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Carneiro BC, Ormond Filho AG, Guimarães JB. MRI of Pediatric Foot and Ankle Conditions. Foot Ankle Clin 2023; 28:681-695. [PMID: 37536825 DOI: 10.1016/j.fcl.2023.04.007] [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: 08/05/2023]
Abstract
The increase in competitive sports practice among children and lack of ionizing radiation have resulted in a higher demand for MRI examinations. MRI of the children skeleton has some particularities that can lead orthopedists, pediatricians, and radiologists to diagnostic errors. The foot and ankle have several bones with abundant radiolucent and high signal intensity cartilage in several ossification centers, apophysis and physis, that can make this interpretation even harder. The present revision aims to show, how to differentiate between normal developmental findings and anatomic variants from pathologic conditions, whether mechanical, inflammatory, infectious, or neoplastic.
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Affiliation(s)
- Bruno Cerretti Carneiro
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, SP, Brazil; Department of Diagnostic Imaging, United Health Group Brazil, São Paulo, SP, Brazil
| | - Alípio G Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, SP, Brazil
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, SP, Brazil; Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, SP, Brazil.
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Mateen S, Van JC. Ligament Insufficiency with Flatfoot: Spring Ligament and Deltoid Ligament. Clin Podiatr Med Surg 2023; 40:307-314. [PMID: 36841581 DOI: 10.1016/j.cpm.2022.11.008] [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
The objective of this article was to review the deltoid ligament and spring ligament specifically as they pertain to ligament insufficiency and adult-acquired flatfoot deformity. Discussion includes the normal and abnormal biomechanical forces that extend through these ligaments in normal and flatfoot deformity. Current literature related to spring ligament repair as part of the flatfoot deformity reconstruction is also reviewed.
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Affiliation(s)
- Sara Mateen
- Foot and Ankle Deformity and Orthoplastics, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jennifer C Van
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
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Mateen S, Sansosti LE, Meyr AJ. A Critical Biomechanical Evaluation of Foot and Ankle Soft Tissue Repair. Clin Podiatr Med Surg 2022; 39:521-533. [PMID: 35717067 DOI: 10.1016/j.cpm.2022.02.011] [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: 11/16/2022]
Abstract
The objective of this article is to review the biomechanical stresses that occur during normal physiologic function of lower extremity soft tissue anatomic structures and to use this as a baseline for a critical analysis of the medical literature because it relates to surgical reconstruction following injury. The Achilles tendon, anterior talofibular ligament, plantar plate, and spring ligament are specifically evaluated.
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Affiliation(s)
- Sara Mateen
- Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA, USA
| | - Laura E Sansosti
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA, USA
| | - Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA, USA.
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Parviainen M, Pihlajamäki H, Kautiainen H, Kiviranta I. Incidence and Risk Factors of Foot and Ankle Disorders in Male Finnish Conscripts. Mil Med 2018; 184:e352-e358. [DOI: 10.1093/milmed/usy297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/31/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mickael Parviainen
- Mehiläinen Medical Centre, Pohjoinen Hesperiankatu 17C, Helsinki, Finland
| | - Harri Pihlajamäki
- Department of Orthopaedics and Traumatology, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Ilkka Kiviranta
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Finland, HUS, Finland
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Abstract
One of the most common orthopedic problems in the authors' practice is flatfoot and, although it is most commonly treated conservatively, there is still lack of consensus about the type of surgical treatment that is best recommended in a specific patient. Keeping in mind that medial soft tissue reconstruction alone has not proved enough as an isolated procedure and that osteotomies and arthrodesis are considered more invasive surgery, arthroereisis is a quick, easy, and reproducible technique that seems to have good results without major complications in the correct patient. Indications, biomechanical principles, and technique are described in this article.
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Affiliation(s)
- Cristian A Ortiz
- Foot and Ankle Department, Clinica Universidad de los Andes, Universidad del, Santiago, Chile.
| | - Emilio Wagner
- Foot and Ankle Department, Clinica Alemana, Universidad del Desarrollo, Avenida la Plaza 2501, Santiago 7620001, Chile
| | - Pablo Wagner
- Foot and Ankle Department, Clinica Alemana, Universidad del Desarrollo, Avenida la Plaza 2501, Santiago 7620001, Chile
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Giannini S, Cadossi M, Mazzotti A, Persiani V, Tedesco G, Romagnoli M, Faldini C. Bioabsorbable Calcaneo-Stop Implant for the Treatment of Flexible Flatfoot: A Retrospective Cohort Study at a Minimum Follow-Up of 4 Years. J Foot Ankle Surg 2018. [PMID: 28633776 DOI: 10.1053/j.jfas.2017.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Arthroereisis of the subtalar joint is a common surgical technique in Europe for the management of flexible flatfoot in the pediatric population. In most cases, it is performed using a calcaneo-stop metallic screw. Despite the good clinical results, screw removal is always advised after 2 to 3 years. The use of a bioabsorbable screw might overcome the need for a second operation to remove a nonabsorbable device. We report the results of a biodegradable calcaneo-stop screw at a minimum of 4 years of follow-up. Eighty-eight procedures were performed on 44 children. All patients were clinically and radiologically evaluated preoperatively and at a minimum 4-year follow-up period. Patient satisfaction and plantar collapse using Viladot's classification were recorded. Meary's talus-first metatarsal angle and talocalcaneal angle were measured on radiographs preoperatively and at the last follow-up visit. The presence of the device at the last follow-up examination was assessed by magnetic resonance imaging. The mean follow-up duration was 56 months. Of the 44 patients, 33 (75%) reported excellent clinical outcomes, 9 (20.5%) good outcomes, and 2 (4.5%) poor. Foot print improvement was registered for all patients. The mean Meary's talus-first metatarsal angle had improved from 160.6° ± 7.7° preoperatively to 170.6° ± 6.5° at the last follow-up visit (p < .001). The talocalcaneal angle had decreased from 39.9° ± 5.2° preoperatively to 29.4° ± 4° at the last follow-up examination (p < .001). At the 4-year follow-up point, the implant could be seen to have almost completely biodegraded on magnetic resonance imaging. Two screw breakages occurred. The bioabsorbable calcaneo-stop screw seems to be an effective solution for flexible flatfoot in pediatric patients. Also, owing to its biodegradable composition, the need of a second operation for implant removal will not always be necessary.
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Affiliation(s)
- Sandro Giannini
- Professor Emeritus, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Matteo Cadossi
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Antonio Mazzotti
- Medical Doctor, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
| | - Valentina Persiani
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Giuseppe Tedesco
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Matteo Romagnoli
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Cesare Faldini
- Professor and Director, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
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Patient-perceived outcomes after subtalar arthroereisis with bioabsorbable implants for flexible flatfoot in growing age: a 4-year follow-up study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:707-712. [PMID: 29299766 DOI: 10.1007/s00590-017-2119-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/21/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Results of subtalar arthroereisis in flexible flatfoot have been mainly reported in the literature using clinical or radiographical findings. However, the aim of this study is to evaluate the patient-perceived quality of life using self-reported questionnaires after subtalar arthroereisis using a bioabsorbable implant. METHODS Italian modified FFI and the SEFAS scores were submitted to a consecutive series of 173 patients who underwent surgical treatment for flatfoot deformity using a bioabsorbable endo-orthotic implant. Postoperative complication rates were assessed. Time needed to resume normal sports activities was recorded. RESULTS Mean population age was 11.2 years with slight variability between males and females. At a mean follow-up of 4 years, arthroereisis with bioabsorbable implants showed excellent results for the perception of the quality of life with an average result for FFI score of 4.5 and an average SEFAS score of 47.19. Time needed to resume sport activities was 4.7 months ± 0.2 with almost no difference between the groups. Four patients needed a second procedure for implant removal. CONCLUSION Arthroereisis using a bioabsorbable implant offers good results in terms of satisfaction and quality of life with a negligible rate of failures and patient complaints based on self-reported questionnaires. The patient reported high degrees of satisfaction, and their quality of life was not compromised at all by the procedure.
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Faldini C, Mazzotti A, Panciera A, Perna F, Stefanini N, Giannini S. Bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot. Musculoskelet Surg 2017; 102:11-19. [PMID: 28717988 DOI: 10.1007/s12306-017-0491-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022]
Abstract
Flatfoot is a common condition in growing-age patients. Despite its common presentation, nowadays surgical indications and treatments are still debated. Arthroereisis is a widely used technique, and several implants designs have been proposed over time. Despite the good results shown in the literature, the main drawback of these techniques has always been the need for a second surgery for implant removal. Bioabsorbable devices have been introduced to overcome this necessity.Correct approach to the patient, indications and contraindications and available studies on bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot were analyzed in this narrative review. Even if only a few studies have been published in the literature, bioabsorbable implants showed good clinical results comparable to non-absorbable implants and with a rare necessity for implant removal or revision. When correct indications and proper surgical technique are followed, arthroereisis with bioabsorbable implants appears to be an effective solution for the treatment of pediatric flexible flatfoot.
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Affiliation(s)
- C Faldini
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - A Panciera
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - F Perna
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - N Stefanini
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Giannini
- Professor Emeritus, Orthopeadics and Traumatology, University of Bologna - Alma Mater Studiorum, Bologna, Italy
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Evaluation of foot static disturbances in patients with rheumatic diseases. Reumatologia 2017; 55:73-78. [PMID: 28539678 PMCID: PMC5442297 DOI: 10.5114/reum.2017.67601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/14/2017] [Indexed: 01/10/2023] Open
Abstract
Objectives Rheumatic diseases such as osteoarthritis and rheumatoid arthritis constitute the most frequent pathological states leading to the development of foot deformities, which reduce quality of life and cause disability. The aim of the present study was to compare the results of plantoconturographic examinations, obtained by means of a computer podoscope, in osteoarthritis and rheumatoid arthritis patients. Special attention was paid to the differences in the values of each parameter determining the level of foot function. Material and methods The study was performed in 94 female patients divided into two groups according to the type of disease. There were 54 patients with rheumatoid arthritis and 40 with osteoarthritis. The control group consisted of 34 healthy women. The plantographic assessment of static foot structure was carried out by means of a device for computer-aided foot examination. Results A fallen transverse arch of the right foot was statistically much more frequent in the rheumatoid arthritis patients than in osteoarthritis patients or the control group (p < 0.005 and p < 0.05, respectively). Significant differences in the values of the Wejsflog index were observed in the case of left foot between rheumatoid arthritis patients and the control group (p < 0.05). Similarly, there were statistically significant differences in the values of the hallux valgus angle (α) for the right foot between rheumatoid arthritis and osteoarthritis patients or control group (in both cases p < 0.05). Conclusions Rheumatic diseases predispose patients to disturbances of static foot function. The obtained results highlight the importance of diagnosing foot static disturbances in the prevention of destructive changes affecting the functioning of osteoarthritis and rheumatoid arthritis patients.
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