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Bayıroğlu G, Pisirici P, Feyzioğlu Ö. The effect of different subtalar joint pronation amounts on postural stability, function and lower extremity alignment in healthy individuals. Foot (Edinb) 2024; 60:102123. [PMID: 39096694 DOI: 10.1016/j.foot.2024.102123] [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: 03/05/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION The prone foot posture has a negative effect on postural stability, function, and knee valgus, but to our knowledge, the contribution of the degree of pronation has not been examined. METHODS 39 participants aged 18-40, with Foot Posture Index (FPI) scores between 6-12 and without any pain complaints were included. Participants with 6-9 points were included in the pronation group (PG) (n = 19), and participants with 10-12 points were included in the hyperpronation group (HPG) (n = 20). Static and dynamic postural stability, Foot and Ankle Ability Measure (FAAM), and frontal plane projection angles (FPPA) were measured for all participants. RESULTS The initial data of the participants are distributed homogeneously. In the intergroup evaluation only FPI-1 (p = 0.001; p < 0.05), FPI-4 (p = 0.00; p < 0.05), FPI-5 (p = 0.00; p < 0.05) and FPI-T (p = 0.000; p < 0.05) scores were found significantly different. CONCLUSION Pronation and hyperpronation of the subtalar joint did not lead to a difference in postural stability, function, and knee valgus in healthy individuals. It may be more beneficial to focus on the prone posture rather than the degree of pronation.
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Affiliation(s)
- Gülsüm Bayıroğlu
- Bahçeşehir University, Graduate Education Institute, Physiotherapy and Rehabilitation Master of Science Program, Istanbul, Turkey.
| | - Pelin Pisirici
- Bahçeşehir University, Health Sciences Faculty, Physiotherapy and Rehabilitation Department, Ihlamur Yıldız Caddesi, No:8, Gayrettepe, Beşiktaş, 34353 İstanbul, Turkey.
| | - Özlem Feyzioğlu
- Acıbadem Mehmet Ali Aydınlar University, Health Sciences Faculty, Physiotherapy and Rehabilitation Department, Istanbul, Turkey.
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Liu C, Zhang H, Li J, Li S, Li G, Jiang X. The effects of foot orthoses on radiological parameters and pain in children with flexible flat feet: a systematic review and meta-analysis. Front Pediatr 2024; 12:1388248. [PMID: 39156020 PMCID: PMC11327157 DOI: 10.3389/fped.2024.1388248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/11/2024] [Indexed: 08/20/2024] Open
Abstract
Objective This study aimed to investigate the impact of foot orthoses on foot radiological parameters and pain in children diagnosed with flexible flatfoot. Methods A comprehensive search was conducted across several databases, including PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO, covering publications from the inception of each database up to 8 June 2024. The study focused on randomized controlled trials investigating the use of foot orthoses for treating flexible flat feet in children. Four researchers independently reviewed the identified literature, extracted relevant data, assessed the quality of the studies, and performed statistical analyses using RevMan 5.4 software. Results Six studies involving 297 participants were included. The methodological quality of the included literature ranged from moderate to high. Radiological parameters of the foot improved significantly in older children with flexible flat feet following foot orthotic intervention compared to controls, particularly in the lateral talar-first metatarsal angle [mean difference (MD) = -2.76, 95% confidence interval (95% CI) -4.30 to -1.21, p = 0.0005], lateral talo-heel angle (MD = -5.14, 95% CI -7.76 to -2.52, p = 0.0001) and calcaneal pitch angle (MD = 1.79, 95% CI 0.88-2.69, p = 0.0001). These differences were statistically significant. Additionally, foot orthoses significantly improved the ankle internal rotation angle and reduced foot pain in children with symptomatic flexible flatfoot (MD = -2.51, 95% CI -4.94 to -0.07, p = 0.04). Conclusion The use of foot orthoses positively impacts the improvement of radiological parameters of the foot and reduces pain in older children with flexible flat feet. However, in younger children with flexible flat feet, the improvement from foot orthoses was not significant, likely due to challenges in radiological measurements caused by the underdevelopment of the ossification centers in the foot. Further studies are needed. Consequently, the results of this meta-analysis support the implementation of an early intervention strategy using foot orthoses for the management of symptomatic flat feet in older children. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO [CRD42023441229].
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Affiliation(s)
| | | | | | | | - GuQiang Li
- Department of Special Education and Rehabilitation, Binzhou Medical University, Yantai, Shandong, China
| | - XiangZhan Jiang
- Department of Special Education and Rehabilitation, Binzhou Medical University, Yantai, Shandong, China
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Jiang Y, Yang J, Tian H, Jiang C, Wang H. Comparative study of the effects of custom-made insole and ordinary insole in adults with flexible flatfoot on different slopes. Technol Health Care 2024:THC231785. [PMID: 39031402 DOI: 10.3233/thc-231785] [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: 07/22/2024]
Abstract
BACKGROUND Flatfoot (pes planus) is a common foot deformity, and its causes are mainly related to age, gender, weight, and genetics. Previous studies have shown that custom-made insoles could have a positive effect in improving plantar pressure and symptoms in individuals with flexible flatfeet, but it remains to be explored whether they can still show benefits in daily walking on different slopes. OBJECTIVE This study aims to investigate a custom-made insole based on plantar pressure redistribution and to verify its effectiveness by gait analysis on different slopes. METHODS We recruited 10 subjects and compared the peak pressure and impulse in each area between custom-made insole (CI) and ordinary insole (OI) groups. RESULTS The results illustrate that CI raises the pressure in T area, improves the ability of the subjects to move forward in the slope walking, which was beneficial to gait stability. CONCLUSION The redistribution of pressure in MF and MH area is promoted to provide active protection for subjects. Meanwhile, CI could decrease the impulse in MF area during uphill and level walking, which effectively reduces the accumulation of fatigue during gait. Moreover, avoiding downhill walking could be able to protect foot from injury in daily life.
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Affiliation(s)
- Yangzheng Jiang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Jiantao Yang
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Hui Tian
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Chuan Jiang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Hongzhu Wang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
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Adeeb N, Farooqui SI, Meher Hasan Z, Khan A, Rizvi J. Foot Muscle Exercise: A Novel Approach to Improve Motor Functions in Children with Down Syndrome Having Pes Planus - A Randomized Controlled Trial. Dev Neurorehabil 2024; 27:145-153. [PMID: 38889352 DOI: 10.1080/17518423.2024.2365798] [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: 03/04/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE The study aimed to determine the efficacy of foot muscle exercises in children with DS having pes planus. METHODS Forty-seven subjects randomly assigned to foot muscle exercises (study group) or an arch support insole with one-leg balance exercises (control group), thrice weekly intervention for 12-weeks followed by a home program with residual effect assessed after 24-weeks from baseline. RESULTS The motor functions were significantly improved in both groups (p = 0.00). A positive residual effect was found in the study group for both parameters. Whilst in the control group it failed to give a positive residual effect for GMFM-88, while PBS yielded positive outcomes. The study group showed significantly better results than the control group in comparison. CONCLUSION The novel finding suggests that the foot muscle exercise has the potential to improve motor functions in children with Down syndrome and it can be used as an alternative therapeutic approach to the conventional method.
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Affiliation(s)
- Nazia Adeeb
- Department of Physical Therapy, A.C.E.L.P (Institute of Child Development), Karachi, Pakistan
| | | | - Zainab Meher Hasan
- Department of Physical Therapy, A.C.E.L.P (Institute of Child Development), Karachi, Pakistan
| | - Abid Khan
- College of Physical Therapy, Faculty of Allied Health Sciences, Ziauddin, University
| | - Jaza Rizvi
- College of Physical Therapy, Faculty of Allied Health Sciences, Ziauddin, University
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Suh JH, Yoon SY. Comparing the effects of University of California Biomechanics Laboratory and custom-made semi-rigid insole on pedobarographic parameters in pediatric flexible flat foot. Prosthet Orthot Int 2023; 47:614-620. [PMID: 37227812 DOI: 10.1097/pxr.0000000000000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Pediatric flexible flat foot (PFFF) is often associated with pain along the medial longitudinal arch and potential disability. There are several conservative treatment options for PFFF, ranging from intrinsic muscle exercises to orthosis, including University of California Biomechanics Laboratory (UCBL) and custom-made semi-rigid insoles. OBJECTIVES To investigate and compare the effect of UCBL and custom-made semi-rigid insoles on pedobarographic and radiologic parameters in PFFF. STUDY DESIGN This study prepared a retrospective chart review of 143 children diagnosed with PFFF between the age of 4 and 12 years. METHODS Data of twenty-seven children with PFFF who were prescribed foot orthoses between the age of 4 and 12 years were retrospectively reviewed. Medical charts were retrospectively reviewed, and pedobarographic and radiological parameters assessed before and 1 year after application of orthoses were reviewed. RESULTS The difference in the calcaneal pitch angle and the center of pressure excursion index (CPEI) were significantly improved in the custom-made semi-rigid insole group compared to that in the UCBL group. The contact area ratio of the midfoot and toe and CPEI at 1 year after wearing the insole was significantly improved in the custom-made semi-rigid insole group compared to that in the UCBL group. Moreover, the calcaneal pitch angle and CPEI were significantly improved 1 year after application of the insole in the custom-made semi-rigid insole group. CONCLUSIONS This result showed that the custom-made semi-rigid insole is more effective in improving the deviation of the center pressure curve and calcaneal pitch angle than the UCBL. The custom-made semi-rigid insole may help relieve foot instability during gait and improve the medial longitudinal arch in children with PFFF.
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Affiliation(s)
- Jee Hyun Suh
- Department of Rehabilitation Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Seo Yeon Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, South Korea
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Maarj M, Pacey V, Tofts L, Clapham M, Coda A. The Impact of Podiatric Intervention on the Quality of Life and Pain in Children and Adolescents with Hypermobility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6623. [PMID: 37681763 PMCID: PMC10487040 DOI: 10.3390/ijerph20176623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
The purpose of this study was to evaluate the effect of custom-made orthotics on pain, health-related quality of life (HRQoL), function and fatigue in children and adolescents with generalised joint hypermobility (GJH) and lower limb pain. Fifty-three children aged 5-18 years were fitted with custom-made polypropylene orthotics. Visual analogue scale (VAS) assessed lower limb pain severity, Paediatric Quality of Life Inventory assessed HRQoL and fatigue and six-minute walk test (6 MWT) measured functional endurance at baseline, at 1 month and 3 months post-intervention. A mixed model including a random intercept for participant and a fixed effect for time was used to assess differences in outcomes over time. Fifty-two children completed the study (mean age 10.6-years). Children reported significantly reduced pain (mean VAS reduction -27/100, 95%CI: -33, -21), improved HRQoL (mean total improvement 11/100, 95%CI: 7, -15), functional capacity (mean 6MWT improvement 27 m, 95%CI: 18, -36) and fatigue (mean total improvement 13/100, 95%CI: 9, -17) after 1 month of wearing the custom-made orthotics. From 1 month to 3 months there was further statistically but not clinically significant reduction in pain while benefit on other outcomes was maintained. In this study, children with GJH reported reduced lower limb pain, improved HRQoL, functional endurance and fatigue after a month post-fitting of custom-made orthotics which was maintained over a 3 month period. Orthotics were well-tolerated with no serious adverse events reported.
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Affiliation(s)
- Muhammad Maarj
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia
- Narrabeen Sports Medicine Centre, Sydney Academy of Sport, Narrabeen 2101, Australia
| | - Verity Pacey
- Department of Health Sciences, Macquarie University, Macquarie Park 2109, Australia
| | - Louise Tofts
- Narrabeen Sports Medicine Centre, Sydney Academy of Sport, Narrabeen 2101, Australia
- Department of Health Sciences, Macquarie University, Macquarie Park 2109, Australia
| | - Matthew Clapham
- Hunter Medical Research Institute, New Lambton Heights 2035, Australia
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia
- Hunter Medical Research Institute, New Lambton Heights 2035, Australia
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Molina-García C, Reinoso-Cobo A, Cortés-Martín J, Lopezosa-Reca E, Marchena-Rodriguez A, Banwell G, Ramos-Petersen L. Efficacy of Personalized Foot Orthoses in Children with Flexible Flat Foot: Protocol for a Randomized Controlled Trial. J Pers Med 2023; 13:1269. [PMID: 37623519 PMCID: PMC10456098 DOI: 10.3390/jpm13081269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or clear treatment approach. There are multiple conservative and surgical treatments, the implantation of foot orthoses (FO) being the most used treatment. The evidence supporting FO is very thin. It is not clearly known what the effect of these is, nor when it is convenient to recommend them. The main objective of this protocol is to design a randomized controlled trial to determine if personalized FO, together with a specific exercise regimen, produce the same or better results regarding the signs and symptoms of PFF, compared to only specific exercises. In order to respond to the stated objectives, we have proposed a randomized controlled clinical trial, in which we intend to evaluate the efficacy of FO together with strengthening exercises, compared to a control group in which placebos will be implanted as FO treatment along with the same exercises as the experimental group. For this, four measurements will be taken throughout 18 months (pre-treatment, two during treatment and finally another post-treatment measurement). The combination of FO plus exercise is expected to improve the signs and symptoms (if present) of PFF compared to exercise alone and the placebo FO group. In addition, it is expected that in both conditions the biomechanics of the foot will improve compared to the initial measurements.
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Affiliation(s)
- Cristina Molina-García
- Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Campus de los Jerónimos 135, 30107 Murcia, Spain;
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucia, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - Eva Lopezosa-Reca
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
| | - Ana Marchena-Rodriguez
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
| | - George Banwell
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
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Yasin MS, Al-Labadi GM, Alshrouf MA, AlRaie BA, Ibrahim RA, AlRaie LA. Pediatric and Adolescent Flatfoot: A Questionnaire Based Middle East and North Africa Study. Int J Gen Med 2023; 16:2055-2061. [PMID: 37275331 PMCID: PMC10237185 DOI: 10.2147/ijgm.s400720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/07/2023] [Indexed: 06/07/2023] Open
Abstract
Background Flatfoot is commonly seen in the community and is a common cause of concern for parents because it could become symptomatic and lead to decreased quality of life. One of the most used management approaches is foot orthoses, although no clear evidence supports their use. We aimed to study flatfoot symptoms' prevalence, effect on activities of daily living, and the use and effectiveness of orthoses. Methodology This was a cross-sectional study that included five countries from the Middle East and North Africa region (Jordan, Palestine, Syria, Egypt, and Iraq). Data were collected using an online questionnaire directed toward parents of children aged 0 to 16 from September to December 2020. The demographic factors were expressed as frequencies (percentages) using standard descriptive statistical parameters, and Pearson's chi-square test was used to examine the relationship between study factors. Results 1256 participants were recruited using this online survey. The majority (29.6%) of children were diagnosed in the age group of 0 to 2. The abnormal appearance of the foot was the most common (78.7%) complaint. Overall, 54.2% of patients were prescribed orthoses, of which 36.8% noticed improvement in flatness and 37.6% reported relief of symptoms. Conclusion This study demonstrated that most participants have no or minimal symptoms and that there is a mismatch between participants' expectations and the actual effectiveness of orthoses. Taking into consideration that there is no clear evidence to support the corrective effect of orthoses, we recommend that physicians prescribing them adhere more to their proper indications and spend more time and effort counseling and addressing patients' and parents' concerns about this developmental stage.
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Affiliation(s)
- Mohamad S Yasin
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Ghayda’a M Al-Labadi
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Ali Alshrouf
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Bayan A AlRaie
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Raneem A Ibrahim
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Lana A AlRaie
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
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Markowicz M, Skrobot W, Łabuć A, Poszytek P, Orlikowska A, Perzanowska E, Krasowska K, Drewek K, Kaczor JJ. The Rehabilitation Program Improves Balance Control in Children with Excessive Body Weight and Flat Feet by Activating the Intrinsic Muscles of the Foot: A Preliminary Study. J Clin Med 2023; 12:jcm12103364. [PMID: 37240471 DOI: 10.3390/jcm12103364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND determining the appropriate rehabilitation protocol is essential to influence the correction of flat feet, e.g., by activating the intrinsic muscles of the foot. Therefore, this study aimed to determine the impact of the exercises activating the intrinsic foot muscles for postural control in children with flat feet, with normal and excessive body weight. METHODS Fifty-four children aged 7 to 12 were enrolled in the research. Forty-five children were qualified for the final evaluation. Each child in the experimental group was demonstrated an appropriate technique for performing a short foot exercise without compensation by extrinsic muscle. The participants then performed a supervised short foot training session once a week and on other days of the week under the supervision of caregivers for 6 weeks. Flat feet were scored on the foot posture index scale. A postural test was evaluated with a Biodex balance system SD. Statistical significance in the foot posture index scale and postural test were evaluated using an analysis of variance (ANOVA) with Tukey's post-hoc test. RESULTS according to the six indices of the foot posture index scale, five indicators showed statistically significant improvement after rehabilitation. At the 8-12 platform mobility level, it was revealed that the excessive body weight group had significant improvements in the overall stability index and medio-lateral stability index, with eyes closed. CONCLUSION our results indicate that a 6-week rehabilitation program based on the activation of the intrinsic muscles of the foot resulted in an improvement in the foot position. This, in turn, affected balance control, especially in children with excess body weight in conditions of closed eyes.
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Affiliation(s)
- Maria Markowicz
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Wojciech Skrobot
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Agnieszka Łabuć
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Paulina Poszytek
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Agnieszka Orlikowska
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Ewelina Perzanowska
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Katarzyna Krasowska
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Konrad Drewek
- Cathedral and Clinic for Orthopaedics and Traumatology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jan J Kaczor
- Division of Bioenergetics and Physiology of Exercise, Medical University of Gdansk, 80-210 Gdansk, Poland
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Žukauskas S, Barauskas V, Degliūtė-Muller R, Čekanauskas E. Really Asymptomatic? Health-Related Quality of Life and Objective Clinical Foot Characteristics among 5-10-Year-Old Children with a Flexible FlatFoot. J Clin Med 2023; 12:jcm12093331. [PMID: 37176771 PMCID: PMC10179374 DOI: 10.3390/jcm12093331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
The potential effects of asymptomatic flexible flatfoot (FF) on children's health-related quality of life (QoL) and objective clinical foot characteristics have been poorly investigated in the literature. Therefore, this study aimed to analyse these indicators, comparing the children with asymptomatic FF and a control group. METHODS In total, 351 children were enrolled in this cross-sectional study-160 children with asymptomatic FF and 191 controls (children with normal feet). The children and their parents completed the Paediatric Quality of Life Inventory (PedsQLTM 4.0). The objective foot characteristics included clinical foot posture measures, footprints, general hyperlaxity, and X-ray measurements. RESULTS Children with asymptomatic FF had a significantly lower QoL (overall and all four dimensions). The parents' assessment of the QoL of their children with asymptomatic FF in most cases was lower compared to their children's self-reported QoL. Moreover, almost all clinical foot measures also had significantly worse profiles among asymptomatic FF cases compared to the controls. This was observed with the Foot Posture Index-6 (FPI-6), the navicular drop (ND) test, the Chippaux-Smirak Index (CSI), Staheli's Index (SI), the Beighton scale, and radiological angles (except the talo-first metatarsal angle). CONCLUSION The findings suggest that asymptomatic FF not always reflects a normal foot development. This condition is related to decreased health-related quality of life, so the 5-10-year-old children's and their parents' complaints should be considered more closely in identification, treatment, and monitoring plans.
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Affiliation(s)
- Saidas Žukauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Vidmantas Barauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Ramunė Degliūtė-Muller
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Emilis Čekanauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Channasanon S, Praewpipat B, Duangjinda N, Sornchalerm L, Tesavibul P, Paecharoen S, Tanodekaew S. 3D-printed medial arch supports of varying hardness versus a prefabricated arch support on plantar pressure: A 1-month randomized crossover study in healthy volunteers. Prosthet Orthot Int 2023; 47:210-217. [PMID: 36037286 DOI: 10.1097/pxr.0000000000000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 06/01/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Foot orthoses are commonly used as a noninvasive treatment to relieve foot pain. The custom full-length insoles with various materials and designs have been studied for their effectiveness in reducing plantar pressure. However, few studies have been conducted with respect to custom medial arch support on the relationships between material hardness and measured plantar pressure and level of comfort. OBJECTIVES To evaluate the effects of the hardness of custom medial arch supports on plantar pressure and comfort perception. STUDY DESIGN Randomized crossover study. METHODS Two custom silicone medial arch supports of varying hardness (A and B) were fabricated using 3D printing technology and tested in 12 healthy volunteers against a commercially prefabricated arch support (C). The volunteers wore three medial arch supports in a random order, one month for each arch support with 3-4 days of washout period before wearing the next one. The plantar pressure was measured and analyzed according to each foot zone: forefoot, midfoot, and hindfoot, comparing before intervention, immediately after intervention, and 1 month after intervention. The comfort perception was assessed by collecting volunteer feedback with a questionnaire after using each medial arch support. RESULTS After 1-month intervention, both 3D-printed and prefabricated medial arch supports demonstrated significantly higher average pressure in the midfoot ( P < 0.001), whereas significantly lower average pressure in the forefoot ( P < 0.001) and hindfoot ( P = 0.014, 0.026, and 0.018 for A, B, and C, respectively), compared with those before intervention. There were no significant differences in plantar pressure distribution between the 3D-printed and prefabricated medial arch supports. However, the 3D-printed medial arch supports resulted in better comfort than the prefabricated arch support. CONCLUSIONS The material hardness had no apparent effect on plantar pressure distribution. The three medial arch supports showed reducing plantar heel pressure. Further research is needed to investigate the potential effect of 3D-printed silicone medial arch supports on reducing foot pain in patients.
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Affiliation(s)
- Somruethai Channasanon
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), Pathumthani, Thailand
| | - Bongkoch Praewpipat
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), Pathumthani, Thailand
| | - Nitkamon Duangjinda
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), Pathumthani, Thailand
| | - Lertchai Sornchalerm
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), Pathumthani, Thailand
| | - Passakorn Tesavibul
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), Pathumthani, Thailand
| | - Siranya Paecharoen
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Siriporn Tanodekaew
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), Pathumthani, Thailand
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Kim JY, Kim SA, Kim Y, Hwang I, Heo NH. Radiologic changes of long term foot insole use in symptomatic pediatric flatfoot. Medicine (Baltimore) 2023; 102:e33152. [PMID: 36897708 PMCID: PMC9997835 DOI: 10.1097/md.0000000000033152] [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: 07/17/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
Clinically, flatfoot, known as pes planus, is quite prevalent. It is classified into 2 types: flexible and rigid, both of which may or may not have symptoms. If a flexible flatfoot is symptomatic, it must be treated to prevent subsequent complications. In principle, most physicians initially use conservative methods, such as foot insoles. This study aimed to demonstrate the effect of long term use of a foot insole using plain radiography as an objective measurement in children with symptomatic flexible flatfoot (SFFF) in large samples. This study analyzed the medical records of 292 children aged < 18 years who were diagnosed with SFFF. Of these, 200 children (62 boys and 138 girls, mean age: 6.49 ± 2.96 years) were selected and conservatively treated with foot insoles. They were periodically followed up within 3 to 4 months to modify the foot insole and perform radiologic evaluations, such as foot radiography. The calcaneal pitch angle (CPA) and talo first metatarsal angle were measured and compared individually using foot lateral radiographs, which were pictured in a bilateral barefoot state. The treatment was terminated by repeating the same procedure until the symptoms disappeared. A significant improvement (P < .001) was observed in the radiological indicators, both CPA and talo first metatarsal angle, regardless of age, after the application of soft foot insoles. However, the right foot CPA in the group with valgus deformity was an exception (P = .078). This study showed that in children diagnosed with SFFF under 18 years of age, wearing a periodically revised foot insole as conservative treatment could not only decrease the symptoms, but also improve the radiologic indices.
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Affiliation(s)
- Joon Yeop Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Soo A Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Yuntae Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Insu Hwang
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
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Molina-García C, Banwell G, Rodríguez-Blanque R, Sánchez-García JC, Reinoso-Cobo A, Cortés-Martín J, Ramos-Petersen L. Efficacy of Plantar Orthoses in Paediatric Flexible Flatfoot: A Five-Year Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020371. [PMID: 36832500 PMCID: PMC9955448 DOI: 10.3390/children10020371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Paediatric flexible flatfoot (PFF) is a very common condition and a common concern among parents and various healthcare professionals. There is a multitude of conservative and surgical treatments, with foot orthoses (FO) being the first line of treatment due to their lack of contraindications and because the active participation of the child is not required, although the evidence supporting them is weak. It is not clear what the effect of FO is, nor when it is advisable to recommend them. PFF, if left untreated or uncorrected, could eventually cause problems in the foot itself or adjacent structures. It was necessary to update the existing information on the efficacy of FO as a conservative treatment for the reduction in signs and symptoms in patients with PFF, to know the best type of FO and the minimum time of use and to identify the diagnostic techniques most commonly used for PFF and the definition of PFF. A systematic review was carried out in the databases PubMed, EBSCO, Web of Science, Cochrane, SCOPUS and PEDro using the following strategy: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) on child patients with PFF, compared to those treated with FO or not being treated, assessing the improvement of signs and symptoms of PFF. Studies in which subjects had neurological or systemic disease or had undergone surgery were excluded. Two of the authors independently assessed study quality. PRISMA guidelines were followed, and the systematic review was registered in PROSPERO: CRD42021240163. Of the 237 initial studies considered, 7 RCTs and CCTs published between 2017 and 2022 met the inclusion criteria, representing 679 participants with PFF aged 3-14 years. The interventions of the included studies differed in diagnostic criteria, types of FO and duration of treatment, among others. All articles conclude that FO are beneficial, although the results must be taken with caution due to the risk of bias of the included articles. There is evidence for the efficacy of FO as a treatment for PFF signs and symptoms. There is no treatment algorithm. There is no clear definition for PFF. There is no ideal type of FO, although all have in common the incorporation of a large internal longitudinal arch.
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Affiliation(s)
- Cristina Molina-García
- Health Sciences Ph.D. Program, Universidad Católica de Murcia UCAM, Campus de Los Jerónimos n°135, Guadalupe, 30107 Murcia, Spain
| | - George Banwell
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- San Cecilio Clinical University Hospital, 18016 Granada, Spain
- Correspondence:
| | - Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
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14
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Oerlemans LNT, Peeters CMM, Munnik-Hagewoud R, Nijholt IM, Witlox A, Verheyen CCPM. Foot orthoses for flexible flatfeet in children and adults: a systematic review and meta-analysis of patient-reported outcomes. BMC Musculoskelet Disord 2023; 24:16. [PMID: 36611153 PMCID: PMC9825043 DOI: 10.1186/s12891-022-06044-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis examined the effectiveness of orthoses for flexible flatfeet in terms of patient-reported outcomes in children and adults. METHODS EMBASE, Medline (OvidSP), Web-of-Science, Scopus, CINAHL, Cochrane Central Register of Controlled Clinical Trials, i.e., Cochrane Central and Pubmed were searched to identify relevant studies since their inception up to February 2021. We included randomized controlled trials (RCT) and prospective studies in which patient reported outcomes at baseline and follow-up in an orthoses group were compared with a no orthoses or sham sole group. Methodological quality of the studies was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I). A meta-analysis was performed where there were multiple studies with the same outcome measures, which was the case for the Visual Analogue Scale (VAS) for pain in adults. RESULTS In total nine studies were included: four RCT in children (N = 353) and four RCT and one prospective study in adults (N = 268) were included. There was considerable heterogeneity between studies. A meta-analysis demonstrated that pain reduction between baseline and follow-up was significantly larger in the orthoses (N = 167) than in the control groups in adults (N = 157; - 4.76, 95% CI [- 9.46, - 0.06], p0.05). CONCLUSION Due to heterogeneity in study designs, we cannot conclude that foot orthoses are useful for flexible flatfoot in children and adults. However, based on the meta-analysis orthoses might be useful in decreasing pain in adults. The authors did not receive support from any organization for the submitted work.
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Affiliation(s)
- Leonoor N T Oerlemans
- Department of Orthopaedics, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands
| | - Charles M M Peeters
- Department of Orthopaedics, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands
- Department of Orthopaedics, University Medical Center of Groningen, Groningen, The Netherlands
| | - Roelina Munnik-Hagewoud
- Department of Orthopaedics, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands
- Department of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - Ingrid M Nijholt
- Department of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
- Department of Radiology and Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Adhiambo Witlox
- Department of Orthopaedics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cees C P M Verheyen
- Department of Orthopaedics, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands.
- Department of Orthopaedics, University Medical Center of Groningen, Groningen, The Netherlands.
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15
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Hikawa K, Tsutsui T, Ueyama T, Yang J, Hara Y, Torii S. Effects of a 9-weeks arch support intervention on foot morphology in young soccer players: a crossover study. BMC Sports Sci Med Rehabil 2022; 14:193. [PMID: 36376907 PMCID: PMC9664602 DOI: 10.1186/s13102-022-00590-3] [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] [Received: 07/27/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Background A flat foot is a common cause of chronic sports injuries and therefore many opportunities for arch support interventions exist. However, young athletes change their foot morphology due to developmental influences even without intervention. Therefore, developmental influences need to be considered when examining the effects of arch support, but there have not been sufficient longitudinal studies to date. This study aimed to determine the effect of the arch support intervention by performing a 9-weeks arch support intervention on the foot morphology and cross-sectional area of the foot muscles in flat-footed young athletes. Thirty-one elementary school boys (Age 11.4 ± 0.5 years, Height 145.2 ± 7.4 cm, Weight 38.8 ± 8.3 kg, BMI 18.2 ± 2.2 kg/m2) with a decreased medial longitudinal arch in the foot posture index were selected as participants from a local soccer club and randomly divided into two groups. Methods In one group, in the intervention period, an existing arch supporter was used to provide arch support, while in the other group, no special intervention was provided in the observation period. To account for developmental effects, the intervention study was conducted as an 18-weeks crossover study in which the intervention and observational phases were switched at 9 weeks after the intervention. Foot morphology was assessed using a three-dimensional foot measuring machine, and the cross-sectional area (CSA) of the internal and external muscles of the foot was assessed using an ultrasound imaging device. We examined the effect of the intervention by comparing the amount of change in the measurement results between the intervention and observation periods using corresponding t-tests and Wilcoxon signed-rank sum test, analysis of covariance methods. Results After adapting the exclusion criteria, 14 patients (28 feet) were included in the final analysis. The CSA of the abductor hallucis muscle (ABH) increased 9.7% during the intervention period and 3.0% during the observation period (p = 0.01). The CSA of the flexor digitorum longus muscle (FDL) increased 7.7% during the intervention period and 4.2% during the observation period (p = 0.02). Conclusion A 9-weeks arch supporter intervention may promote the development of the ABH and FDL CSA in young flat-footed soccer players.
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16
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Li J, Yang Z, Rai S, Li X, Jiang G, Pan X, Tang X. Effect of Insoles Treatment on School-Age Children with Symptomatic Flexible Flatfoot: A 2-Year Follow-Up Study. Indian J Orthop 2022; 56:1985-1991. [PMID: 36310549 PMCID: PMC9561439 DOI: 10.1007/s43465-022-00698-1] [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: 11/28/2021] [Accepted: 07/02/2022] [Indexed: 02/04/2023]
Abstract
Background Flatfoot is common among children. Symptomatic flexible flatfoot is one of the various types which needs treatment. Wearing insoles is considered one of the conservative therapies, but its effects are still uncertain. This study aims to provide evidence for the efficacy of insoles treatment among school-aged children with symptomatic flexible flatfoot. Methods Patient who were Children who were diagnosed with symptomatic flexible flatfoot and received insoles treatment in authors' institute were retrospectively included. Their ages, body mass index, pain positions, pain frequency, valgus angle, arch index and visual analogue scale (VAS) score were collected before and after insole treatment. Results A total of 32 children were included in this study. The results showed that wearing insoles for 2 years caused a significant improvement in pain frequency, valgus angle, arch index and VAS score. Conclusions This study indicated that pediatric symptomatic flexible flatfoot could be relieved by wearing insoles for 2 years. Insole treatment might be a workable option for pediatric symptomatic flexible flatfoot in children older than 6 years old.
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Affiliation(s)
- Jin Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Zimo Yang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, National Academy of Medical Sciences, Mahankal, Kathmandu, 44600 Nepal
| | - Xiangrui Li
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Guoyong Jiang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Xiaofei Pan
- Shafeile Rehabilitation Devices Co Ltd, Wuhan, 430000 China
| | - Xin Tang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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Zairi M, Msakni A, Mohseni AA, Othmen A, Mensia K, Saied W, Bouchoucha S, Boussetta R, Nessib MN. Calcaneal lengthening osteotomy in the management of idiopathic flatfoot in children: cCase series of twenty-one feet. Int J Surg Case Rep 2022; 99:107634. [PMID: 36099766 PMCID: PMC9568701 DOI: 10.1016/j.ijscr.2022.107634] [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] [Received: 08/19/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Flatfoot is a frequent reason for consultation in pediatric orthopedics. The calcaneal lengthening osteotomy according to the EVANS technique is a therapeutic alternative. The objective of this work was to evaluate the short and medium term clinical and radiological results of calcaneal lengthening osteotomy in children with idiopathic flat foot valgus. Methods This study concerned 12 children and 15 ft treated surgically by calcaneal lengthening osteotomy by an orthopedic surgeon in a pediatric orthopedic surgery center. The evaluation of the results was clinical according AOFAS score and radiological. Results The deformity was reducible in all of our patients. The mean preoperative AOFAS score was 61, postoperatively 90. The overall result was excellent in 11 cases (11 ft) and good in 4 cases. The postoperative radiological result was close to normal values. Conclusion Calcaneal lengthening osteotomy is a reliable and recommended technique for the correction of symptomatic idiopathic flatfoot. Level of evidence: IV, Case series. Flatfoot is a frequent reason for consultation in pediatric orthopedics. Orthopedic management was recommended up to 9 years old. Knowing how to choose the feet to be operated on is important. Calcaneal lengthening osteotomy is a reliable and recommended technique for the correction of symptomatic idiopathic flatfoot.
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18
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The Effect of Customized and Silicon Insoles on Mid- and Hindfoot in Adult Flexible Pes Planovalgus. Indian J Orthop 2022; 56:1897-1905. [PMID: 35879953 PMCID: PMC9299753 DOI: 10.1007/s43465-022-00699-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Flexible flat foot or pes planovalgus is a common foot deformity, and silicone and customized insole are commonly used as a non-operative treatment modality of flexible planovalgus. However, there are inadequate data and limited evidence available regarding the immediate effects of their use in midfoot and hindfoot of adults. The aim of this study is to quantify and compare the radiological parameters immediately on weightbearing with silicon and customized insoles and without them to assess the effect on midfoot and hindfoot of the flexible planovalgus in adults. METHODS A total number of 11 (8 females and 3 males) subjects with flexible pes planovalgus deformity without any other foot deformity were included in the study. Each patient was assessed three times in a random sequence without and with use of either silicon insoles or customized insole. The radiographic parameters without insole, with silicon insole, and with customized insole conditions were calculated using online available computer software Kinovea. RESULTS One-way ANOVA analysis was performed between groups (without insole, with silicone insole and with customized insole). The hindfoot parameters depicted that calcaneal inclination angle (CIA) was significant increased (P = 0.000) and talar declination angle (TDA) was significantly decreased (P = 0.003) only with the use of customized insole compared to without insole. The midfoot parameters depicted that the first metatarsal angle (FMA) and talonavicular coverage angle (TCA) were significantly lower with customized insole (P = 0.00) as compared to other two groups and significantly lower with silicone insole (P = 0.00) as compared to without insole group. CONCLUSION The results imply that the compressibility of the insole material affects the forefoot and hindfoot biomechanics differently. This study concludes that silicone insole affects only the midfoot which bears 45% of bodyweight and customized insole affects both midfoot and more importantly the hindfoot which bears 55% of bodyweight.
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Ataabadi PA, Abbassi A, Letafatkar A, Vanwanseele B. The effects of foot orthosis and low-dye tape on lower limb joint angles and moments during running in individuals with pes planus. Gait Posture 2022; 96:154-159. [PMID: 35660425 DOI: 10.1016/j.gaitpost.2022.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 05/07/2022] [Accepted: 05/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pes Planus or Flat feet is one of the most common lower limb abnormalities. When runners with this abnormality participate in recreational running, interventional therapies could help in pain alleviation and enhance performance. To determine the most effective treatment, however, a biomechanical examination of the effects of each treatment modality is required. RESEARCH QUESTION The aim of the present study was to investigate the effects of Foot Orthoses (FOs) and Low-Dye Tape (LDT) on lower limb joint angles and moments during running in individuals with pes planus. METHODS kinematic and kinetic data of 20 young people with pes planus were measured during running in three conditions: (1) SHOD (2) with shoes and FOs (3) with shoes and LDT. One-way repeated measure ANOVA was used to investigate the impacts of the FOs and LDT on the lower limb joint angles and moments throughout the stance phase of the running cycle. RESULTS The results showed that FOs reduced ankle eversion compared to SHOD and LDT (P < 0.001) and decreased the dorsiflexion angle (P = 0.005) and the plantarflexor moment compared to the SHOD (P < 0.001). FOs increased knee adduction angle (P = 0.021) and knee external rotator moment (P < 0.001) compared to both conditions and increased knee extensor and abductor moments compared to SHOD (P < 0.001). At the hip joint, FOs only increased hip external rotation compared with the LDT condition (P = 0.031); and LDT increased hip extensor moment compared to SHOD and FOs (P = 0.037) and also increased hip adduction angle compared to SHOD (P = 0.037). SIGNIFICANCE FOs with a medial wedge appears to increase the external knee adduction moment and knee adduction angles, which are risk factors for the development and progression of knee osteoarthritis. Further, usage of FOs seems to reduce the ankle joint role in propulsion as it impacts the ankle sagittal angles and moments.
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Affiliation(s)
- Peyman Aghaie Ataabadi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran.
| | - Ali Abbassi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
| | - Amir Letafatkar
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
| | - Benedicte Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven University, Leuven, Belgium
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Herdea A, Neculai AG, Ulici A. The Role of Arthroereisis in Improving Sports Performance, Foot Aesthetics and Quality of Life in Children and Adolescents with Flexible Flatfoot. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070973. [PMID: 35883957 PMCID: PMC9323989 DOI: 10.3390/children9070973] [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: 06/01/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
Abstract
Flexible flatfoot represents one of the most common deformities of the lower limb, affecting children and adolescents. Aesthetic aspect, abnormal gait, pain and fatigue are by far the most important symptoms which determine parents to bring their children to the orthopedist. We set out to conduct a prospective study, case-controlled, including patients with symptomatic flexible flatfeet operated on by arthroereisis surgery and comparing them to a normal feet group of children age- and sex-matched (control group). Minimum follow-up time was 2 years. In total, 33 patients with bilateral arthroereisis were included and 36 patients formed the control group (12.12 +/− 1.85 years vs. 11.81 ± 2.40 years, p = 0.54). Quality of life improved postoperatively (p = 0.18) and was not different from the control group. Median running time improved postoperatively by 2.25 s (p < 0.0001) and got closer to the median running time from the control group (22.30 s compared to 20.94 s, p = 0.01). All radiological angles improved (p < 0.0001), but quality of life improvement was correlated with talonavicular coverage angle and Meary angle measurements. Flatfoot in children and adolescents may be a condition in which the quality of life and sports performance are decreased, compared to healthy children. Arthroereisis is a minimally invasive surgical procedure with a short recovery time and a short period before resumption of sport activities, which can be useful in certain types of flexible flatfoot due to its effectiveness on symptom reduction.
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Affiliation(s)
- Alexandru Herdea
- 11th Department of Pediatric Orthopedics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Pediatric Orthopedics Department, Grigore Alexandrescu Children’s Emergency Hospital, 011743 Bucharest, Romania;
| | - Adrian-Gabriel Neculai
- Pediatric Orthopedics Department, Grigore Alexandrescu Children’s Emergency Hospital, 011743 Bucharest, Romania;
| | - Alexandru Ulici
- 11th Department of Pediatric Orthopedics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Pediatric Orthopedics Department, Grigore Alexandrescu Children’s Emergency Hospital, 011743 Bucharest, Romania;
- Correspondence: ; Tel.: +40-0723188988
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Smolle MA, Svehlik M, Regvar K, Leithner A, Kraus T. Long-term clinical and radiological outcomes following surgical treatment for symptomatic pediatric flexible flat feet: a systematic review. Acta Orthop 2022; 93:367-374. [PMID: 35347339 PMCID: PMC8958850 DOI: 10.2340/17453674.2022.2254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Albeit pediatric flexible flat foot (FFF) is a common condition, only a minority of patients become symptomatic. Long-term outcomes of surgically treated pediatric patients with symptomatic FFF are largely unknown. In this systematic review, studies providing outcomes at a mean follow-up of at least 4 years after the procedure in these patients were analyzed. MATERIAL AND METHODS A PubMed search was undertaken involving original articles published up to July 2021 on outcome in children aged 6 to 14 with surgically treated FFF and mean (or minimum) follow-up of at least 4 years. Radiographic and clinical outcomes were analyzed. RESULTS Of initially 541 entries, 10 could be included in the systematic review (all level IV), involving 846 pediatric patients with 1,536 symptomatic FFF. Pooled mean radiological (n = 8) and clinical follow-up (n = 10) was 5.3 (range 0.5-15) and 7.0 (range 4.1-15) years, respectively. Surgical procedures included arthroereisis (n = 8), lateral column lengthening (n = 1), and Horseman procedure (n = 1). Overall relative frequency of implant-associated complications and wound-healing problems was 3.2% and 1.3%, as well as 2.8% and 1.6% following subtalar arthroereisis only. From preoperative to latest radiological assessment following subtalar arthroereisis (including 3 studies with radiological follow-up < 48 months), pooled median decrease in talonavicular coverage angle (TNCA; -9.2°), anteroposterior talocalcaneal angle (A-TCA; -6.5°), lateral talocalcaneal angle (L-TCA; -3.5°), talar declination angle (TDA; -14°), Moreau Costa Bertani angle (MCB; -13°), and talo-firstmetatarsal angle (L-T1MA; -10°) was observed, as was an increase in calcaneal pitch (4.5°). INTERPRETATION In symptomatic pediatric FFF patients, surgery is associated with a manageable complication profile, and results in satisfactory long-term clinical as well as radiological outcome. Yet scientific evidence is low, warranting larger scaled studies in the future.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
| | - Martin Svehlik
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
| | - Katharina Regvar
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
| | - Tanja Kraus
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz.
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22
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Abstract
BACKGROUND Paediatric flat feet are a common presentation in primary care; reported prevalence approximates 15%. A minority of flat feet can hurt and limit gait. There is no optimal strategy, nor consensus, for using foot orthoses (FOs) to treat paediatric flat feet. OBJECTIVES To assess the benefits and harms of foot orthoses for treating paediatric flat feet. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase to 01 September 2021, and two clinical trials registers on 07 August 2020. SELECTION CRITERIA We identified all randomised controlled trials (RCTs) of FOs as an intervention for paediatric flat feet. The outcomes included in this review were pain, function, quality of life, treatment success, and adverse events. Intended comparisons were: any FOs versus sham, any FOs versus shoes, customised FOs (CFOs) versus prefabricated FOs (PFOs). DATA COLLECTION AND ANALYSIS We followed standard methods recommended by Cochrane. MAIN RESULTS We included 16 trials with 1058 children, aged 11 months to 19 years, with flexible flat feet. Distinct flat foot presentations included asymptomatic, juvenile idiopathic arthritis (JIA), symptomatic and developmental co-ordination disorder (DCD). The trial interventions were FOs, footwear, foot and rehabilitative exercises, and neuromuscular electrical stimulation (NMES). Due to heterogeneity, we did not pool the data. Most trials had potential for selection, performance, detection, and selective reporting bias. No trial blinded participants. We present the results separately for asymptomatic (healthy children) and symptomatic (children with JIA) flat feet. The certainty of evidence was very low to low, downgraded for bias, imprecision, and indirectness. Three comparisons were evaluated across trials: CFO versus shoes; PFO versus shoes; CFO versus PFO. Asymptomatic flat feet 1. CFOs versus shoes (1 trial, 106 participants): low-quality evidence showed that CFOs result in little or no difference in the proportion without pain (10-point visual analogue scale (VAS)) at one year (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.67 to 1.07); absolute decrease (11.8%, 95% CI 4.7% fewer to 15.8% more); or on withdrawals due to adverse events (RR 1.05, 95% CI 0.94 to 1.19); absolute effect (3.4% more, 95% CI 4.1% fewer to 13.1% more). 2. PFOs versus shoes (1 trial, 106 participants): low to very-low quality evidence showed that PFOs result in little or no difference in the proportion without pain (10-point VAS) at one year (RR 0.94, 95% CI 0.76 to 1.16); absolute effect (4.7% fewer, 95% CI 18.9% fewer to 12.6% more); or on withdrawals due to adverse events (RR 0.99, 95% CI 0.79 to 1.23). 3. CFOs versus PFOs (1 trial, 108 participants): low-quality evidence found no difference in the proportion without pain at one year (RR 0.93, 95% CI 0.73 to 1.18); absolute effect (7.4% fewer, 95% CI 22.2% fewer to 11.1% more); or on withdrawal due to adverse events (RR 1.00, 95% CI 0.90 to 1.12). Function and quality of life (QoL) were not assessed. Symptomatic (JIA) flat feet 1. CFOs versus shoes (1 trial, 28 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain (0 to 10 scale, 0 no pain) between groups (MD -1.5, 95% CI -2.78 to -0.22). Low-quality evidence showed improvements in function with CFOs (Foot Function Index - FFI disability, 0 to 100, 0 best function; MD -18.55, 95% CI -34.42 to -2.68), child-rated QoL (PedsQL, 0 to 100, 100 best quality; MD 12.1, 95% CI -1.6 to 25.8) and parent-rated QoL (PedsQL MD 9, 95% CI -4.1 to 22.1) and little or no difference between groups in treatment success (timed walking; MD -1.33 seconds, 95% CI -2.77 to 0.11), or withdrawals due to adverse events (RR 0.58, 95% CI 0.11 to 2.94); absolute difference (9.7% fewer, 20.5 % fewer to 44.8% more). 2. PFOs versus shoes (1 trial, 25 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain between groups (MD 0.02, 95% CI -1.94 to 1.98). Low-quality evidence showed no difference between groups in function (FFI-disability MD -4.17, 95% CI -24.4 to 16.06), child-rated QoL (PedsQL MD -3.84, 95% CI -19 to 11.33), or parent-rated QoL (PedsQL MD -0.64, 95% CI -13.22 to 11.94). 3. CFOs versus PFOs (2 trials, 87 participants): low-quality evidence showed little or no difference between groups in pain (0 to 10 scale, 0 no pain) at 3 months (MD -1.48, 95% CI -3.23 to 0.26), function (FFI-disability MD -7.28, 95% CI -15.47 to 0.92), child-rated QoL (PedsQL MD 8.6, 95% CI -3.9 to 21.2), or parent-rated QoL (PedsQL MD 2.9, 95% CI -11 to 16.8). AUTHORS' CONCLUSIONS Low to very low-certainty evidence shows that the effect of CFOs (high cost) or PFOs (low cost) versus shoes, and CFOs versus PFOs on pain, function and HRQoL is uncertain. This is pertinent for clinical practice, given the economic disparity between CFOs and PFOs. FOs may improve pain and function, versus shoes in children with JIA, with minimal delineation between costly CFOs and generic PFOs. This review updates that from 2010, confirming that in the absence of pain, the use of high-cost CFOs for healthy children with flexible flat feet has no supporting evidence, and draws very limited conclusions about FOs for treating paediatric flat feet. The availability of normative and prospective foot development data, dismisses most flat foot concerns, and negates continued attention to this topic. Attention should be re-directed to relevant paediatric foot conditions, which cause pain, limit function, or reduce quality of life. The agenda for researching asymptomatic flat feet in healthy children must be relegated to history, and replaced by a targeted research rationale, addressing children with indisputable foot pathology from discrete diagnoses, namely JIA, cerebral palsy, congenital talipes equino varus, trisomy 21 and Charcot Marie Tooth. Whether research resources should continue to be wasted on studying flat feet in healthy children that do not hurt, is questionable. Future updates of this review will address only relevant paediatric foot conditions.
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Affiliation(s)
- Angela M Evans
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Keith Rome
- Division of Rehabilitation & Occupation Studies, AUT University, Auckland 1020, New Zealand
| | - Matthew Carroll
- Department of Podiatry, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Fiona Hawke
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia
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23
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Abstract
BACKGROUND Paediatric flat feet are a common presentation in primary care; reported prevalence approximates 15%. A minority of flat feet can hurt and limit gait. There is no optimal strategy, nor consensus, for using foot orthoses (FOs) to treat paediatric flat feet. OBJECTIVES To assess the benefits and harms of foot orthoses for treating paediatric flat feet. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase to 01 September 2021, and two clinical trials registers on 07 August 2020. SELECTION CRITERIA We identified all randomised controlled trials (RCTs) of FOs as an intervention for paediatric flat feet. The outcomes included in this review were pain, function, quality of life, treatment success, and adverse events. Intended comparisons were: any FOs versus sham, any FOs versus shoes, customised FOs (CFOs) versus prefabricated FOs (PFOs). DATA COLLECTION AND ANALYSIS We followed standard methods recommended by Cochrane. MAIN RESULTS We included 16 trials with 1058 children, aged 11 months to 19 years, with flexible flat feet. Distinct flat foot presentations included asymptomatic, juvenile idiopathic arthritis (JIA), symptomatic and developmental co-ordination disorder (DCD). The trial interventions were FOs, footwear, foot and rehabilitative exercises, and neuromuscular electrical stimulation (NMES). Due to heterogeneity, we did not pool the data. Most trials had potential for selection, performance, detection, and selective reporting bias. No trial blinded participants. We present the results separately for asymptomatic (healthy children) and symptomatic (children with JIA) flat feet. The certainty of evidence was very low to low, downgraded for bias, imprecision, and indirectness. Three comparisons were evaluated across trials: CFO versus shoes; PFO versus shoes; CFO versus PFO. Asymptomatic flat feet 1. CFOs versus shoes (1 trial, 106 participants): low-quality evidence showed that CFOs result in little or no difference in the proportion without pain (10-point visual analogue scale (VAS)) at one year (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.67 to 1.07); absolute decrease (11.8%, 95% CI 4.7% fewer to 15.8% more); or on withdrawals due to adverse events (RR 1.05, 95% CI 0.94 to 1.19); absolute effect (3.4% more, 95% CI 4.1% fewer to 13.1% more). 2. PFOs versus shoes (1 trial, 106 participants): low to very-low quality evidence showed that PFOs result in little or no difference in the proportion without pain (10-point VAS) at one year (RR 0.94, 95% CI 0.76 to 1.16); absolute effect (4.7% fewer, 95% CI 18.9% fewer to 12.6% more); or on withdrawals due to adverse events (RR 0.99, 95% CI 0.79 to 1.23). 3. CFOs versus PFOs (1 trial, 108 participants): low-quality evidence found no difference in the proportion without pain at one year (RR 0.93, 95% CI 0.73 to 1.18); absolute effect (7.4% fewer, 95% CI 22.2% fewer to 11.1% more); or on withdrawal due to adverse events (RR 1.00, 95% CI 0.90 to 1.12). Function and quality of life (QoL) were not assessed. Symptomatic (JIA) flat feet 1. CFOs versus shoes (1 trial, 28 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain (0 to 10 scale, 0 no pain) between groups (MD -1.5, 95% CI -2.78 to -0.22). Low-quality evidence showed improvements in function with CFOs (Foot Function Index - FFI disability, 0 to 100, 0 best function; MD -18.55, 95% CI -34.42 to -2.68), child-rated QoL (PedsQL, 0 to 100, 100 best quality; MD 12.1, 95% CI -1.6 to 25.8) and parent-rated QoL (PedsQL MD 9, 95% CI -4.1 to 22.1) and little or no difference between groups in treatment success (timed walking; MD -1.33 seconds, 95% CI -2.77 to 0.11), or withdrawals due to adverse events (RR 0.58, 95% CI 0.11 to 2.94); absolute difference (9.7% fewer, 20.5 % fewer to 44.8% more). 2. PFOs versus shoes (1 trial, 25 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain between groups (MD 0.02, 95% CI -1.94 to 1.98). Low-quality evidence showed no difference between groups in function (FFI-disability MD -4.17, 95% CI -24.4 to 16.06), child-rated QoL (PedsQL MD -3.84, 95% CI -19 to 11.33), or parent-rated QoL (PedsQL MD -0.64, 95% CI -13.22 to 11.94). 3. CFOs versus PFsO (2 trials, 87 participants): low-quality evidence showed little or no difference between groups in pain (0 to scale, 0 no pain) at 3 months (MD -1.48, 95% CI -3.23 to 0.26), function (FFI-disability MD -7.28, 95% CI -15.47 to 0.92), child-rated QoL (PedsQL MD 8.6, 95% CI -3.9 to 21.2), or parent-rated QoL (PedsQL MD 2.9, 95% CI -11 to 16.8). AUTHORS' CONCLUSIONS Low to very low-certainty evidence shows that the effect of CFOs (high cost) or PFOs (low cost) versus shoes, and CFOs versus PFOs on pain, function and HRQoL is uncertain. This is pertinent for clinical practice, given the economic disparity between CFOs and PFOs. FOs may improve pain and function, versus shoes in children with JIA, with minimal delineation between costly CFOs and generic PFOs. This review updates that from 2010, confirming that in the absence of pain, the use of high-cost CFOs for healthy children with flexible flat feet has no supporting evidence, and draws very limited conclusions about FOs for treating paediatric flat feet. The availability of normative and prospective foot development data, dismisses most flat foot concerns, and negates continued attention to this topic. Attention should be re-directed to relevant paediatric foot conditions, which cause pain, limit function, or reduce quality of life. The agenda for researching asymptomatic flat feet in healthy children must be relegated to history, and replaced by a targeted research rationale, addressing children with indisputable foot pathology from discrete diagnoses, namely JIA, cerebral palsy, congenital talipes equino varus, trisomy 21 and Charcot Marie Tooth. Whether research resources should continue to be wasted on studying flat feet in healthy children that do not hurt, is questionable. Future updates of this review will address only relevant paediatric foot conditions.
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Affiliation(s)
- Angela M Evans
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Keith Rome
- Division of Rehabilitation & Occupation Studies, AUT University, Auckland 1020, New Zealand
| | - Matthew Carroll
- Department of Podiatry, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Fiona Hawke
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia
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24
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Maarj M, Coda A, Tofts L, Williams C, Santos D, Pacey V. Outcome measures for assessing change over time in studies of symptomatic children with hypermobility: a systematic review. BMC Pediatr 2021; 21:527. [PMID: 34839813 PMCID: PMC8628404 DOI: 10.1186/s12887-021-03009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Generalised joint hypermobility (GJH) is highly prevalent among children and associated with symptoms in a fifth with the condition. This study aimed to synthesise outcome measures in interventional or prospective longitudinal studies of children with GJH and associated lower limb symptoms. Methods Electronic searches of Medline, CINAHL and Embase databases from inception to 16th March 2020 were performed for studies of children with GJH and symptoms between 5 and 18 years reporting repeated outcome measures collected at least 4 weeks apart. Methodological quality of eligible studies were described using the Downs and Black checklist. Results Six studies comprising of five interventional, and one prospective observational study (total of 388 children) met the inclusion criteria. Interventional study durations were between 2 and 3 months, with up to 10 months post-intervention follow-up, while the observational study spanned 3 years. Three main constructs of pain, function and quality of life were reported as primary outcome measures using 20 different instruments. All but one measure was validated in paediatric populations, but not specifically for children with GJH and symptoms. One study assessed fatigue, reporting disabling fatigue to be associated with higher pain intensity. Conclusions There were no agreed sets of outcome measures used for children with GJH and symptoms. The standardisation of assessment tools across paediatric clinical trials is needed. Four constructs of pain, function, quality of life and fatigue are recommended to be included with agreed upon, validated, objective tools.
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Affiliation(s)
- Muhammad Maarj
- Narrabeen Sports Medicine Centre, Sydney Academy of Sport, Sydney, Australia. .,Department of Health Sciences, Newcastle University, Newcastle, Australia.
| | - Andrea Coda
- Department of Health Sciences, Newcastle University, Newcastle, Australia.,Priority Research Centre Health Behaviour, Hunter Medical Research Institute HMRI, Newcastle, Australia
| | - Louise Tofts
- Narrabeen Sports Medicine Centre, Sydney Academy of Sport, Sydney, Australia.,Department of Health Professions, Macquarie University, Sydney, Australia
| | - Cylie Williams
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Derek Santos
- Department of Health Sciences, Queen Margaret University, Scotland, UK
| | - Verity Pacey
- Department of Health Professions, Macquarie University, Sydney, Australia
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25
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Camurcu Y, Ucpunar H, Karakose R, Ozcan S, Sahin V. Foot orthoses use for pediatric flexible flatfoot: comparative evaluation of quality of life for children and parents. J Pediatr Orthop B 2021; 30:282-286. [PMID: 32453124 DOI: 10.1097/bpb.0000000000000750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to comparatively evaluate the quality of life scores of patients with pediatric flexible flatfoot (PFF) according to the use of foot orthoses. We also aimed to compare quality of life scores of children and their parents. Nonobese children aged between 5 and 10 years old who were diagnosed as PFF according to physical and radiological examinations were included in this cross-sectional comparative study. All children and their parents completed the Turkish translation of Oxford ankle foot questionnaire (OxAFQ) which contains four domains (physical, school and play, emotional, and footwear). Patients were grouped according to the use of foot orthoses (group I: no foot orthoses group and group II: foot orthoses group). Comparison of OxAFQ scores demonstrated no significant differences between the two groups. However, the mean emotional scores of parents were significantly lower in group II (P = 0.007). In group I, the mean emotional score of children was significantly lower compared to their parents' scores (P = 0.001). In group II, the mean physical score of children was significantly lower compared to their parents' scores (P = 0.003). According to our results, we observed no significant difference in terms of quality of life scores between children using foot orthoses and not using foot orthoses. However, we observed significantly lower emotional scores in parents whose children were using foot orthoses. We recommend that physicians should be aware of low physical scores in children with PFF and should inform parents about this situation rather than considering foot orthoses to relieve parents' concern about foot deformity.
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Affiliation(s)
- Yalkin Camurcu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
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26
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YILDIZ Ş, ŞAHİN S, BEK N. Fizyolojik Pes Planus Görülen Çocuklarda Sağlıkla İlgili Yaşam Kalitesi ile Alt Ekstremite Biyomekaniksel Özellikleri Arasındaki İlişkinin İncelenmesi – Pilot Çalışma. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2021. [DOI: 10.33631/duzcesbed.800903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Žukauskas S, Barauskas V, Čekanauskas E. Comparison of multiple flatfoot indicators in 5-8-year-old children. Open Med (Wars) 2021; 16:246-256. [PMID: 33623820 PMCID: PMC7885299 DOI: 10.1515/med-2021-0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/15/2020] [Accepted: 01/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background The foot posture is age dependent. The purpose of this study was to investigate the relationship between the 6-item version of the foot posture index (FPI) and other clinical, foot anthropometric, radiological measurements for the foot position in 5–8-year-old children. Methods A total of 301 participants with a mean age of 6.4 ± 1.14 years were enrolled in the study. Children were examined physically, clinically, and radiologically to measure the FPI and navicular drop (ND) test, resting calcaneal stance position (RCSP) angle, Chippaux–Smirak index (CSI), Staheli index (SI), calcaneal pitch (CP) angle, talocalcaneal angle (TCA), and the first lateral metatarsal angle. Tibial torsions, internal rotation of the hip as an indirect method of femoral anteversion, and Beighton scale were analyzed for factors associated with flatfoot prevalence. Results The study included children with normal and flexible flatfeet. Statistical analysis showed a significant FPI score correlation with other parameters (SI, CSI, RCSP, ND, CP, TMA, and TCA showed strong and moderate correlations, p < 0.001). Overall, the strongest associates are CSI (β = 0.34) and ND (β = 0.28). Other indicators have relatively small relationships with the FPI. Conclusion A positive correlation was observed between FPI-6 and ND test, CSI in 5–8-year-old children. All three prominent foot posture indicators (FPI-6, ND, and CSI) might be used as a primary or preferred tool in clinical practice.
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Affiliation(s)
- Saidas Žukauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, Pramonės pr. 47-24, Kaunas, Kauno m., LT-50461, Lithuania
| | - Vidmantas Barauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307, Kaunas, Lithuania
| | - Emilis Čekanauskas
- Department of Paediatric Surgery Pediatric Orthopedics - Traumatology Unit, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307, Kaunas, Lithuania
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28
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Huang YP, Peng HT, Wang X, Chen ZR, Song CY. The arch support insoles show benefits to people with flatfoot on stance time, cadence, plantar pressure and contact area. PLoS One 2020; 15:e0237382. [PMID: 32817709 PMCID: PMC7446821 DOI: 10.1371/journal.pone.0237382] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pes planus (flatfoot) is a common deformity characterized by the midfoot arch collapses during walking. As the midfoot is responsible for shock absorption, persons with flatfoot experience increased risk of injuries such as thumb valgus, tendinitis, plantar fasciitis, metatarsal pain, knee pain, lower-back pain with prolonged uphill, downhill, and level walking, depriving them of the physical and mental health benefits of walking as an exercise. METHODS Fifteen female college students with flatfoot were recruited. A wireless plantar-pressure system was used to measure the stance time, cadence, plantar pressure, and contact area. Parameters were compared between wearing flat and arch-support insoles using a two-way repeated measures ANOVA with on an incline, decline, and level surface, respectively. The significance level α was set to 0.05. The effect size (ES) was calculated as a measure of the practical relevance of the significance using Cohen's d. RESULTS On the level surface, the stance time in the arch-support insole was significantly shorter than in the flat insole (p<0.05; ES = 0.48). The peak pressure of the big toe in the arch-support insole was significantly greater than in the flat insole on the uphill (p<0.05; ES = 0.53) and level surfaces (p<0.05; ES = 0.71). The peak pressure of the metatarsals 2-4 and the contact area of the midfoot in the arch-support insole were significantly greater than in the flat insole on all surfaces (all p< 0.05). CONCLUSIONS These results imply that wearing an arch-support insole provides benefits in the shortened stance time and generation of propulsion force to the big toe while walking on uphill and level surfaces and to the metatarsals 2-4 while walking on the level surface. More evenly distributed contact areas across the midfoot may help absorb shock during uphill, downhill and level walking.
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Affiliation(s)
- Yu-ping Huang
- School of Sports Science, Nantong University, Jiangsu, China
- Graduate Institute of Sport Coaching Science & Department of Physical Education, Chinese Culture University, Taipei, Taiwan
| | - Hsien-Te Peng
- Graduate Institute of Sport Coaching Science & Department of Physical Education, Chinese Culture University, Taipei, Taiwan
| | - Xin Wang
- Department of Sports Human Science, Shenyang Sport University, Shenyang, China
| | - Zong-Rong Chen
- Graduate Institute of Sport Coaching Science & Department of Physical Education, Chinese Culture University, Taipei, Taiwan
- Department of Athletic Performance, National University of Kaohsiung, Kaohsiun, Taiwan
| | - Chen-Yi Song
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- * E-mail:
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Bilateral Foot Orthoses Elicit Changes in Gait Kinematics of Adolescents with Down Syndrome with Flatfoot. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144994. [PMID: 32664499 PMCID: PMC7400424 DOI: 10.3390/ijerph17144994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022]
Abstract
Background: Subjects with Down Syndrome (DS) are characterized by specific physiological alterations, including musculoskeletal abnormalities. Flat Foot (FF), caused by hypotonia and ligament laxity, represents one of the most common disabling disorders in this population. Conservative treatments promote the use of orthopaedic insoles and plantar supports. The aim of this study was to evaluate the impact of Foot Orthoses (FOs) on the gait pattern of subjects with DS, assessing the biomechanical effects associated with their use. Methods: Twenty-nine subjects were screened under two conditions-walking barefoot (WB); with shoes and insoles (WSI), during three trials for each. Assessments were performed through the 3D gait analysis, using an optoelectronic system, force platforms, and video recording. Specifically, synthetic indices of gait kinematics, i.e., gait profile score (GPS) and gait variable score (GVS) were calculated and compared with Wilcoxon signed-rank test, to evaluate between-conditions. Results: Significant variations were found in GVS foot progression index, representative of foot rotation during walking, in adolescents only. Conclusions: Bilateral FOs has a positive immediate impact on gait quality in adolescents with DS, as confirmed by quantitative analysis. FOs prescription is an evidence-based early approach to slow down biomechanical abnormalities and prevent relative symptoms.
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30
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Braito M, Radlwimmer M, Dammerer D, Hofer-Picout P, Wansch J, Biedermann R. Tarsometatarsal bone remodelling after subtalar arthroereisis. J Child Orthop 2020; 14:221-229. [PMID: 32582390 PMCID: PMC7302416 DOI: 10.1302/1863-2548.14.190190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Subtalar arthroereisis has been described for the treatment of flexible juvenile flatfoot. However, the mechanism responsible for deformity correction has not yet been investigated adequately. The aim of this study was to document the effect of subtalar arthroereisis on the tarsometatarsal bone morphology. METHODS We retrospectively reviewed the clinical and radiological data of 26 patients (45 feet) with juvenile flexible flatfoot deformity treated by subtalar arthroereisis at our department between 2000 and 2018. Radiological evaluation included angular measurements of tarsometatarsal bone morphology as well as hindfoot and midfoot alignment. Mean radiographic follow-up was 19.4 months (sd 8.8; 12 to 41). RESULTS A significant change of angular measurements of tarsometatarsal bone morphology was found after subtalar arthroereisis (p < 0.001). While there was an increase of the distal medial cuneiform angle (DMCA) and the medial cuneo-first metatarsal angle on the anteroposterior view, a decrease of the naviculo-medial cuneiform angle and the medial cuneo-first metatarsal angle was seen on the lateral view. Furthermore, we found significant improvements of all hindfoot and midfoot alignment parameters except the lateral tibio-calcaneal angle and the calcaneal pitch angle (p < 0.001). CONCLUSION Our data support the theory of tarsometatarsal bone remodelling, which may contribute to the effect of subtalar arthroereisis for the treatment of flexible juvenile flatfoot. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthias Braito
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria
| | - Maria Radlwimmer
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria
| | | | - Jürgen Wansch
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria
| | - Rainer Biedermann
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria,Correspondence should be sent to Rainer Biedermann, Department of Orthopedics, Medical University of Innsbruck, Austria, Anichstraße 35, A-6020 Innsbruck, Austria. E-Mail:
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Lam WK, Pak LY, Wong CKW, Tan MF, Park SK, Ryu J, Leung AKL. Effects of arch-support orthoses on ground reaction forces and lower extremity kinematics related to running at various inclinations. J Sports Sci 2020; 38:1629-1634. [PMID: 32308132 DOI: 10.1080/02640414.2020.1754704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
While foot orthoses are commonly used in running, little is known regarding biomechanical risk potentials during uphill running. This study investigated the effects of arch-support orthoses on kinetic and kinematic variables when running at different inclinations. Sixteen male participants ran at different inclinations (0°, 3° and 6°) when wearing arch-support and flat orthoses on an instrumented treadmill. Arch-support orthoses induced longer contact time, larger initial ankle dorsiflexion, maximum ankle eversion, and knee sagittal range of motion (RoM) (p < 0.05). As incline slopes increased, vertical impact peak and loading rate, stride length, and ankle coronal RoM decreased, but contact time, stride frequency, initial ankle dorsiflexion and inversion, maximum dorsiflexion, initial knee flexion, and ankle sagittal RoM increased (p < 0.05). Furthermore, knee sagittal RoM was lowest when running at an inclination of 3°. The interaction effect indicated that in arch-support condition, participants running at 6° induced higher maximum ankle eversion than running at 0° (p < 0.05), while no differences were found in flat orthosis condition. These findings suggest that the use of arch-support orthoses would influence running biomechanics that is related to injury risks. Running at higher inclination led to more alterations to biomechanical variables than at lower inclination.
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Affiliation(s)
- Wing-Kai Lam
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University , Guangzhou, China.,Department of Kinesiology, Shenyang Sport University , Shenyang, China.,Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Limited Company , Beijing, China
| | - Lok-Yee Pak
- Department of Biomedical Engineering, The Hong Kong Polytechnic University , Hong Kong, China
| | - Charis King-Wai Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University , Hong Kong, China
| | - Mohammad Farhan Tan
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Limited Company , Beijing, China.,Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University , Singapore
| | - Sang-Kyoon Park
- Motion Innovation Centre, Korea National Sport University , Seoul, Republic of Korea
| | - Jiseon Ryu
- Motion Innovation Centre, Korea National Sport University , Seoul, Republic of Korea
| | - Aaron Kam-Lun Leung
- Department of Biomedical Engineering, The Hong Kong Polytechnic University , Hong Kong, China
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Clayton-Smith J, Bromley R, Dean J, Journel H, Odent S, Wood A, Williams J, Cuthbert V, Hackett L, Aslam N, Malm H, James G, Westbom L, Day R, Ladusans E, Jackson A, Bruce I, Walker R, Sidhu S, Dyer C, Ashworth J, Hindley D, Diaz GA, Rawson M, Turnpenny P. Diagnosis and management of individuals with Fetal Valproate Spectrum Disorder; a consensus statement from the European Reference Network for Congenital Malformations and Intellectual Disability. Orphanet J Rare Dis 2019; 14:180. [PMID: 31324220 PMCID: PMC6642533 DOI: 10.1186/s13023-019-1064-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A pattern of major and minor congenital anomalies, facial dysmorphic features, and neurodevelopmental difficulties, including cognitive and social impairments has been reported in some children exposed to sodium valproate (VPA) during pregnancy. Recognition of the increased risks of in utero exposure to VPA for congenital malformations, and for the neurodevelopmental effects in particular, has taken many years but these are now acknowledged following the publication of the outcomes of several prospective studies and registries. As with other teratogens, exposure to VPA can have variable effects, ranging from a characteristic pattern of major malformations and significant intellectual disability to the other end of the continuum, characterised by facial dysmorphism which is often difficult to discern and a more moderate effect on neurodevelopment and general health. It has become clear that some individuals with FVSD have complex needs requiring multidisciplinary care but information regarding management is currently lacking in the medical literature. METHODS An expert group was convened by ERN-ITHACA, the European Reference Network for Congenital Malformations and Intellectual Disability comprised of professionals involved in the care of individuals with FVSD and with patient representation. Review of published and unpublished literature concerning management of FVSD was undertaken and the level of evidence from these sources graded. Management recommendations were made based on strength of evidence and consensus expert opinion, in the setting of an expert consensus meeting. These were then refined using an iterative process and wider consultation. RESULTS Whilst there was strong evidence regarding the increase in risk for major congenital malformations and neurodevelopmental difficulties there was a lack of high level evidence in other areas and in particular in terms of optimal clinical management.. The expert consensus approach facilitated the formulation of management recommendations, based on literature evidence and best practice. The outcome of the review and group discussions leads us to propose the term Fetal Valproate Spectrum Disorder (FVSD) as we feel this better encompasses the broad range of effects seen following VPA exposure in utero. CONCLUSION The expert consensus approach can be used to define the best available clinical guidance for the diagnosis and management of rare disorders such as FVSD. FVSD can have medical, developmental and neuropsychological impacts with life-long consequences and affected individuals benefit from the input of a number of different health professionals.
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Affiliation(s)
- Jill Clayton-Smith
- Division of Evolution and Genomic Sciences School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Rebecca Bromley
- Division of Evolution and Genomic Sciences School of Biological Sciences, University of Manchester, Manchester, UK
- Paediatric Psychosocial Department, Royal Manchester Children’s Hospital, Manchester Academic Health Sciences Centre, Manchester, UK
| | - John Dean
- Clinical Genetics, Clinical Genetics Service, Ashgrove House, Foresterhill, Aberdeen, UK
| | - Hubert Journel
- Génétique Médicale – Consultation, CHBA Centre Hospitalier Bretagne Atlantique - CH Chubert, 20 boulevard du Général Maurice Guillaudot, BP 70555, 56017 Vannes Cedex, France
| | - Sylvie Odent
- Service de Génétique Clinique, CNRS UMR 6290, Université de Rennes, CHU de Rennes - Hôpital Sud, 16 Boulevard de Bulgarie, 35203 Rennes Cedex 2, France
| | - Amanda Wood
- Aston Brain Centre, School of Life and Health Sciences, Aston Triangle, Birmingham, UK
- Brain and Mind, Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Melbourne, Australia
| | - Janet Williams
- INFACT/FACSA, Independent Fetal Anti-Convulsant Trust & FACS Syndrome Association, Preston, UK
| | - Verna Cuthbert
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Latha Hackett
- Child and Adolescent Mental Health Services (CAMHS), Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Neelo Aslam
- Child and Adolescent Mental Health Services (CAMHS), Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Heli Malm
- Teratology Information Service, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Tukholmankatu 17, 00029 HUS, Helsinki, Finland
| | - Gregory James
- Department of Neurosurgery, Great Ormond Street Hospital, Great Ormond Street, London, UK
- Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH UK
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Lena Westbom
- Lund University, Barnmed klin, SUS, Lund, Sweden
| | - Ruth Day
- Guardian Medical Centre, Guardian Street, Warrington, UK
| | - Edmund Ladusans
- Department of Paediatric Cardiology, Royal Manchester Children’s Hospital, Oxford Road, Manchester, UK
| | - Adam Jackson
- Department of Neurology, Salford Royal Hospital NHS Trust, Stott Lane, Salford, UK
| | - Iain Bruce
- Paediatric ENT Department, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Robert Walker
- Department of Paediatric Anaesthesia, Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Sangeet Sidhu
- Department of Paediatric Nephrology, Royal Manchester Children’s Hospital, Oxford Road, Manchester, UK
| | - Catrina Dyer
- Cleft Lip and Palate Team, Royal Manchester Children’s Hospital, Oxford Road, Manchester, UK
| | - Jane Ashworth
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Daniel Hindley
- Community Paediatrics, Bolton NHS Foundation Trust, Breightmet Health Centre, Bolton, UK
| | - Gemma Arca Diaz
- Department of Neonatology, Hospital Clinic (Maternitat), Sabino Arana 1, 08028 Barcelona, Spain
| | - Myfanwy Rawson
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Peter Turnpenny
- Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Gladstone Rd, Exeter, UK
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