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Gougoulias N, Christidis P, Christidis G, Oshba H, Lampridis V. Naviculocuneiform joint arthrodesis in a cohort of 36 patients. Foot (Edinb) 2024; 60:102115. [PMID: 38901354 DOI: 10.1016/j.foot.2024.102115] [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: 07/28/2021] [Revised: 05/29/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Arthrodesis of the naviculocuneiform joint (NCJ) can be performed in isolation or in conjunction with arthrodesis of other joints, often in the presence of deformity. In the literature there is relative rarity of articles reporting on results and complications of NCJ arthrodesis. PATIENTS AND METHODS Thirty-six patients (36 feet) with symptomatic NCJ arthritis underwent arthrodesis. Mean age was 59.1 years (SD 13.1; range 26-78) and 24 were women. Adjuvant procedures were performed simultaneously in 29 patients, whilst 17 had planovalgus and 1 had cavovarus foot deformity. RESULTS Union of the NCJ arthrodesis was achieved in 35 out of 36 (97.2 %) patients, whilst one patient developed non-union. Mean time to union was 13.1 weeks (SD 3.8; range 8-24). Two patients (5.6 %) developed deep infection and 5 patients (13.9 %) required secondary surgical procedures. Twenty-three patients (63.9 %) rated the outcome as good or excellent, 11 (30.6 %) as fair and 2 (5.6 %) as poor. CONCLUSIONS NCJ arthrodesis was part of a more complex procedure in most of the patients. Whilst union was achieved in almost all patients and complication rate was acceptable, only 64 % rated their outcome as good or excellent. LEVEL OF CLINICAL EVIDENCE IV.
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Affiliation(s)
- Nikolaos Gougoulias
- Frimley Health NHS Foundation Trust, Frimley Park Hospital, Surrey, United Kingdom; Department of Orthopaedic Surgery, General Hospital of Katerini, Greece
| | | | | | - Hesham Oshba
- Frimley Health NHS Foundation Trust, Frimley Park Hospital, Surrey, United Kingdom
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Casciato D, Wynes J. The Navicular Cuneiform Joint: Updates on Avoiding and Managing a Nonunion. Clin Podiatr Med Surg 2023; 40:613-621. [PMID: 37716740 DOI: 10.1016/j.cpm.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Naviculocuneiform arthrodesis, while often used to support the medial column during management of primary/post-traumatic arthritis, deformity correction, or in the surgical treatment of progressive collapsing foot deformity, can develop nonunion. Addressing this condition hinges on the assessment of various parameters such as patient/host factors and recognition of the etiology of the nonunion. In this article, methods of optimizing this surgical intervention through anatomic and physiologic considerations are highlighted. Further, information is provided to assist foot and ankle surgeons in performing a comprehensive work-up to allow for successful reconstruction and optimal patient outcomes.
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Affiliation(s)
- Dominick Casciato
- Department of Orthopaedics, Limb Preservation and Deformity Correction Fellowship, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jacob Wynes
- Department of Orthopaedics, Limb Preservation and Deformity Correction Fellowship, University of Maryland School of Medicine, Baltimore, MD, USA.
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Chen F, Yuan C, Liang M, Le G, Xu J. Comparison of different surgical treatments for stage II progressive collapsing foot deformity: a finite element analysis. J Orthop Surg Res 2023; 18:719. [PMID: 37741994 PMCID: PMC10518082 DOI: 10.1186/s13018-023-04216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND This study analyzed the advantages and disadvantages of different procedures for stage IIA progressive collapsing foot deformity (PCFD) through three-dimensional finite element models. METHODS A previous validated stage IIA PCFD FEA model was established consisting of 16 bones, 56 ligaments, 5 muscles and soft tissues. The ligament properties of the spring, deltoid, short plantar and long plantar ligaments, and plantar fascia were attenuated according to a previous publication. Medial column fusion (MCF), medializing calcaneal osteotomy (MCO), lateral column lengthening (LCL), and subtalar joint arthroereisis (SJA) operations were simulated in this model. The indexes of plantar stress distribution, maximum von Mises of the medial and lateral columns, strain of the medial ligaments and plantar fascia that supported the medial longitudinal arch, arch height, talo-first metatarsal angle, calcaneus pitch angle, and talonavicular coverage angle were all compared before and after simulated single-foot weight loading. RESULTS The maximum plantar stress of PCFD decreased with MCO and SJA but increased with MCF and LCL. MCF and LCL failed to significantly reduce the stress on the medial column fragments, thereby increasing their stress. Both MCO and SJA relieved medial plantar stress. MCF had no significant effect on stress relief of the medial ligament. MCO, LCL, and SJA were all shown to reduce the pressure on the medial plantar ligament, with LCL having the most obvious effect. All four procedures corrected the arch deformity; however, MCF was not as effective as the other methods. SJA is the best method for restoring arch height and correcting arch deformities. For stage IIA PCFD, isolated MCF failed to reduce pressure on the medial column; however, isolated MCO significantly reduced the pressure on the medial plantar and ligamentous soft tissues while restoring the foot's arch and correcting the hindfoot valgus. CONCLUSION SJA with type II sinus tarsi implant effectively transferred pressure from the medial plantar tract to the lateral side and restored the arch. Isolated LCL was not found suitable for stage IIA PCFD.
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Affiliation(s)
- Fanglin Chen
- Department of Orthopedics, Liuzhou Workers' Hospital, Liuzhou, Guangxi, China
| | - Chengjie Yuan
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mian Liang
- Department of Clinical Laboratory, Liuzhou Traditional Chinese Medical Hospital, The Third Affiliated Hospital of Guangxi University of Chinese Medicine, Liuzhou, Guangxi, China
| | - Guoping Le
- Department of Orthopedics, Liuzhou Workers' Hospital, Liuzhou, Guangxi, China
| | - Jian Xu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Naldo JV, Kugach K. Naviculocuneiform Arthrodesis for Treatment of Adult-Acquired Flatfoot Deformity. Clin Podiatr Med Surg 2023; 40:293-305. [PMID: 36841580 DOI: 10.1016/j.cpm.2022.11.004] [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: 12/31/2022]
Abstract
The adult-acquired flatfoot is a complex multiplanar deformity that requires the foot and ankle surgeon to balance soft tissue, correct hindfoot valgus, and address instability of the medial column. The naviculocuneiform joint is historically underappreciated in regard to its involvement in medial column instability relative to the talonavicular and tarsometatarsal joints. Proper clinical and radiographic evaluation of the medial column, specifically evaluating for deformity at each medial column joint, will allow the surgeon to ensure correction of deformity and decrease the recurrence of instability or failure of the reconstruction.
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Affiliation(s)
- Jason V Naldo
- Department of Orthopaedics, Virginia Tech Carilion, School of Medicine, Carilion Clinic Institute for Orthopaedics & Neurosciences, 2900 Lamb Circle, Suite L-760, Christiansburg, VA 24073, USA.
| | - Kelly Kugach
- Carilion Clinic, Institute for Orthopaedics & Neurosciences, 1906 Belleview Avenue, Med Ed 202, Roanoke, VA 24014, USA
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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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Deformity Correction of the Midfoot/Hindfoot/Ankle. Clin Podiatr Med Surg 2022; 39:233-272. [PMID: 35365325 DOI: 10.1016/j.cpm.2021.11.011] [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: 11/22/2022]
Abstract
The correction of the deformed arthritic foot and ankle is a complicated and somewhat controversial topic. After conservative methods fail, there is a wide range of possible bony procedures and arthrodesis that maybe performed. The appropriate work up and understanding of the pathomechanics is vital to the correct choice of procedures to correct these deformities. Once the work up and procedure selection is done, the operation must also be technically performed well and with efficiency, as most often the condition is corrected with a variety of procedures. This article discusses some of the most common procedures necessary to fully correct deformity of the midfoot, hindfoot, and ankle. This article will also discuss the authors' technique and pearls.
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Wininger AE, Klavas DM, Gardner SS, Ahuero JS, Harris JD, Varner KE. Plantar Plating for Medial Naviculocuneiform Arthrodesis in Progressive Collapsing Foot Deformity. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221088517. [PMID: 35386584 PMCID: PMC8978315 DOI: 10.1177/24730114221088517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Medial column procedures are commonly used to treat progressive collapsing foot deformity (PCFD) reconstruction. The aim of this research is to present the clinical results of plantar plating for medial naviculocuneiform (NC) arthrodesis when NC joint pathology contributes to medial arch collapse. The authors hypothesized that lag screws with a plantar neutralization plate would result in a satisfactory NC joint fusion rate. Methods: A single-surgeon, retrospective case series was performed on patients with flexible PCFD who underwent NC arthrodesis using lag screws and a contoured neutralization plate applied plantarly across the medial NC joint as part of PCFD reconstruction. Thirteen patients (11 females, 2 males; mean age 53.1 [34-62] years) between 2016 and 2019 were identified for inclusion. Mean follow-up was 25.2 ± 12.7 months. Preoperative and postoperative anteroposterior talo–first metatarsal angle, lateral talo–first metatarsal angle, talonavicular coverage angle, and calcaneal pitch were measured. Union was evaluated radiologically. AOFAS midfoot scores were recorded at final follow-up. Results: All parameters demonstrated a significant improvement. Fusion was confirmed in 11 of 13 patients (85%) at a mean 5.7 ± 2.1 months. One patient required a revision of their NC fusion because of symptomatic nonunion. There were no cases of symptomatic plantar hardware. Conclusion: The results of this small cohort series suggest that lag screw with plantar plate NC arthrodesis yielded generally improved short-term radiographic and clinical outcomes in PCFD patients with medial arch collapse through the NC joint. Level of Evidence: Level IV, retrospective case series.
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Affiliation(s)
| | - Derek M. Klavas
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | | | - Jason S. Ahuero
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | - Joshua D. Harris
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
| | - Kevin E. Varner
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX, USA
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Kuestermann H, Ettinger S, Yao D, Schwarze M, Plaass C, Stukenborg-Colsman C, Claassen L. Biomechanical evaluation of naviculocuneiform fixation with lag screw and locking plates. Foot Ankle Surg 2021; 27:911-919. [PMID: 33483221 DOI: 10.1016/j.fas.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/27/2020] [Accepted: 12/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND There have been no biomechanical evaluations of naviculocuneiform (NC) joint fixation. This study compared biomechanically 3 different fixation constructs for NC-1-3 joint fixation. METHODS The present study compared the three fixation constructs lag screw with locking plate for each NC joint, two crossed lag screws for each NC joint and a separate lag screw for each NC joint with bridging locking plates. NC-1-3 fixation was performed stepwise, and rotation of each joint was evaluated after the application of each lag screw or locking plate and their removal. RESULTS All examined fixation techniques led to a significant reduced rotation of the NC joints. For NC-1 rotation decreased from 2.8° (Range 1.2-6.6°) to 0.6° (0.2-3.0°) for lag screw and locking plate (p = 0.002) and from 5.0° (1.7-9.8°) to 1.0° (0.1-3.6°) for crossed lag screws (p = 0.002). For NC-2, locking plate constructs were better with 0.2° (0.1-0.5°) compared to crossed lag screw osteosynthesis with 0.9° (0.2-1.6°) (p = 0.011). CONCLUSION Each evaluated fixation technique led to a reduced NC joint rotation. The fixation of any NC joint had no relevant effect on the adjacent NC joints. The results might support surgeons treating NC joint disorders.
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Affiliation(s)
- Henry Kuestermann
- Diakovere Annastift - Orthopedic Department of the Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625 Hannover, Germany.
| | - Sarah Ettinger
- Diakovere Annastift - Orthopedic Department of the Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625 Hannover, Germany.
| | - Daiwei Yao
- Diakovere Annastift - Orthopedic Department of the Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625 Hannover, Germany.
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials of the Hannover Medical School, Haubergstrasse 3, 30625 Hannover, Germany.
| | - Christian Plaass
- Diakovere Annastift - Orthopedic Department of the Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625 Hannover, Germany.
| | - Christina Stukenborg-Colsman
- Diakovere Annastift - Orthopedic Department of the Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625 Hannover, Germany.
| | - Leif Claassen
- Diakovere Annastift - Orthopedic Department of the Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625 Hannover, Germany.
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Kindred KB, Wavrunek MR, Blacklidge DK, Miller JM, Patel S. Deep Peroneal Neurectomy for Midfoot Arthritis. J Foot Ankle Surg 2021; 60:276-282. [PMID: 33223440 DOI: 10.1053/j.jfas.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 02/03/2023]
Abstract
Osteoarthrosis of the tarsometatarsal joint (TMTJ) and naviculocuneiform joint (NCJ) is a common pathology treated by foot and ankle specialists. Arthrodesis is the most widely accepted surgical treatment. Patients that are not candidates for arthrodesis are often left without surgical treatment options. Neurectomy has been described for treatment of upper extremity joint arthrosis but has not been well described in the foot. The deep peroneal nerve innervates the first, second, third TMTJs and NCJ. We present a retrospective case series on the outcomes of patients treated with deep peroneal neurectomy for TMTJ and NCJ arthrosis (N = 34 feet in 26 patients). The median postoperative American Orthopedic Foot and Ankle Society midfoot score was 53 (range 16-75) points. Twenty two (85%) of 26 patients stated that their expectations were met as a result of the deep peroneal neurectomy procedure, and 20 (77%) of 26 patients stated that they would have deep peroneal neurectomy for their symptoms again. There were recurrent symptoms prompting patients to seek additional treatment in 7 (21%) of 34 feet. Recurrent pain is also documented in hand denervation studies and the physiologic explanation remains unclear. Our results suggest that deep peroneal neurectomy is an effective treatment option for TMTJ and NCJ arthritis and may be particularly helpful in patients that are poor candidates for arthrodesis.
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Affiliation(s)
- Kristin B Kindred
- Fellow, American Health Network Foot and Ankle Reconstructive Surgery Fellowship, Carmel, IN.
| | - Mark R Wavrunek
- Fellow, American Health Network Foot and Ankle Reconstructive Surgery Fellowship, Carmel, IN
| | - Douglas K Blacklidge
- Surgeon, American Health Network Foot and Ankle Reconstructive Surgery Fellowship, Kokomo and Lafayette, IN
| | - John Michael Miller
- Surgeon, American Health Network Foot and Ankle Reconstructive Surgery Fellowship, Kokomo and Lafayette, IN
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10
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Osman AE, El-Gafary KA, Khalifa AA, El-Adly W, Fadle AA, Abubeih H. Medial displacement calcaneal osteotomy versus lateral column lengthening to treat stage II tibialis posterior tendon dysfunction, a prospective randomized controlled study. Foot (Edinb) 2021; 47:101798. [PMID: 33957531 DOI: 10.1016/j.foot.2021.101798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Adult-acquired flatfoot deformity (AAFD) requires optimum planning that often requires several procedures for deformity correction. The objective of this study was to detect the difference between MDCO versus LCL in the management of AAFD with stage II tibialis posterior tendon dysfunction regarding functional, radiographic outcomes, efficacy in correction maintenance, and the incidence of complications. PATIENT AND METHODS 42 Patients (21 males and 21 females) with a mean age of 49.6 years (range 43-55), 22 patients had MDCO while 20 had LCL. Strayer procedure, spring ligament plication, and FDL transfer were done in all patients. Pre- and Postoperative (at 3 and 12 months) clinical assessment was done using AOFAS and FFI questionnaire. Six radiographic parameters were analyzed, Talo-navicular coverage and Talo-calcaneal angle in the AP view, Talo- first metatarsus angle, Talo-calcaneal angle and calcaneal inclination angle in lateral view and tibio-calcaneal angle in the axial view, complications were reported. RESULTS At 12 months, significant improvement in AOFAS and FFI scores from preoperative values with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups were maintained at 12 months. However, the calcaneal pitch angle and the TNCA were better in the LCL at 12 months than MDCO, 17̊±2.8 versus 13.95̊±2.2 (p=0.001) and 13.70̊±2.2 versus 19.05̊±3.2 (p<0.001) respectively. 11 patients (26.2%) had metal removal, seven (16.6%) in the MDCO, and four (9.6%) in the LCL. Three (7.1%) in the LCL group had subtalar arthritis, only one required subtalar fusion. CONCLUSION LCL produced a greater change in the realignment of AAFD, maintained more of their initial correction, and were associated with a lower incidence of additional surgery than MDCO, however, a higher incidence of degenerative change in the hindfoot was observed with LCL.
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Affiliation(s)
- Ahmed E Osman
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | | | - Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | - Wael El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Amr A Fadle
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Hossam Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
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11
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Martinelli N, Bianchi A, Prandoni L, Maiorano E, Sansone V. Quality of Life in Young Adults after Flatfoot Surgery: A Case-Control Study. J Clin Med 2021; 10:451. [PMID: 33498965 PMCID: PMC7866205 DOI: 10.3390/jcm10030451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/21/2022] Open
Abstract
The true impact of surgery for flatfoot deformities on patient's quality of life and health status remains poorly defined. The aim of this study is to evaluate the quality of life and the return to daily tasks and sports or physical activities in young adults after surgical correction of flatfoot deformity. Patients treated for bilateral symptomatic flat foot deformity were retrospectively studied. The healthy control group comprised a matched reference population with no history of foot surgery or trauma that was voluntary recruited from the hospital community. All subjects were asked to fill out questionnaires centered on the assessment of the health-related quality of life (Short-form 36; SF-36) and physical activity (International Physical Activity Questionnaire; IPAQ). Most study group SF-36 subscales were lower when compared to the control group. Among the study group, post-operatively, 36.6% of patients managed to resume low levels of sports activity, 40% were sufficiently active and were able to perform moderate sports activity (an activity that requires moderate physical effort and which forces the patient to breathe with a frequency only moderately higher than normal), while 23.3% of them were active or very active and were able to perform intense physical activity. Most IPAQ scores were statistically different from the control group. The present study suggests that patients treated with medializing calcaneal osteotomy and navicular-cuneiform arthrodesis for symptomatic flafoot had lower levels of quality of life and physical activity when compared to healthy subjects. After surgery, patients showed a significant improvement in the clinical scores.
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Affiliation(s)
- Nicolò Martinelli
- IRCCS Galeazzi, Via R. Galeazzi 4, 20100 Milan, Italy; (A.B.); (L.P.); (E.M.); (V.S.)
| | - Alberto Bianchi
- IRCCS Galeazzi, Via R. Galeazzi 4, 20100 Milan, Italy; (A.B.); (L.P.); (E.M.); (V.S.)
| | - Lorenzo Prandoni
- IRCCS Galeazzi, Via R. Galeazzi 4, 20100 Milan, Italy; (A.B.); (L.P.); (E.M.); (V.S.)
| | - Emanuele Maiorano
- IRCCS Galeazzi, Via R. Galeazzi 4, 20100 Milan, Italy; (A.B.); (L.P.); (E.M.); (V.S.)
| | - Valerio Sansone
- IRCCS Galeazzi, Via R. Galeazzi 4, 20100 Milan, Italy; (A.B.); (L.P.); (E.M.); (V.S.)
- Department of Orthopedics, University of Milan, 20122 Milan, Italy
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12
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Claaßen L, Ettinger S, Yao D, Lerch M, Stukenborg-Colsman C, Plaaß C. [Surgical procedures for the correction and stabilization of pes planovalgus]. DER ORTHOPADE 2020; 49:968-975. [PMID: 33136193 DOI: 10.1007/s00132-020-03992-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The medial column of the foot is a relevant factor of the pathogenesis of pes planovalgus. Crucial anatomic structures are the tibiocalcaneonavicular ligament complex, the naviculocuneiform joints, including the ossa cuneiformia, and the first tarsometatarsal joint. A combination of bony and soft tissue reconstructive techniques must, therefore, be taken into account when treating pes planovalgus. The present article presents stabilizing and correcting surgical procedures for the medial column of the foot, including basic anatomy and biomechanics.
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Affiliation(s)
- L Claaßen
- Orthopädische Klinik der Medizinischen Hochschule Hannover, DIAKOVERE Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
| | - S Ettinger
- Orthopädische Klinik der Medizinischen Hochschule Hannover, DIAKOVERE Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - D Yao
- Orthopädische Klinik der Medizinischen Hochschule Hannover, DIAKOVERE Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - M Lerch
- Orthopädische Klinik der Medizinischen Hochschule Hannover, DIAKOVERE Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - C Stukenborg-Colsman
- Orthopädische Klinik der Medizinischen Hochschule Hannover, DIAKOVERE Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - C Plaaß
- Orthopädische Klinik der Medizinischen Hochschule Hannover, DIAKOVERE Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
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13
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Cifuentes-De la Portilla C, Pasapula C, Larrainzar-Garijo R, Bayod J. Finite element analysis of secondary effect of midfoot fusions on the spring ligament in the management of adult acquired flatfoot. Clin Biomech (Bristol, Avon) 2020; 76:105018. [PMID: 32413775 DOI: 10.1016/j.clinbiomech.2020.105018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/22/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical treatment of adult acquired flatfoot deformity can involve arthrodesis of the midfoot to stabilize the medial column. Few experimental studies have assessed the biomechanical effects of these fusions, because of the difficulty of measuring these parameters in cadavers. Our objective was to quantify the biomechanical stress caused by various types of midfoot arthrodesis on the Spring ligament. To date this is not known. METHODS An innovative finite element model was used to evaluate flatfoot scenarios treated with various combinations of midfoot arthrodesis. All the bones, cartilages and tissues related to adult acquired flatfoot deformity were included, respecting their biomechanical characteristics. The stress changes on the Spring ligament were quantified. Both foot arch lengthening and falling were measured for each of the midfoot arthrodeses evaluated. FINDINGS Arthrodesis performed for stabilization of the talonavicular joint leads to a higher decrease in stress on the Spring ligament. Talonavicular fusion generated a Spring ligament stress decrease of about 61% with respect to the reference case (without any fusion). However, fusing the naviculocuneiform joints leads to an increase in the stress on the Spring ligament. INTERPRETATION This important finding has been unknown to date. We advocate caution regarding fusion of the naviculocuneiform joint as it leads to increased stresses across the Spring ligament and therefore accelerates the development of planovalgus.
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Affiliation(s)
| | | | - Ricardo Larrainzar-Garijo
- Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), Universidad de Zaragoza, Spain.
| | - Javier Bayod
- Orthopaedics and Trauma Department, Surgery Department - Hospital Universitario Infanta Leonor, Madrid, Spain
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Chan F, Bowlby MA, Christensen JC. Medial Column Biomechanics: Nonsurgical and Surgical Implications. Clin Podiatr Med Surg 2020; 37:39-51. [PMID: 31735268 DOI: 10.1016/j.cpm.2019.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Understanding of medial column biomechanics is paramount to a successful outcome in both conservative and surgical treatment. Dysfunctions of the dynamic stabilizers as well as the static stabilizers of the medial column play a role in pathomechanics. Conservative options for addressing the medial column include custom foot orthotics and bracing. Options for addressing the medial column surgically with the goal to restore a stable tripod configuration, include first tarsometatarsal joint arthrodesis, opening plantarflexory medial cuneiform osteotomy, and naviculocuneiform arthrodesis.
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Affiliation(s)
- Francis Chan
- Private Practice, 5000 Kingsway, Suite #320, Burnaby, BC V5H 2E4, Canada.
| | - Melinda A Bowlby
- Department of Orthopedics, Swedish Medical Center, Seattle, WA, USA; Department of Orthopedics, Providence Medical Center, Everett, WA, USA
| | - Jeffrey C Christensen
- Department of Orthopedics, Swedish Medical Center, Seattle, WA, USA; Department of Orthopedics, Providence Medical Center, Everett, WA, USA
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