligament Disease With Stage 2 to 3 Adult-Acquired Flatfoot Deformity Confirmed via Magnetic Resonance Imaging: A Retrospective Study. J Foot Ankle Surg 2019; 58:243-247. [PMID: 30583836 DOI: 10.1053/j.jfas.2018.08.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 02/03/2023]
Abstract
Lateral hindfoot pain associated with stage 2 to 3 adult-acquired flatfoot is often attributed to subfibular impingement. Preoperative magnetic resonance imaging (MRI) is generally performed to assess the extent of degeneration within the posterior tibial tendon, attenuation of medial soft tissue constraints, and degeneration of hindfoot and/or ankle articulations. The purpose of this study is to determine the incidence of lateral collateral ligament disease/injury associated with stages 2 and 3 adult-acquired flatfoot. The subjects were identified using a searchable computerized hospital database between 2015 and 2017. Stage 2 or 3 adult-acquired flatfoot deformity was confirmed in patients via chart review and MRI analysis. Lateral ankle ligament injury was confirmed using patient MRI results per the hospital radiologist and documented within the patients' chart. Inclusion criteria required that patients be diagnosed with Johnson and Strom stage 2 or 3 flatfoot deformity with documented lateral ankle pain and that preoperative MRI scans be available with the radiologist's report. Patient exclusion criteria included patients <18 years of age, patients with flatfoot deformity caused by previous trauma, tarsal coalition, neuropathic arthritis, patients with previous surgery, or patients with incomplete medical records. In total, 118 patients were identified with these parameters. Of the 118 patients, 74 patients (62.7%) had documented lateral ankle ligament injury on MRI. Of the 77 patients with stage 2 adult-acquired flatfoot, 55 (71.4%) had confirmed lateral ankle ligament injury on MRI. Of the 41 patients with stage 3 adult-acquired flatfoot, 19 (46.3%) had confirmed lateral ankle ligament injury on MRI. This study demonstrates a relatively high incidence of lateral ligament disease associated with adult-acquired flatfoot deformity. These findings might have long-term implications regarding ankle arthritis after surgical management of adult-acquired flatfoot.
Collapse
Affiliation(s)
- Sham Persaud
- Resident, Division of Foot & Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Matthew J Hentges
- Faculty, Division of Foot & Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Alan R Catanzariti
- Director of Residency Training, Division of Foot & Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA.
| |
Collapse
|
6
|
Kobayashi H, Kageyama Y, Shido Y. Calcaneocuboid Distraction Arthrodesis With Synthetic Bone Grafts: Preliminary Results of an Innovative Bone Grafting Procedure in 13 Patients. J Foot Ankle Surg 2018; 56:1223-1231. [PMID: 28843551 DOI: 10.1053/j.jfas.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Indexed: 02/03/2023]
Abstract
Calcaneocuboid distraction arthrodesis (CCDA) is regarded as an effective method for reconstructing adult-acquired flatfoot deformity. In the present study, we present our experience with newly developed rigid β-tricalcium phosphate wedges to treat CCDA to better understand the outcomes of this synthetic bone grafting procedure. A total of 13 feet in 13 patients underwent CCDA with synthetic bone grafts. One male (7.69%) and 12 females (92.31%), with a mean age of 65.07 ± 11.83 (range 36 to 77) years, were followed up for a mean duration of 32.76 ± 12.81 (range 18 to 55) months. Successful graft union was postoperatively obtained in 12 of the 13 feet (92.31%). The mean preoperative visual analog scale and American Orthopaedic Foot and Ankle Society scale score were 7.97 ± 1.52 (range 5.4 to 10) and 54.46 ± 14.72 (range 18 to 75), respectively. These scores improved to 1.52 ± 1.78 (range 0 to 6.2) and 85.46 ± 13.38 (range 50 to 97) postoperatively (p = .001 for both comparisons). On radiographic analysis, the talonavicular coverage angle, first metatarsal talar angle, calcaneal pitch, and heel alignment angle had significantly improved (p = .001, p = .028, p = .006, and p = .001, respectively). The use of bone graft substitutes in CCDA is a viable treatment option for reconstructing flexible flatfoot deformity. Although good clinical and radiographic outcomes were obtained, our method is even more challenging than conventional methods and should be used with caution. Rigid locking fixation with a long period of protected weightbearing is highly recommended to attain uneventful bone healing.
Collapse
Affiliation(s)
- Hayato Kobayashi
- Director, Department of Orthopaedic Surgery, Fujieda Heisei Memorial Hospital, Shizuoka, Japan.
| | - Yasunori Kageyama
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Suzukake Central Hospital, Shizuoka, Japan
| | - Yoji Shido
- Assistant Professor, Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| |
Collapse
|
7
|
Meyr AJ, Sansosti LE, Ali S. A pictorial review of reconstructive foot and ankle surgery: evaluation and intervention of the flatfoot deformity. J Radiol Case Rep 2017; 11:26-36. [PMID: 29299095 DOI: 10.3941/jrcr.v11i6.2757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This pictorial review focuses on basic procedures performed within the field of podiatric surgery, specifically for elective reconstruction of the midfoot and rearfoot with focus on the flatfoot deformity. Our goal is to demonstrate objective radiographic parameters that surgeons utilize to initially define the deformity, lead to procedure selection, and judge post-operative outcomes. We hope that radiologists will employ this information to improve their assessment of post-operative radiographs following reconstructive foot surgeries. First, relevant radiographic measurements are defined and their role in procedure selection explained. Second, the specific surgical procedures of the Evans calcaneal osteotomy, medial calcaneal slide osteotomy, Cotton osteotomy, subtalar joint arthroeresis, and arthrodeses of the rearfoot are described. Finally, specific plain film radiographic findings that judge post-operative outcomes for each procedure are detailed.
Collapse
Affiliation(s)
- Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania, USA
| | - Laura E Sansosti
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
8
|
Arvinius C, Manrique E, Urda A, Cardoso Z, Galeote JE, Marco F. A mid-term follow-up of Koutsogiannis' osteotomy in adult-acquired flatfoot stage II and "early stage III". SICOT J 2017; 3:24. [PMID: 28304274 PMCID: PMC5356448 DOI: 10.1051/sicotj/2017011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/24/2017] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Koutsogiannis' osteotomy has been widely described to treat adult-acquired flatfoot. However, few articles describe its midterm follow-up. Our aim was to study clinical and radiological outcomes at least one year after surgery and to analyze whether a combined procedure on the medial soft tissue affected these outcomes. METHODS We performed a retrospective study of 30 feet of patients who underwent a Koutsogiannis' osteotomy due to adult-acquired flatfoot stage II and "early stage III": a stage III acquired flatfoot without any important structural deformities. The parameters studied were additional medial soft tissue procedures, clinical outcome through the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and midfoot score as well as complications and radiological measurements. RESULTS Sixteen cases were "early stage III" and 14 stage II. Thirteen patients underwent an associated posterior tibial tendon (PTT) revision: in three cases an end-to-end suture was possible, seven cases needed a FDL transposition, and three underwent synovectomy. Statistically significant improvement was found in the AOFAS score although no significant changes were seen radiologically. No additional benefit was found with the revision of the posterior tibial tendon. As to clinical and radiological results, no differences were found between stage II and "early stage III". Five cases presented a mild dysesthesia but only one patient needed neurolysis. CONCLUSIONS We consider the Koutsogiannis' osteotomy to be a safe and effective procedure to reduce pain in patients with stage II and "early stage III" adult-acquired flatfoot.
Collapse
Affiliation(s)
- Camilla Arvinius
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Elena Manrique
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Antonio Urda
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Zulema Cardoso
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Jose Enrique Galeote
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Fernando Marco
- Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| |
Collapse
|
9
|
Cöster MC, Rosengren BE, Bremander A, Karlsson MK. Surgery for adult acquired flatfoot due to posterior tibial tendon dysfunction reduces pain, improves function and health related quality of life. Foot Ankle Surg 2015; 21:286-9. [PMID: 26564733 DOI: 10.1016/j.fas.2015.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/04/2015] [Accepted: 04/13/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with adult acquired flatfoot deformity (AAFD) due to posterior tibial tendon dysfunction (PTTD) may require surgery but few reports have evaluated the outcome. METHODS We evaluated 21 patients with a median age of 60 (range 37-72) years who underwent different surgical reconstructions due to stage II AAFD before and 6 and 24 months after surgery by the validated Self-Reported Foot and Ankle Score (SEFAS), Short Form 36 (SF-36) and Euroquol 5 Dimensions (EQ-5D). RESULTS The improvement from before to 24 months after surgery was in SEFAS mean 12 (95% confidence interval 8-15), SF-36 physical function 21 (10-22), SF-36 bodily pain 28 (17-38), EQ-5D 0.2 (0.1-0.3) and EQ-VAS 11 (2-21). CONCLUSION Surgery for AFFD due to PTTD results in reduced pain and improved function and health related quality of life. The outcome scores have been demonstrated as useful. It has also been shown, since there is a further improvement between 6 and 24 months after surgery, that a minimum follow-up of 2 years is needed. LEVEL OF CLINICAL EVIDENCE III - prospective observational cohort study.
Collapse
Affiliation(s)
- M C Cöster
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden.
| | - B E Rosengren
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden
| | - A Bremander
- Departments of Rheumatology and Clinical Sciences Lund, Lund University, Lund, Sweden
| | - M K Karlsson
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden
| |
Collapse
|
10
|
Espinosa N, Maurer MA. Stage I and II Posterior Tibial Tendon Dysfunction: Return to Running? Clin Sports Med 2015; 34:761-8. [PMID: 26409594 DOI: 10.1016/j.csm.2015.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Posterior tibial tendon dysfunction can be a difficult entity to treat in the athletic population. Understanding the deformity components allows the physician to maximize nonoperative intervention with orthotics and physical therapy. Not all patients improve with nonoperative treatment, and surgical intervention can be successful in minimizing symptoms. Although return to full athletic activity is not universally possible, an active lifestyle is possible for many after surgical reconstruction.
Collapse
Affiliation(s)
- Norman Espinosa
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
| | - Marc A Maurer
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland
| |
Collapse
|