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Cigercioglu NB, Bazancir‐Apaydin Z, Apaydin H, Baltaci G, Guney‐Deniz H. Differences in ankle and knee muscle architecture and plantar pressure distribution among women with knee osteoarthritis. J Foot Ankle Res 2024; 17:e12028. [PMID: 38820170 PMCID: PMC11296719 DOI: 10.1002/jfa2.12028] [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: 03/18/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The aim of this study was to compare the plantar pressure distribution and knee and ankle muscle architecture in women with and without knee osteoarthritis (OA). METHODS Fifty women with knee OA (mean age = 52.11 ± 4.96 years, mean Body mass index (BMI) = 30.94 ± 4.23 kg/m2) and 50 healthy women as a control group (mean age = 50.93 ± 3.78 years, mean BMI = 29.06 ± 4.82 kg/m2) were included in the study. Ultrasonography was used to evaluate knee and ankle muscles architecture and femoral cartilage thickness. The plantar pressure distribution was evaluated using the Digital Biometry Scanning System and Milleri software (DIASU, Italy). Static foot posture was evaluated using the Foot Posture Index (FPI), and pain severity was assessed using the Visual Analog Scale. RESULTS The OA group exhibited lower muscle thickness in Rectus Femoris (RF) (p = 0.003), Vastus Medialis (VM) (p = 0.004), Vastus Lateralis (p = 0.023), and Peroneus Longus (p = 0.002), as well as lower Medial Gastrocnemius pennation angle (p = 0.049) and higher Fat thickness (FT) in RF (p = 0.033) and VM (p = 0.037) compared to the control group. The OA group showed thinner femoral cartilage thickness (p = 0.001) and higher pain severity (p = 0.001) than the control groups. FPI scores were higher (p = 0.001) in OA group compared to the control group. The plantar pressure distribution results indicated an increase in total surface (p = 0.027), total load (p = 0.002), medial load (p = 0.005), and lateral load (p = 0.002) on dominant side in OA group compared to the control group. CONCLUSIONS Knee and ankle muscle architecture, knee extensor muscle FT, and plantar pressure distribution in the dominant foot differed in individuals with knee OA compared to the control group.
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Affiliation(s)
- Nazli Busra Cigercioglu
- Faculty of Physical Therapy and RehabilitationDepartment of Musculoskeletal Physiotherapy and RehabilitationHacettepe UniversityAnkaraTurkey
| | - Zilan Bazancir‐Apaydin
- Faculty of Health ScienceDepartment of Physiotherapy and RehabilitationAnkara Medipol UniversityAnkaraTurkey
| | - Hakan Apaydin
- Department of RheumatologyAnkara Etlik City HospitalAnkaraTurkey
| | - Gul Baltaci
- Department of Physiotherapy and RehabilitationIstanbul Atlas University Faculty of Health ScienceIstanbulTurkey
| | - Hande Guney‐Deniz
- Faculty of Physical Therapy and RehabilitationDepartment of Musculoskeletal Physiotherapy and RehabilitationHacettepe UniversityAnkaraTurkey
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Hsu WC, Chou LW, Chiu HY, Hsieh CW, Hu WP. A Study on the Effects of Lateral-Wedge Insoles on Plantar-Pressure Pattern for Medial Knee Osteoarthritis Using the Wearable Sensing Insole. SENSORS (BASEL, SWITZERLAND) 2022; 23:84. [PMID: 36616681 PMCID: PMC9824433 DOI: 10.3390/s23010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Patients with knee osteoarthritis have a unique plantar-pressure pattern during walking, and lateral-wedge insoles are one of the treatment options. Participants were randomly assigned to either the lateral-wedge insole group or the ordinary insole group. The Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and plantar-pressure test scores were evaluated at the baseline and at 20 weeks. Plantar pressure data were collected using a pressure insole with 89 sensing locations. In the ordinary insole group, the function and total WOMAC scores decreased significantly (function score, 24.8 (baseline) to 16.5 (week 20); total score, 34.9 (baseline) to 24.6 (week 20)). During walking, the transverse width of the center of pressure as a percentage of foot width (%Trans) significantly increased in the ordinary insole group (baseline, 6.3%; week 20, 14.8%). In addition, the values of partial foot pressure as a percentage of body weight (%PFP) on the forefoot (baseline, 30.3%; week 20, 39.2%) and heel (baseline, 28.1%; week 20, 16.9%) also increased significantly in the ordinary insole group. Significant group-by-time interaction effects were observed for partial foot pressure per body weight in the forefoot (p = 0.031) and heel (p = 0.024). In the ordinary insole group, the plantar pressure on the heel significantly decreased (p = 0.011) and that on the forefoot significantly increased (p = 0.023). In contrast, plantar pressure remained stable in all regions in the lateral-wedge insole group. Thus, lateral-wedge insoles may protect against plantar pressure deterioration in patients with knee osteoarthritis.
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Affiliation(s)
- Wei-Ching Hsu
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung City 41354, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Taichung City 41354, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Taichung City 41354, Taiwan
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 40402, Taiwan
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung City 40402, Taiwan
| | - Hsiao-Yen Chiu
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung City 41354, Taiwan
| | - Chang-Wei Hsieh
- Department of Computer Science & Information Engineering, Asia University, Taichung City 41354, Taiwan
| | - Wen-Pin Hu
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung City 41354, Taiwan
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Early Notice Pointer, an IoT-like Platform for Point-of-Care Feet and Body Balance Screening. MICROMACHINES 2022; 13:mi13050682. [PMID: 35630149 PMCID: PMC9144081 DOI: 10.3390/mi13050682] [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: 03/14/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022]
Abstract
Improper foot biomechanics associated with uneven bodyweight distribution contribute to impaired balance and fall risks. There is a need to complete the panel of commercially available devices for the self-measurement of BMI, fat, muscle, bone, weight, and hydration with one that measures weight-shifting at home as a pre-specialist assessment system. This paper reports the development of the Early Notice Pointer (ENP), a user-friendly screening device based on weighing scale technology. The ENP is designed to be used at home to provide a graphic indication and customised and evidence-based foot and posture triage. The device electronically detects and maps the bodyweight and distinct load distributions on the main areas of the feet: forefoot and rearfoot. The developed platform also presents features that assess the user's balance, and the results are displayed as a simple numerical report and map. The technology supports data display on mobile phones and accommodates multiple measurements for monitoring. Therefore, the evaluation could be done at non-specialist and professional levels. The system has been tested to validate its accuracy, precision, and consistency. A parallel study to describe the frequency of arch types and metatarsal pressure in young adults (1034 healthy subjects) was conducted to explain the importance of self-monitoring at home for better prevention of foot arch- and posture-related conditions. The results showed the potential of the newly created platform as a screening device ready to be wirelessly connected with mobile phones and the internet for remote and personalised identification and monitoring of foot- and body balance-related conditions. The real-time interpretation of the reported physiological parameters opens new avenues toward IoT-like on-body monitoring of human physiological signals through easy-to-use devices on flexible substrates for specific versatility.
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Changes to foot pressure pattern in post-stroke individuals who have started to walk independently during the convalescent phase. Gait Posture 2021; 90:307-312. [PMID: 34564003 DOI: 10.1016/j.gaitpost.2021.09.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 09/05/2021] [Accepted: 09/15/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abnormal foot contact patterns following stroke affect functional gait; however, objective analysis targeting independent walking is lacking. RESEARCH QUESTION How do walking abilities and foot pressure patterns differ between post-stroke individuals who achieved independent walking and healthy controls? Secondarily, how do the abilities and patterns in post-stroke individuals change before and after achieving independent walking? Can these changes become criteria for permitting independent walking? METHODS Twenty-eight individuals with hemiplegia and 32 controls were enrolled. Motor dysfunction score (MDScore), walking speed (WSpeed), and foot pressure patterns were measured when they were first able to walk without orthosis or physical assistance (1st assessment) and when they achieved independent walking around discharge (2nd assessment). Foot pressure patterns were measured using insole-type foot pressure-measuring system. Ratios of partial foot pressure to body weight (%PFP), ratios of anteroposterior length of center of pressure (COP; %Long), and backward moving distance of COP to the foot length (%Backward) were calculated. Parameters during the 2nd assessment were compared with those of controls and those during the 1st assessment. During the 2nd assessment, relationships among the parameters, MDScore, and WSpeed were analyzed. RESULTS During the 2nd assessment, no difference was observed in both %Long and %Backward between the non-paretic limbs and the controls. While the %Backward was higher, the %PFP of toes and %Long were lower in the paretic limb than in the controls. Although the %Backward was lower, both %PFP of toes and %Long of the paretic limb were higher in the 2nd assessment than in the 1st assessment. During the 2nd assessment, both %Long and % Backward values of the paretic limb moderately correlated with MDScore and WSpeed. SIGNIFICANCE After improvement of foot pressure in toes, both an increase in anteroposterior length and a decrease in backward moving of COP path were objective signs permitting independent walking.
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Kato M, Warashina H, Kataoka A, Ando T, Mitamura S. Calcaneal insufficiency fractures following ipsilateral total knee arthroplasty. Injury 2021; 52:1978-1984. [PMID: 34030864 DOI: 10.1016/j.injury.2021.05.008] [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: 01/31/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Only a few reports have described calcaneal insufficiency fractures (IFs) following total knee arthroplasty (TKA). Herein, we describe nine cases of calcaneal IFs following ipsilateral TKA. The purpose of this study was to investigate the incidence of calcaneal fractures following TKA and determine the characteristics of patients with IFs. PATIENTS AND METHODS We retrospectively investigated cases of calcaneal IF that occurred following TKA. We collected and analyzed radiographic and magnetic resonance imaging (MRI) findings as well as patient demographic data. We compared the demographic data, bone mineral density (BMD), and preoperative hip-knee-ankle angle (HKA) between cases with a calcaneal fracture following TKA and 100 cases without a fracture following TKA. RESULTS We performed a total of 1548 knee arthroplasties at our clinic from 2011 to 2020. Nine calcaneal IFs in eight patients were diagnosed following ipsilateral TKA. All patients were women with varus knee osteoarthritis (mean age, 71.8 years). The average change in the alignment angle was 14.7° ± 5.4°. In eight cases, dysfunction was observed in the opposite lower limb. The postoperative onset of hindfoot pain started at an average of 5.6 months. In seven patients, calcaneal fractures occurred idiopathically, but in one patient, two fractures occurred after long-distance walking. No abnormal findings on a calcaneus radiograph were seen for six fractures. MRI demonstrated a definite fracture line and bone marrow edema in all patients. All patients, except one with type 2 diabetes mellitus (T2DM), had osteoporosis. Fractures healed without complications in eight patients; however, the calcaneal anterior facet fracture became displaced and caused a flat foot in one case. The calcaneal IF rate was 0.58% among all cases. Besides one case with T2DM, significant differences were observed in preoperative HKA and BMD between cases with a calcaneal fracture following TKA and those without a fracture. CONCLUSIONS A change in the load on the calcaneus due to changes in the alignment of the lower extremities after TKA may cause calcaneal IFs. Orthopedic surgeons should be aware of the possible occurrence of calcaneal IFs following TKA, especially in women with osteoporosis and severe varus knee.
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Affiliation(s)
- Michitaka Kato
- Department of Orthopaedic Surgery, Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011, Japan.
| | - Hideki Warashina
- Department of Orthopaedic Surgery, Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011, Japan
| | - Akito Kataoka
- Department of Rehabilitation, Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011, Japan
| | - Takanori Ando
- Department of Radiology, Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011, Japan
| | - Shingo Mitamura
- Department of Rehabilitation, Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011, Japan
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Sato H, Okada K, Wakasa M, Saito A, Kimoto M, Takahashi Y, Shibata K, Kamada T, Shinde T. Effect of heel lifts in elderly individuals with spinal kyphosis. Clin Biomech (Bristol, Avon) 2021; 83:105307. [PMID: 33662652 DOI: 10.1016/j.clinbiomech.2021.105307] [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: 08/12/2020] [Revised: 12/22/2020] [Accepted: 02/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The present study aimed to elucidate the effects of heel lifts on spinal alignment, walking, and foot pressure pattern in elderly individuals with spinal kyphosis. METHODS The spinal alignment, walking speed, step length and foot pressure of 33 community-dwelling elderly individuals with spinal kyphosis (3 men, 30 women; mean age 77.3 years) were examined before and after the application of 10-mm moderately elastic heel lifts. FINDINGS Spinal alignment of total inclination (mean value 6.9°vs 4.5°) and thoracic angle (43.6°vs 36.2°) were significantly lower after the application of heel lifts than before the application. The lumbar angle (7.3°vs 10.0°) was significantly higher after the application than before the application. Walking speed (0.78 vs 0.88 m/s) and step length (0.42 m vs 0.45 m) were significantly higher after the application. The partial foot pressure as a percentage of body weight of the hallux (6.7% vs 9.0%) and lateral toes (6.5% vs 9.0%) was significantly higher after the application of heel lifts than before the application. The partial foot pressure as a percentage of body weight of the heel (68.9% vs 57.5%) was significantly lower after the application than before the application. INTERPRETATION In conclusion, heel lifts influenced the sagittal spinal alignment of elderly individuals. Walking speed and step length increased after the application of these devices. Increase in foot pressure in the hallux and lateral toe areas was probably related to these improvements in walking parameters.
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Affiliation(s)
- Hiromichi Sato
- Department of Rehabilitation, Akita Kosei Medical Center, 1-1-1, Nishibukuro, Akita City, Akita, Japan.
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1, Hondou, Akita City, Akita, Japan.
| | - Masahiko Wakasa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1, Hondou, Akita City, Akita, Japan.
| | - Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1, Hondou, Akita City, Akita, Japan.
| | - Minoru Kimoto
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1, Hondou, Akita City, Akita, Japan
| | - Yusuke Takahashi
- Department of Rehabilitation, Akita University Hospital, 44-2, Hiroomote Hasunuma, Akita City, Akita, Japan.
| | - Kazuyuki Shibata
- Department of Rehabilitation, Akita City Hospital, 4-30, Kawamoto Matsuoka Town, Akita City, Akita, Japan
| | - Tetsuaki Kamada
- Department of Rehabilitation, Akita Kosei Medical Center, 1-1-1, Nishibukuro, Akita City, Akita, Japan
| | - Takuto Shinde
- Department of Rehabilitation, Akita City Hospital, 4-30, Kawamoto Matsuoka Town, Akita City, Akita, Japan
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Burssens A, De Roos D, Barg A, Welck MJ, Krähenbühl N, Saltzman CL, Victor J. Alignment of the hindfoot in total knee arthroplasty: a systematic review of clinical and radiological outcomes. Bone Joint J 2021; 103-B:87-97. [PMID: 33380206 DOI: 10.1302/0301-620x.103b1.bjj-2020-0143.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Patients with a deformity of the hindfoot present a particular challenge when performing total knee arthroplasty (TKA). The literature contains little information about the relationship between TKA and hindfoot alignment. This systematic review aimed to determine from both clinical and radiological studies whether TKA would alter a preoperative hindfoot deformity and whether the outcome of TKA is affected by the presence of a postoperative hindfoot deformity. METHODS A systematic literature search was performed in the databases PubMed, EMBASE, Cochrane Library, and Web of Science. Search terms consisted of "total knee arthroplasty/replacement" combined with "hindfoot/ankle alignment". Inclusion criteria were all English language studies analyzing the association between TKA and the alignment of the hindfoot, including the clinical or radiological outcomes. Exclusion criteria consisted of TKA performed with a concomitant extra-articular osteotomy and case reports or expert opinions. An assessment of quality was conducted using the modified Methodological Index for Non-Randomized Studies (MINORS). The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42019106980). RESULTS A total of 17 studies were found to be eligible for review. They included six prospective and ten retrospective studies, and one case-control study. The effects of TKA showed a clinical improvement in the hindfoot deformity in three studies, but did not if there was osteoarthritis (OA) of the ankle (one study) or a persistent deformity of the knee (one study). The radiological alignment of the hindfoot corrected in 11 studies, but did not in the presence of a rigid hindfoot varus deformity (in two studies). The effects of a hindfoot deformity on TKA included a clinical association with instability of the knee in one study, and a shift in the radiological weightbearing axis in two studies. The mean MINORS score was 9.4 out of 16 (7 to 12). CONCLUSION TKA improves both the function and alignment of the hindfoot in patients with a preoperative deformity of the hindfoot. This may not apply if there is a persistent deformity of the knee, a rigid hindfoot varus deformity, or OA of the ankle. Moreover, a persistent deformity of the hindfoot may adversely affect the stability and longevity of a TKA. These findings should be interpreted with caution due to the moderate methodological quality of the studies which were included. Therefore, further prospective studies are needed in order to determine at which stage correction of a hindfoot deformity is required to optimize the outcome of a TKA. Cite this article: Bone Joint J 2021;103-B(1):87-97.
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Affiliation(s)
- Arne Burssens
- Department of Orthopaedics, Royal National Orthopaedic Hospital, UCL Institute of Orthopaedics and Musculoskelatal Science, Stanmore, UK.,Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| | - Dries De Roos
- Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Matt J Welck
- Department of Orthopaedics, Royal National Orthopaedic Hospital, UCL Institute of Orthopaedics and Musculoskelatal Science, Stanmore, UK
| | - Nicola Krähenbühl
- Deparment of Orthopaedics and Traumatology, Kantonsspital Baselland, Liestal, Switzerland.,Department of Orthopaedics and Traumatology, Universitätsklinik Balgrist, Zurich, Switzerland
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Jan Victor
- Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
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Mansur H, Rocha FA, Sousa PGTDE, Castro IMDE. RELATIONSHIP BETWEEN THE KNEE AND HINDFOOT AXES IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:229-232. [PMID: 33144837 PMCID: PMC7580291 DOI: 10.1590/1413-785220202805231351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the correlation between knee axis and hindfoot axis in patients with advanced gonarthrosis, and the association between ankle function and angular deformities. METHODS 72 patients were enrolled in the study: 66% were women, and mean age was 58.7 years. The anatomical axis of the knee and hindfoot were measured by short knee radiographs and long axial view of the hindfoot. RESULTS Among the study group, 79.2% presented varus knee (mean 15º ± 7.69º) and 20.8% valgus (mean 15.9º ± 7.7º). 63.9% had hindfoot varus (mean 8.5º ± 6.07º) and 36.1% valgus (mean 3.9º ± 3.92º) (p < 0.05). The mean value for the American Orthopaedic Foot and Ankle Society (AOFAS) score was 74.26 points, and values were significantly higher among patients with hindfoot varus (p < 0.05). We found no correlation between gender or AOFAS score and knee and hindfoot axes, nor between deformities in the knee and hindfoot axes (p > 0.05). The subgroup genu valgum - hindfoot varus presented a moderate correlation (r = 0.564; p < 0.05). CONCLUSION We found no association between the anatomical axes of the knee and hindfoot. Patients with gonarthrosis and hindfoot varus presented a better ankle function. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
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Affiliation(s)
- Henrique Mansur
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
- Universidade de Brasília, Brasília, DF, Brazil
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Mansur H, Rocha FA, Garcia PBL, de Alencar FHU, Guilme P, de Castro IM. Alteration of Hindfoot Axis After Total Knee Arthroplasty. J Arthroplasty 2019; 34:2376-2382. [PMID: 31262620 DOI: 10.1016/j.arth.2019.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It has been shown that total knee arthroplasty (TKA) can correct the alignment of the lower limb, not only correcting the knee axis, but also affecting the alignment of the hindfoot. However, there is still not a significant amount of work in the literature. METHODS A prospective study was carried out in which 72 patients were radiographically (long axial view of the hindfoot) and clinically (American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale) evaluated before and 3 months after TKA. We investigated whether there were any significant associations between measurements of the axes, hindfoot angle, and AOFAS score with the type of deviation of the patient's axis. RESULTS For the subgroups "hindfoot valgus-knee valgus," "hindfoot valgus-knee varus," and "hindfoot varus-knee valgus," a reduction in angle after surgery was observed; for the cases "hindfoot varus-knee varus," an increase in angle after surgery was observed. However, the Wilcoxon test showed that only the changes in the hindfoot axis of the "hindfoot varus-knee valgus" subgroup are statistically significant (P < .05). After surgery, the Wilcoxon test showed that the AOFAS score changes are statistically significant for all subgroups for which it was possible to perform the test (P < .05). CONCLUSION TKA promotes changes in the postoperative hindfoot axis, significantly in patients with knee valgus and hindfoot varus. In addition, TKA provides significant improvement in the postoperative AOFAS score. LEVEL OF EVIDENCE IIB.
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Affiliation(s)
- Henrique Mansur
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Felipe Almeida Rocha
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | | | | | - Pedro Guilme
- Department of Knee Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Isnar Moreira de Castro
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
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