American College of Foot and Ankle Surgeons Clinical Consensus Statement: Appropriate Clinical Management of Adult-Acquired Flatfoot Deformity

Acute effects of athletic taping on arch deformity and plantar pressure in young female adults with flexible flatfoot

OBJECTIVE

This work aimed to explore the acute effects of athletic taping techniques on foot arch deformity and plantar pressure in young female adults with flexible flatfoot (FFT).

METHODS

Twenty young female adults with FFT were recruited in the current study. Each participant was randomly divided into two taping groups, namely, augmented low-dye (ALD) and modified low-dye (MLD). The foot arch deformity and plantar pressure were measured at baseline, after taping and after 20 min of walking. The foot arch deformity was determined based on navicular drop distance (NDD) and resting calcaneal stance position (RCSP).

RESULTS

Compared with baseline, the NDD values were significantly lower after taping. After 20 min of walking, ALD taping resulted in a lower NDD value than MLD (p < 0.001). ALD maintained a higher RCSP than baseline after 20 min of walking (p = 0.004). Furthermore, compared with baseline, medial midfoot force-time integration (p = 0.013) and contact area (p = 0.022) increased after taping with MLD, and peak pressure in the medial midfoot increased after walking for 20 min with MLD (p = 0.026). Peak pressure in the second to fifth toes significantly decreased after 20 min of walking with ALD compared with that after taping immediately (p = 0.002).

CONCLUSIONS

ALD and MLD taping could improve FFT arch deformity and plantar pressure distribution, prospectively changing peak pressure of the second to fifth toe area and medial midfoot after 20 min of walking, integrated contact area and force-time integration medial midfoot during walking in young female adults. Furthermore, ALD taping could improve FFT deformity more than using MLD after 20 min of walking. Thus, when treating FFT in young female adults, ALD taping should be considered adaptively to guide arch support production and correct midfoot pronation.

Lateral Column Lengthening For Flexible Adult Acquired Flatfoot: Systematic Review and Meta-Analysis

Flexible Adult Acquired Flatfoot is known to have multiplanar components and can often be a challenge to manage in the clinical setting, with resistance to non-surgical intervention. Lateral Column Lengthening is a favorable option for surgical management, although there are several methods in achieving this, an opening wedge osteotomy of the anterior calcaneus or distraction arthrodesis of the calcaneocuboid joint appear to be the 2 most widespread. In this review we conducted in systematic fashion, analysis of the available literature utilizing the following electronic bibliographic databases, in line with the PRISMA-P checklist: MEDLINE, CINHAL, EMBASE, and the Cochrane library without date restriction up to November 1, 2019. Results identified 21 studies which were assessed for quality using the Coleman methodology score and later evaluated using the PICO analysis system. From 172 participants, we found a higher rate of graft failure with the use of allograft versus autograft, although from a total 355 cases union rates were reported as similar. From the 355, fewer complications with arthrodesis in comparison to osteotomy were reported, including that of post-operative lateral column pain. Surgical intervention using either lateral column procedure yields excellent clinical and radiological results, the literature findings marginally favor the arthrodesis procedure and autograft over allograft. Keeping graft size under 8 mm was found to be clinically important to mitigate overlengthening of the lateral column and biomechanical testing exhibited triangular graft superiority. Where significant correction is required the addition of a medial column stabilization procedure will mitigate post-operative intractable lateral column pain.

Medial Displacement Calcaneal Osteotomy for Unilateral Adult Acquired Flatfoot: Effects of Minimally Invasive Surgery on Pain, Alignment, Functioning, and Quality of Life

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.