Foot Build Registration System (FBRS) to evaluate foot posture: a reliability study with healthy subjects and patients with Charcot-Marie-Tooth disease

Inframalleolar Varus Deformity: Role of Calcaneal Osteotomies

The cavo varus foot is a complex pathology due to skeletal deformity and neuro-muscular unbalance. The key concept for a successful treatment is to consider the whole foot and ankle complex from a bone and soft tissue perspective. Undercorrection is the main issue in cavo varus foot management, which may be attributed to intrinsic correction defects of the described calcaneal osteotomies or to a lack of understanding about the pathology and the subsequent algorithm of treatment. The authors disclose their daily algorithm of treatment, considering the foot and ankle complex and the role of calcaneal osteotomies in ankle inframalleolar deformities.

Long-term results after triple arthrodesis: Influence of alignment on ankle osteoarthritis and clinical outcome

BACKGROUND

Pain, deformity and instability are the main reasons for fusion of the tarsal joints, a triple arthrodesis. The short and midterm results show that mobility, function and satisfaction increase postoperatively. However, osteoarthritis (OA) of the adjacent ankle joint is described as a long-term complication. Alignment of the foot could be an influencing factor. The aim of this study was to examine whether malalignment after triple arthrodesis leads to a higher grade of OA at long-term follow-up.

METHODS

Between 1991 and 2002, 81 patients underwent a triple arthrodesis. Preoperatively, postoperatively, 3, 7.5 and 15 years after surgery, dorsoplantar (DP) and lateral X-rays were taken and used to evaluate the degree of OA and the geometry of the foot. The degree of OA was estimated using the Kellgren and Lawrence score. The geometry of the foot was assessed using Meary's angle; a Meary's angle exceeding 15° in DP and/or greater than -5 to 5° from the lateral view was defined as malalignment. In addition to the radiological evaluation, clinical scores (FFI and AOFAS) were recorded.

RESULTS

Thirty-five patients (40 feet) were available for analysis 15 years after surgery. In 19 cases there was an increase in ankle OA following the operation. Eight feet showed malalignment on the lateral view and 28 on the DP view. There was no difference in both an increase of ankle OA or clinical outcome between correct aligned feet and feet classified as malaligned. Thirty-three patients with 38 treated feet stated that they would decide to undergo the treatment again. Two patients would not want to undergo the same surgery again. The patients were satisfied with the result of surgery, clinical scores improved after surgery and remained stable in the long-term.

CONCLUSIONS

Triple arthrodesis is a salvage procedure in patients with a painful and deformed hindfoot and results in a clinically beneficial outcome, even 15 years after surgery. The present study did not show that malalignment after triple arthrodesis results in a higher grade of OA of the ankle joint in the long-term. The cause of the aggravation of OA is still not fully understood and needs further research. Nevertheless, clinical results are satisfying 15 years postoperatively.

Does osteoarthritis of the ankle joint progress after triple arthrodesis? A midterm prospective outcome study

BACKGROUND

Debate exists regarding the effect of triple fusion on the development of osteoarthritis (OA) of the ankle joint. The midterm outcome after triple arthrodesis and the prevalence of OA following triple arthrodesis are reported in this study. The role of alignment in the development of OA was investigated.

METHODS

Seventy five patients (87 feet) were evaluated in 2003 and of these, 48 patients (55 feet) were available for second evaluation in 2008. X-rays of the ankles and feet were made prior to surgery, in 2003 and in 2008, and the level of osteoarthritis (OA) was graded with the Kellgren and Lawrence score. Of all postoperative X-rays, the AP and lateral talo first metatarsal angle X-rays were compared. Also, standardized digital photos were made to assess the geometry/alignment. The Foot Function Index (FFI) and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were completed. In order to investigate the role of the underlying alignment on the aggravation of ankle osteoarthritis, patients were divided into a 'varus' and a 'valgus' group based on the indication for surgery.

RESULTS

The outcome scores (AOFAS and FFI) after triple arthrodesis remained stable in the present 7.5-year follow-up study. An important increase of OA of the ankle was not established, 58% of the patients showed no aggravation, 31% one-grade and 2% two-grade increase of OA. A trend was found (P=.063) towards aggravation of OA of the ankle in patients of the varus group with the highest medial arches (persistent cavovarus deformity).

CONCLUSION

This study reports minor, not statistically significant, changes of the ankle joint following triple arthrodesis after 7.5 years. Clinical outcome remained stable in time. Clinical relevance It seems that triple arthrodesis as such does not lead to major osteoarthritis of the ankle, given that adequate alignment of the hindfoot is achieved.

LEVEL OF EVIDENCE

Level II, retrospective study.

The effect of posture on the osseous relations in the foot

BACKGROUND

Discrepancies observed between clinical findings and a weightbearing foot X-ray might be caused by a patients' positioning. This study's main objective was to determine the effect of a subjects' posture on the osseous relations of the foot.

METHODS

Anatomical markers were placed on the skin of the foot of 17 subjects. A plantar pressure plate assessed the percentage weight on the foot and weight distribution over the foot. Medial longitudinal foot angles were derived from the markers and compared between the 10 postures. The effect of percentage weight and weight distribution on the foot angles was determined by multiple regression analysis.

RESULTS

The foot angles were significantly affected by the postures. The multiple regression analysis revealed the weight on the foot and the mediolateral weight distribution over the foot as important factors for the foot angles.

CONCLUSION

A subjects posture significantly influences the osseous relations in the foot.

Flat feet, happy feet? Comparison of the dynamic plantar pressure distribution and static medial foot geometry between Malawian and Dutch adults

In contrast to western countries, foot complaints are rare in Africa. This is remarkable, as many African adults walk many hours each day, often barefoot or with worn-out shoes. The reason why Africans can withstand such loading without developing foot complaints might be related to the way the foot is loaded. Therefore, static foot geometry and dynamic plantar pressure distribution of 77 adults from Malawi were compared to 77 adults from the Netherlands. None of the subjects had a history of foot complaints. The plantar pressure pattern as well as the Arch Index (AI) and the trajectory of the center of pressure during the stance phase were calculated and compared between both groups. Standardized pictures were taken from the feet to assess the height of the Medial Longitudinal Arch (MLA). We found that Malawian adults: (1) loaded the midfoot for a longer and the forefoot for a shorter period during roll off, (2) had significantly lower plantar pressures under the heel and a part of the forefoot, and (3) had a larger AI and a lower MLA compared to the Dutch. These findings demonstrate that differences in static foot geometry, foot loading, and roll off technique exist between the two groups. The advantage of the foot loading pattern as shown by the Malawian group is that the plantar pressure is distributed more equally over the foot. This might prevent foot complaints.