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Payas A, Batin S. Is a keystone Bone Anomaly the Main Cause of Flatfoot (Pes Planus)? J Pediatr Orthop 2024; 44:e816-e822. [PMID: 38918893 DOI: 10.1097/bpo.0000000000002760] [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] [Indexed: 06/27/2024]
Abstract
BACKGROUND Flatfoot (pes planus) is a decrease or loss of longitudinal medial arch height. The cause of symptomatic flatfoot occurring in adolescents is still unclear. In this study, the relationship between adolescent pes planus and foot bone shape was investigated. For this purpose, the volume and superficial area data of the foot bones of adolescent individuals with flatfoot deformity and individuals without any foot deformity were compared. METHODS Between September 2022 and June 2023, 30 individuals with adolescent pes planus with a medial arch angle greater than 145 degrees and 30 individuals without any foot deformity were included in the study. Computed tomography (CT) images of the participants' feet were obtained with a General Electric brand IQ model 32 detector CT device with a section thickness of 0.625 mm in accordance with the bone protocol. Using the 3D Slicer program on CT images, foot bones were segmented and the volume and surface area ratios of each foot bone were determined. RESULTS Cuneiforme mediale and cuneiforme intermediale volume ratios in individuals with flatfoot deformity decreased by 14% and 24%, respectively, compared with the control group ( P <0.05). Cuneiforme mediale and cuneiforme intermediale superficial area ratios were found to be 10% and 30% lower in the flatfoot group compared with the control group, respectively ( P <0.05). There was no difference in the volume and superficial area ratios of other foot bones between the groups ( P >0.05). CONCLUSIONS The study results suggest that symptomatic adolescent flatfoot deformity may be associated with developmental anomalies of the os cuneiforme mediale and os cuneiforme intermedium.
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Affiliation(s)
- Ahmet Payas
- Department of Anatomy, Faculty of Medicine, Amasya University, Amasya
| | - Sabri Batin
- Kayseri City Education and Training Hospital Orthopedics and Traumatology Department, Kayseri, Turkey
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Monestier L, Riva G, Latiff M, Marciandi L, Bozzi E, Pelozzi A, Pautasso A, Pilato G, Surace MF, D'Angelo F. Pediatric flexible flatfoot: Does obesity influence the outcomes of arthroereisis? World J Orthop 2024; 15:850-857. [PMID: 39318489 PMCID: PMC11417632 DOI: 10.5312/wjo.v15.i9.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide. Although relationships between obesity and flatfoot have been shown, no studies have investigated the influence of obesity on arthroereisis outcomes. AIM To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants. METHODS This retrospective study included one hundred and sixty-nine pediatric patients (10-14 years old) who underwent subtalar arthroereisis (PEEK PitStop® device) for severe flexible flatfoot. Exclusion criteria were additional procedures, revision of previous corrective surgeries, rigid flatfoot with severe deformity, and neurological or post-traumatic flatfoot. Preoperative/postoperative European Foot and Ankle Society (EFAS) and visual analogue scale (VAS) scores were determined; radiographic assessment was conducted on weight-bearing foot X-rays: Kite angle, first metatarsal-talus angle, Meary angle, calcaneal pitch angle and lateral talo-calcaneal angle were analyzed. RESULTS EFAS and VAS scores improved post-operatively in the whole population. Only seven cases with complications were reported. Radiographic assessment revealed an improvement in all angles. Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes: Relationships were reported between BMI and postoperative EFAS/VAS scores, postoperative calcaneal pitch angle, Kite angle, Meary angle and talo-first metatarsal angle. CONCLUSION Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children, obesity significantly influences clinical and radiographic outcomes of arthroereisis, and obese children tend to perceive more pain and discomfort.
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Affiliation(s)
- Luca Monestier
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Giacomo Riva
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Mahfuz Latiff
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Luca Marciandi
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Elisa Bozzi
- Residency Program in Orthopedics and Trauma, Department of Biotechnologies and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
| | - Alessandra Pelozzi
- Residency Program in Orthopedics and Trauma, Department of Biotechnologies and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
| | - Andrea Pautasso
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Giorgio Pilato
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
| | - Michele Francesco Surace
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
- Division of Orthopedics and Traumatology, Ospedale di Cittiglio, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Fabio D'Angelo
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
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3
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Shu W, Jiang G, Yang Z, Rong Z, Li X, Yu B, Tang X. Four-Year Treatment Effect of Custom-Made Foot Orthosis on Pediatric Symptomatic Accessory Navicular Bone Combined with Flexible Flatfoot. Indian J Orthop 2024; 58:1159-1165. [PMID: 39087034 PMCID: PMC11286606 DOI: 10.1007/s43465-024-01210-7] [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: 01/02/2024] [Accepted: 06/18/2024] [Indexed: 08/02/2024]
Abstract
Purpose Congenital accessory navicular bone (ANB) is a common variant in the foot and is prone to cause several clinical symptoms. Wearing custom-made foot orthosis is considered a desirable option; however, there is limited evidence of its effectiveness. This study aims to report the mid-term effect of foot orthosis for symptomatic pediatric ANBs. Methods School-age children with symptomatic ANBs combined with flexible flatfoot in the authors' institute were recruited and got custom-made foot orthosis treatment. They were followed up over 4 years. The general characteristics of these children were collected before treatment, including age, gender, and body mass index (BMI). The indicators of foot symptoms, including frequency and location of pain, visual analogue scale (VAS), arch index (AI), and hind foot valgus angle (HVA), were measured during pretreatment and at the last follow-up. Results Twenty-seven children were recruited for this study. After 4 years of custom-made foot orthosis treatment, significant improvements showed in pain frequency, VAS, AI, and HVA (P < 0.001). Type II ANBs showed a higher pain index pretreatment (P < 0.001) and reduced after treatment (P < 0.001). Conclusion Mid-term effect of custom-made foot orthosis is inspiring in clinical symptoms of pediatric congenital ANBs combined with flexible flatfoot and may be an optional nonoperative treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-024-01210-7.
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Affiliation(s)
- Wen Shu
- Department of Orthopaedic, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoyong Jiang
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Zimo Yang
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Zhao Rong
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Xiangrui Li
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Bin Yu
- Department of Orthopaedic, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Tang
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
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Jenkins DW, Schlangen M, Winski B, Bolch C. Podiatric conditions observed in Special Olympics athletes: Contrasting data from a USA versus an international population. Foot (Edinb) 2024; 59:102099. [PMID: 38744063 DOI: 10.1016/j.foot.2024.102099] [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: 11/08/2023] [Revised: 04/22/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Persons with intellectual disabilities frequently have podiatric conditions. Findings from the 2018 United States Summer games (USA) venues are compared to those from athletes screened at the 2019 Special Olympics World Summer Games in Abu Dhabi, United Arab Emirates (UAE). METHODS Data from Fit Feet screenings from 2445 United Arab Emirates (UAE) participants were compared to 1244 US participants. RESULTS A sampling of results that reflect significant differences in findings between the USA cohort and Abu Dhabi cohort include ankle joint range of motion, excessive abduction, hallux abducto valgus and pes planus. The overall shoe to foot mismatch was found to be 52.2%. A professional referral was recommended 27.7% of the time in the USA data and 28.5% in the Abu Dhabi data. An urgent referral was requested 5.1% of the time for the USA data and 3.7% of the time in the Abu Dhabi data. CONCLUSION Special Olympics athletes experience a greater prevalence of identifiable podiatric conditions as compared to the general population. Several of the conditions investigated in this study differed significantly between the international Special Olympics cohort and the USA cohort. Assessment of the feet of Special Olympics athletes can help to better appreciate the podiatric conditions in a population of individuals with intellectual disabilities. The variance identified between populations of Special Olympics athletes may be a reflection on the lack of standardization of conditions that are assessed for as well as the disparate characteristics of the clinical volunteers. Future Fit Feet events may wish to consider significant improvements in objectivity and standardization as it pertains to the conditions that are evaluated for in the Fit Feet exam.
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Affiliation(s)
- David W Jenkins
- Arizona College of Podiatric Medicine-Midwestern University Glendale, AZ, USA.
| | | | | | - Charlotte Bolch
- Research and Sponsored Programs, Midwestern University, Glendale, AZ, USA
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Feng ZY, She JY, Hu XY, Liu HS, Wang HJ, Zhu LG, Zheng S, Li JY, Zhang KR, Li YK, Chen C. Exploring flatfeet morphology in children aged 6-12 years: relationships with body mass and body height through footprints and three-dimensional measurements. Eur J Pediatr 2024; 183:1901-1910. [PMID: 38337095 DOI: 10.1007/s00431-024-05471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
The aim of the study was to determine the relationship between flatfoot morphology and body mass and height in children aged 6-12 years. A total of 6471 Chinese children (mean age 9.0 ± 1.9 years, 41% female) were assessed for foot morphometry, body height, and body mass index. Foot morphology, including foot length, width, girth, arch height, hallux valgus angle, and rearfoot valgus angle, was measured using a 3D laser scanner. Flatfoot evaluations were conducted using the Sztriter-Godunov index (KY) from footprints. All measurements were analyzed by age and sex using the mean values of the left and right sides. Comparisons were performed between flatfoot groups, between body mass index (BMI) groups, and between body height groups. The study revealed a significant decrease in the incidence of bipedal flatfoot with age (p < 0.001), whereas the prevalence of obesity remained consistent (p > 0.05). Bipedal flatfoot was associated with distinct morphological changes, including lower arches, reduced instep height, diminished ankle heights and a greater rearfoot valgus angle (p < 0.05). When comparing the BMI groups, overweight children had larger and thicker feet (p < 0.05), but no differences were found in arch height and ankle height (p > 0.05). When comparing the body height groups, short-statured children had a shorter feet girth, shorter arches, and shorter ankle height (p < 0.05), but no differences were found in the rearfoot valgus angle (p > 0.05). CONCLUSION The main characteristics of flat feet include lower arches and instep heights and ankle heights but higher rearfoot valgus angles. In general, overweight children's feet do not have the common features of flat feet. In contrast, short children had similar features of flatfoot except for rearfoot valgus. Assessment of posture, such as rearfoot valgus, can be critical in identifying children with flat feet. WHAT IS KNOWN • The morphology of children's feet is associated with body growth, but the relationship between flatfeet and body mass and height remains controversial. WHAT IS NEW • Three-dimensional foot measurement shows that body mass is generally not associated with flatfeet, while short children have lower arches but no rearfoot valgus.
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Affiliation(s)
- Zi-Yu Feng
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China
| | - Jing-Yi She
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China
| | - Xin-Yao Hu
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, China
| | - Hong-Sheng Liu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hua-Jun Wang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Li-Guo Zhu
- Wangjing Hospital of China Academy of Chinese Medical Sciences (Key Laboratory of Beijing of Traditional Chinese Medicine Bone Setting), Beijing, China
| | - Sheng Zheng
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China
| | - Jian-You Li
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, China
| | - Kai-Rui Zhang
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yi-Kai Li
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China.
| | - Chao Chen
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China.
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Yan S, Zhao Y, Zhang L, Yang L. Arch-related alteration in foot loading patterns affected by the increasing extent of body mass index in children: A follow-up study. Gait Posture 2023; 100:247-253. [PMID: 36641980 DOI: 10.1016/j.gaitpost.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/02/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND A high load on children 's feet can cause arch deformation and negatively affect their normal development. Studies have yet to document how the foot arch varied with different body mass index (BMI) increments and its influence on foot loading patterns. METHODS Barefoot walking trails were conducted using a Footscan® plate system. A follow-up check was performed after twenty-four months. Participants were selected with an initial BMI between 14.5 kg/m2 and 16.5 kg/m2. Totally 75 participants were classified into groups 0-7 according to the BMI increment levels of 0-0.49 kg/m2, 0.50-1.49 kg/m2, 1.50-2.49 kg/m2, 2.50-3.49 kg/m2, 3.50-4.49 kg/m2, 4.50-5.49 kg/m2, 5.50-6.49 kg/m2, 6.50-7.49 kg/m2, respectively. Paired t-tests and effect sizes were used to compare the data. RESULTS The arch index significantly decreased when the BMI reached 20.8 kg/m2. Significantly increased normalized maximum forces were found in the great toe and 1st MTPJ in groups 4-5. Meanwhile, the absence of significance showed under the 3rd-5th, midfoot, and rearfoot in those groups. The normalized maximum force increments under the 3rd-5th MTPJs, midfoot and rearfoot regions in groups 4-5 after the follow-up study were significantly decreased compared with the increments found in groups 0-3, followed by a sudden increase arising under those regions in group 6. It indicates a transition period that leads to alteration in gait pattern characteristics when BMI increases to 18.6-19.9 kg/m2 (between group 3 and group 4). Group 6 displayed significantly increased peak pressure amplitudes under the great toe, 1st-3rd MTPJs, midfoot, and medial rearfoot compared to other groups. SIGNIFICANCE There was a transition period when the BMI of normal-weighted children increased to a certain extent and failed to reach the obesity level, resulting in changes in foot arch structure and loading patterns.
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Affiliation(s)
- Shiyang Yan
- National Engineering Research Center of Clean Technology in Leather Industry, Sichuan University, Chengdu, China; Zhejiang Red Dragonfly Footwear Co., Ltd, Wenzhou, China; Polymer Research Institute, Sichuan University, Chengdu, China
| | - Yihong Zhao
- National Engineering Research Center of Clean Technology in Leather Industry, Sichuan University, Chengdu, China
| | - Longbin Zhang
- KTH MoveAbility Lab, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Luming Yang
- National Engineering Research Center of Clean Technology in Leather Industry, Sichuan University, Chengdu, China.
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Lima PLM, Breziniscki MDP, Pedrassoli GH, Forlim E, Soni JF, Radominski RB, França SN, Carvalho JARD. Skeletal changes of the axial axis and lower limbs in overweight children and adolescents. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021298. [PMID: 37042939 PMCID: PMC10088475 DOI: 10.1590/1984-0462/2023/41/2021298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/31/2022] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To evaluate the presence of axial skeletal deviations in children and adolescents and to relate them to body mass index (BMI), age and sex. METHODS 101 patients aged 7 to 17 years old were included in this study; exclusion criteria were primary orthopedic diseases and syndromes or treatments that affect growth. Patients were grouped according to their BMI Z-score: eutrophic (n=29), overweight (n=18) and obese (n=54). They underwent static clinical inspection was made by simetrographic technique. Intermaleolar distance was obtained, Adam's forward bend and tiptoe tests were performed. RESULTS When comparing obese and eutrophic patients, changes in the cervical spine (p<0.01), spine (p<0.001), hip (p<0.01) and shoulders (p<0.001) were present in more than half of the obese patients (62.5%, 62.2%, 79.9% and 55.4%, respectively). Changes in the knees were more frequent among obese (p<0.001) when compared to eutrophic patients. There was no variation regarding age or sex (p>0.05). CONCLUSIONS being overweight influences skeletal deviations in children and adolescents.
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Wako M, Fujimaki T, Koyama K, Furuya N, Shinohara R, Otawa S, Kobayashi A, Horiuchi S, Kushima M, Yamagata Z, Haro H. A cross-sectional study on the correlations between floating toe, plantar arch posture, and body composition in 8-year-old children. Foot Ankle Surg 2022; 28:1035-1039. [PMID: 35210187 DOI: 10.1016/j.fas.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/01/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Floating toe (FT): inadequately in contact with the ground and flexible flat foot (FFF) are frequently seen in children. According to some reports, inadequate foot muscle strength may cause FT or FFF.Therefore, a relationship may exist between arch formation, FT, and pedal muscle strength. This study aimed to evaluate the correlation of FT with plantar arch posture and body composition, including overall muscle mass. METHODS We conducted our own cohort study in addition to the Japan Environment and Children's Study conducted by the Ministry of the Environment, Japan. Out of 705 eight-year-old children participating in this adjunct study, 578 with recorded footprints were included. Body composition (body weight, body fat percentage, and predicted muscle mass) was assessed using body composition analyzer. Presence of FT or FFF was evaluated using foot pressure plate. We calculated the FT score (small FT score indicates insufficient ground contact of the toes) and the Chippaux-Smirak Index (CSI) using images of the plantar footprint. RESULTS The FT score (an indicator of FT) showed no significant correlation with CSI (an indicator of plantar arch posture). Moreover, no significant correlations between the predicted muscle mass, FT score, and CSI were observed. CONCLUSIONS This is the first report that assessed the relationship of FT with plantar arch posture and body composition in children. This study indicated that muscle strength might not be a major factor for FT and FFF development in children.
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Affiliation(s)
- Masanori Wako
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan.
| | - Taro Fujimaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Kensuke Koyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Naoto Furuya
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Anna Kobayashi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
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Ryu SM, Lee TK, Lee SH. Prevalence of flatfoot among young Korean males and the correlation among flatfoot angles measured in weight-bearing lateral radiographs. Medicine (Baltimore) 2022; 101:e29720. [PMID: 35905246 PMCID: PMC9333471 DOI: 10.1097/md.0000000000029720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Flatfoot causes significant fatigue and pain while walking, and even asymptomatic flatfoot may increase the risk of metatarsal stress fracture during long-distance walking. While most studies have used physical examination or plantar footprints to diagnose flatfoot, a weight-bearing radiograph of the foot provides more objective data. However, data on the prevalence of flatfoot in Asian populations gathered in a nationwide cohort of a specific age group is lacking. We examined the prevalence of flatfoot among 19-year-old male Korean army recruits using a weight-bearing lateral radiograph and evaluated the correlation among flatfoot angles. A total of 560,141 19-year-old Korean males were examined at the regional Military Manpower Administration offices between April 2018 and April 2020. Weight-bearing lateral radiographs of the foot were obtained using an X-ray system while the subjects were standing on a table with their feet in a neutral position. Based on these radiographs, military orthopedic surgeons and radiologists measured the talo-first metatarsal angle (TMA) and calcaneal pitch angle (CPA) for flatfoot diagnosis. Mild flatfoot was diagnosed when the TMA ranged from 6 to 15° or the CPA was <17°, and moderate-to-severe flatfoot was diagnosed when the TMA was 15° or greater or the CPA was <10°. Pearson correlation coefficients and scatter plot matrix were used to evaluate the correlation among the flatfoot angles. Finally, we evaluated the relationship between body mass index (BMI) and flatfoot angles and compared the BMI in subjects with or without self-checked foot deformities including flatfoot and pes cavus. Of the 560,141 subjects, 16,102 (2.9%) were diagnosed as flatfoot, and 5265 (0.9%) were diagnosed with moderate-to-severe flatfoot. The coefficients between TMA and CPA ranged from 0.342 to 0.449 (all P values < 0.001), and those between the 2 sides of TMA and CPA were 0.709 and 0.746 (all P values < 0.001), respectively. BMI had a significant correlation with both TMA and CPA in subjects with flatfoot, and those with self-checked foot deformities had a significantly higher BMI than the group without foot deformities. The prevalence of total flatfoot and moderate-to-severe flatfoot in 19-year-old Korean males based on a weight-bearing lateral radiograph was 2.9% and 0.9%, respectively. The correlation coefficients between TMAs and CPAs showed a low degree of positive correlation. Higher BMI was associated with the likelihood of the presence of flatfoot.
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Affiliation(s)
- Seung Min Ryu
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gyeong-in Regional Military Manpower Administration, Gyeonggi-do, Republic of Korea
| | - Taeg Ki Lee
- Department of Radiology, Gyeong-in Regional Military Manpower Administration, Gyeonggi-do, Republic of Korea
| | - Sun Ho Lee
- Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Orthopedic Surgery, Gwangju Jeonnam Regional Military Manpower Administration, Gwangju, Republic of Korea
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Belikan P, Färber LC, Abel F, Nowak TE, Drees P, Mattyasovszky SG. Incidence of calcaneal apophysitis (Sever's disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years. J Orthop Surg Res 2022; 17:83. [PMID: 35139872 PMCID: PMC8827183 DOI: 10.1186/s13018-022-02979-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background Calcaneal apophysitis, or Sever's disease, is the most common cause of heel pain in childhood and adolescence. It is regarded as an overuse syndrome. Studies on the incidence of calcaneal apophysitis in young athletes and their associated return-to-play time are lacking in the current literature. The aim of our current study was to identify the incidence of calcaneal apophysitis in professional youth soccer, the associated time to return-to-play, predisposing factors and their impact on time to return-to-play.
Methods Retrospective evaluation of injury data gathered from a German youth soccer academy in the years 2009–2018. In total, 4326 injury cases in 612 players were included in the study. The diagnosis and the follow-up visits were carried out in a weekly consultation hour at the youth academy. Results During the observation period of 10 years, 22 cases of calcaneal apophysitis were detected. The incidence of calcaneal apophysitis per 100 athletes per year was found to be 0.36. The mean age of the affected athletes at the time of diagnosis was 11.8 ± 2.1 years (MW ± SD). The complaints were unilateral in 20 and bilateral in two cases. Three of the 22 detected cases of calcaneal apophysitis (13.6%) were recurrent injuries. The mean time to return-to-play of the affected athletes was 60.7 ± 64.9 days (MW ± SD). Athletes with recurrent complaints showed longer recovery time and time to return-to-play when compared to players with primary diagnosed disease. Our results could show that neither age nor body mass index at the time of diagnosis had an impact on time to return-to-play. Conclusions This is the first study investigating the incidence of calcaneal apophysitis and the associated time to return-to-play in youth elite soccer. Calcaneal apophysitis results in substantial time loss for the athletes. Further prospective clinical studies are required to fully understand the etiology and risk factors for calcaneal apophysitis and therefore develop preventive strategies.
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Affiliation(s)
- Patrick Belikan
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Lars-Christopher Färber
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Frédéric Abel
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Tobias E Nowak
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Stefan G Mattyasovszky
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Pavone V, Vescio A, Andreacchio A, Memeo A, Gigante C, Lucenti L, Farsetti P, Canavese F, Moretti B, Testa G, De Pellegrin M. Results of the Italian Pediatric Orthopedics Society juvenile flexible flatfoot survey: diagnosis and treatment options. J Pediatr Orthop B 2022; 31:e17-e23. [PMID: 34101678 DOI: 10.1097/bpb.0000000000000881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objectives of this study were to collect and analyze current diagnosis and treatment options of symptomatic flexible flatfoot (FFF), as well as to identify treatment expectations, among the members of the Italian Pediatric Orthopedics Society (SITOP). Diagnosis and treatment preferences were recorded according to a web-based survey. The survey was divided into six main sections: (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; (6) treatment options. One hundred and ten out of 248 SITOP members answered to the questionnaire. Age (85.5%), pain at the level of the plantar arch or fascia (61.8%), fatigue (59.1%) were the clinical parameters of crucial importance. Heel valgus (85.4%), flexibility (61.8%) and forefoot supination (47.3%) were identified as the most important foot aspects. Ninety-two responders (83.6%) identified the 'improved ability to walk longer without symptoms or discomfort' as the principal treatment expectation. Pain evaluated through the visual analog scale (VAS) was considered crucial in 31.8% of cases. All respondents confirmed they also treat patients with FFF surgically; in particular, 97.3% of SITOP affiliates declare to perform arthroereisis followed by lateral column lengthening (29.1%) and medializing calcaneal osteotomy (9.1%). Although in this survey heterogeneous findings for diagnosis and treatment of patients with symptomatic FFF within SITOP members were found, a large preference for age, heel valgus, flexibility as clinical aspects and parameters, as well as nonoperative treatment and arthroereisis, was reported.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
| | | | - Antonio Memeo
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan
| | - Cosimo Gigante
- Pediatric Orthopaedic Unit, Department of Woman and Child Health, Padua General Hospital, Padua
| | - Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
| | - Pasquale Farsetti
- Department of Orthopaedics Surgery, University of Rome "Tor Vergata", Rome
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lill
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Bari
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
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12
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Hegazy F, Aboelnasr E, Abuzaid M, Kim IJ, Salem Y. Comparing Validity and Diagnostic Accuracy of Clarke's Angle and Foot Posture Index-6 to Determine Flexible Flatfoot in Adolescents: A Cross-Sectional Investigation. J Multidiscip Healthc 2021; 14:2705-2717. [PMID: 34611407 PMCID: PMC8486009 DOI: 10.2147/jmdh.s317439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/31/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Clinically, the foot posture index-6 (FPI-6) and Clarke's angle (CA) are widely utilized to assess static foot posture; however, due to scarcity of scientific evidence, clinicians continue to debate the validity and diagnostic accuracy of these measures in children and adolescents. This study aimed to evaluate and compare the validity and diagnostic accuracy of the FPI-6 and CA in determining adolescents' flexible flatfoot between ages of 12 and 18 years, considering radiographic investigation as a reference standard measure. DESIGN Cross-sectional study. SETTING Governmental hospitals. PARTICIPANTS AND METHODS A sample of 460 people (920 feet) with flexible flatfoot between the ages of 12 and 18 (15.23 ± 0.84 years) was enrolled in the study. The findings of the investigated measures were compared to the reference standard radiographic measure and plotted on the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was determined as a measure of FPI-6 and CA diagnostic accuracy. Intra-rater reliability, sensitivity, specificity, predictive values, and likelihood ratios of FPI-6 and CA were calculated and compared. The post-test probability of flatfoot was determined using the Fagan nomogram. RESULTS CA had a substantially higher intra-rater reliability (ICC=0.99) than the FPI-6 (ICC=0.96), with p-value of 0.001. CA has greater sensitivity (98%) than FPI-6, as well as a superior specificity (99%), positive predictive value (98%), negative predictive value (98.9%), positive likelihood ratio (97), and a lower negative likelihood ratio (0.02). CA had such an area under ROC curve of 0.98 with a 95% confidence interval of 0.95-1.00, while FPI-6 had an area under ROC curve of 0.80 with a 95% confidence interval of (0.77-0.85). CONCLUSION FPI-6 and Clarke's angle are both valid and diagnostically accurate clinical tests for flatfoot detection, with Clarke's angle outperforming FPI-6 in adolescents aged 12 to 18 years with a normal BMI.
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Affiliation(s)
- Fatma Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Emad Aboelnasr
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mohamed Abuzaid
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - In-Ju Kim
- Department of Industrial Engineering and Engineering Management; College of Engineering, University of Sharjah, Sharjah, United Arab Emirates
| | - Yasser Salem
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Long Island, NY, USA
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13
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Molina-Garcia P, Miranda-Aparicio D, Ubago-Guisado E, Alvarez-Bueno C, Vanrenterghem J, Ortega FB. The Impact of Childhood Obesity on Joint Alignment: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6134724. [PMID: 33580953 DOI: 10.1093/ptj/pzab066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE It has been suggested that overweight/obesity (OW/OB) impairs the normal alignment of children and adolescents' musculoskeletal system. However, to date, no study has systematically reviewed or quantified the effect of OW/OB on the development of joint malalignments in children and adolescents. The purpose of this study was to systematically review the association between OW/OB and joint alignment in children and adolescents and to quantify the evidence on whether children and adolescents with OW/OB have a higher risk of developing joint malalignments than their peers of normal weight. METHODS PubMed and Web of Science databases were systematically searched from inception to March 9, 2020. Studies investigating the association between OW/OB and joint alignment in children and adolescents were selected. Nonoriginal articles, participants with movement pattern diseases, and adolescents studied while pregnant were excluded. Two independent reviewers conducted the study selection and data extraction. Qualitative synthesis of evidence and random effect meta-analyses (risk ratio [RR]) were performed. RESULTS Seventy-three studies (5 longitudinal and 68 cross-sectional) met the inclusion criteria involving 1,757,107 children and adolescents. There was consistent evidence supporting associations of OW/OB with rounded shoulder, lumbar hyperlordosis, genu valgum, and flatfoot. Our meta-analysis showed that children and adolescents with OW/OB had a significantly higher risk of lumbar hyperlordosis (RR = 1.41), genu valgum (RR = 5.92), flatfoot (RR = 1.49), and any joint malalignment (RR = 1.68) when compared with their peers of normal weight. The presence of genu valgum and flatfoot were the most robust results. CONCLUSION Based on these findings, OW/OB is associated with the presence of joint malalignments in children and adolescents. IMPACT This is the first study that has systematically reviewed the effect of OW/OB on the development of joint malalignments in children and adolescents.
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Affiliation(s)
- Pablo Molina-Garcia
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Belgium
| | - Damian Miranda-Aparicio
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Esther Ubago-Guisado
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Celia Alvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Jos Vanrenterghem
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Belgium
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Biosciences and Nutrition, Karolinska Institute, Sweden
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14
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Onan D, Ulger O. Investigating the Relationship between Body Mass Index and Pain in the Spine in Children or Adolescents: A Systematic Review. Child Obes 2021; 17:86-99. [PMID: 33570458 DOI: 10.1089/chi.2020.0266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Neck pain (NP), back pain (BP), and low back pain (LBP) are generally defined as "pain in the spine." With the increasing prevalence of childhood obesity, secondary problems such as pain in the spine have arisen. The purpose of this review was to investigate the relationship between body mass index (BMI) and pain in the spine in children or adolescents. Methods: Publications were searched in PubMed, Web of Science, Scopus, and Google Scholar databases up to December 12, 2020. The search strategy in the database consisted of free text words and MeSH terms. Results: Twelve studies were reviewed. It was determined that different methods were used in all 12 studies to evaluate pain. In the evaluation of overweight/obesity, these studies performed BMI assessment by dividing body weight in kilograms by height squared. Five studies showed a relationship between LBP and BMI, two studies showed a relationship between BP and BMI, and two studies showed a relationship between NP and BMI. Conclusions: The review shows that there is a relationship between BMI and pain in the spine, especially LBP. There may be factors affecting this condition such as mechanical loading and hormonal metabolic activity in childhood and adolescence. Different methods are used in the studies in literature for the assessment pain in the spine and BMI, overweight, and obesity.
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Affiliation(s)
- Dilara Onan
- Back and Neck Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ozlem Ulger
- Back and Neck Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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15
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Canbaloglu AE, Ozturk K, Kastamoni Y, Dursun A. The development of the medial longitudinal arch in the intrauterine period. Anat Sci Int 2021; 96:443-449. [PMID: 33586118 DOI: 10.1007/s12565-021-00610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
In this study, we aimed to reveal whether the medial longitudinal arch is formed in the intrauterine period and the structural features of the medial longitudinal arch. The study was conducted on 146 feet of 73 fetuses (38 male, 35 female) aged between 15 and 40 weeks of gestation. The fetuses were grouped by trimesters. The footprints taken were photographed with a millimeter ruler, and the development of the medial longitudinal arch was examined on footprints based on the Clarke index, Chipaux-Smirak index, and Staheli index. In Clarke index and Staheli index, it was observed that the arch height was normalized in the transition from the second trimester to the third trimester, the arch decreased in the transition to full-term, and the rate of pes planus increased. All indices detected pes planus by 81.81% in the full-term period. The rate of pes planus determined according to Clarke index and Staheli index, especially in the third trimester period, was 6.94% and 11.11%, respectively. We have provided a perspective on how the development of the medial longitudinal arch is shaped in the intrauterine period. Based on the results of study, we consider that the data on the medial longitudinal arch, especially in the third trimester period, may be more significant. In the evaluations made from the footprints of premature infants in the intrauterine third trimester period in the future, a study, in which infants detected with pes planus can be followed up and the development of their medial longitudinal arch is evaluated, can be conducted.
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Affiliation(s)
| | - Kenan Ozturk
- Department of Anatomy Faculty of Medicine, Suleyman Demirel University, 32260, Isparta, Turkey
| | - Yadigar Kastamoni
- Department of Anatomy Faculty of Medicine, Suleyman Demirel University, 32260, Isparta, Turkey
| | - Ahmet Dursun
- Department of Anatomy Faculty of Medicine, Suleyman Demirel University, 32260, Isparta, Turkey.
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16
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[Etiology, pathogenesis, clinical features, diagnostics and conservative treatment of adult flatfoot]. DER ORTHOPADE 2020; 49:942-953. [PMID: 33034668 DOI: 10.1007/s00132-020-03995-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND On average, one in six adults is affected by an acquired flatfoot. This foot deformity is characterized by its progression of stages and in 10% of cases causes complaints that require treatment. Untreated, the loss of walking ability may result in the final stage. Correct staging is crucial to being able to offer a specific course of therapy including a wide spectrum of conservative and operative treatments. MATERIAL AND METHODS This review is based on pertinent publications retrieved from a selective search in PubMed and Medline and on the authors' clinical experience. DIAGNOSTICS The loss of function of static (spring ligament complex) and dynamic (tibialis posterior tendon) stabilizers causes the characteristic deformity with loss of the medial arch, hind foot valgus and forefoot abduction. In the late stage, severe secondary osteoarthritis in upper and lower ankle joints occurs and impedes walking ability. The essential physical examination is supplemented by weight-bearing dorsoplantar and lateral radiographs, which provide further information about axial malalignment (Meary's angle, Kite's angle). The long axis hind foot view allows analysis of the hindfoot valgus. MRI provides further information about the integrity of the tibialis posterior tendon, spring ligament complex and cartilage damage. THERAPY The therapy aims to reduce pain, regain function and avoid development of secondary osteoarthritis and degenerative tendon disorders. Progress of the deformity should be stopped. Therefore, the main aspects of the deformity-loss of medial arch, hindfoot valgus and forefoot abduction should be addressed and corrected. In the acute phase, tendovaginitis of the tibialis posterior tendon can be treated sufficiently by anti-inflammatory measures, relieving mechanical loads on the tendon and muscle and physiotherapy.
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17
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Pietrzak K, Nowocień K, Kraszewski B. Flexibility does not affect the dorsiflexion of foot and the popliteal angle in young adults. Foot Ankle Surg 2020; 26:763-765. [PMID: 31668802 DOI: 10.1016/j.fas.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/28/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to assess how flexibility affects the dorsiflexion of foot and the popliteal angle test results in junior high school students. METHODS The subjects were 142 students from the 2nd, and 3rd year of Poznań junior high schools (age between 13 and 15). Each subject was examined 6 times: there were 3 raters, a specialist in orthopaedics, a resident doctor and a physical therapy student, and each of them performed 2 measurements. Flexibility was also measured using the Beighton scale (score from 0 to 9). RESULTS Since the Beighton scale is ordinal in order to evaluate the relationship between flexibility and the range of motion Spearman's rank correlation coefficient was calculated. The statistical analysis showed no correlation between flexibility measured on the Beighton scale and the range of passive foot dorsiflexion and the popliteal angle. CONCLUSIONS The degree of flexibility does not affect the dorsiflexion of the foot and the popliteal angle in junior high students. At this age the range of dorsiflexion is determined by the length of the triceps surae muscle while the popliteal angle depends on the length of the muscles on the back of the thigh.
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Affiliation(s)
- Krzysztof Pietrzak
- The Department of Spondyloorthopedics and Biomechanics of the Spine, University of Medical Sciences, 28 Czerwca 1956 137, Poznań, 61-501, Poland.
| | - Krzysztof Nowocień
- Department of Orthopaedics and Traumatology, University of Medical Sciences Poznan, Poland
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18
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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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Bafor A, Chibuzom CN. Foot and ankle abnormalities among a cohort of Nigerian school children: an epidemiological study. INTERNATIONAL ORTHOPAEDICS 2020; 44:1169-1175. [PMID: 32328738 DOI: 10.1007/s00264-020-04568-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Foot and ankle problems in children are a common cause for paediatric orthopaedic referrals. There is a variation in the reported epidemiology of foot and ankle abnormalities across the globe. The prevalence in our locality was unknown. The objective of this study was to determine the prevalence pattern of foot and ankle problems in our locality as well as compare with patterns from other geographical locations to determine the presence or otherwise, of differences among varying populations. METHODS One thousand seven hundred and fifty-eight Nigerian primary school children aged between five and 13 years were clinically evaluated, checking for weight, height and calculation of BMI. The heel axis angle and hallux angle were measured clinically while determination of flatfeet or high arched feet was made from analysis of foot imprints. RESULTS Hindfoot valgus was the commonest abnormality of the foot and ankle in this population with a prevalence of 34.2% and predominantly in females and older children, while hallux valgus and a high arched foot were the least common abnormalities at 0.6 and 0.7% prevalence rates, respectively. We found no statistically significant relationship between BMI and hindfoot valgus. CONCLUSION Hindfoot valgus is the commonest foot and ankle abnormality among primary school children in our locality.
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Affiliation(s)
- A Bafor
- Department of Orthopaedics & Trauma, University of Benin Teaching Hospital, PMB1111, Benin City, Nigeria.
| | - C N Chibuzom
- Department of Orthopaedics & Trauma, University of Benin Teaching Hospital, PMB1111, Benin City, Nigeria
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20
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Bresnahan PJ, Juanto MA. Pediatric Flatfeet-A Disease Entity That Demands Greater Attention and Treatment. Front Pediatr 2020; 8:19. [PMID: 32117826 PMCID: PMC7026255 DOI: 10.3389/fped.2020.00019] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/14/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Pediatric flatfoot is a common deformity. Unfortunately, the common opinion has been that most children with this faulty foot structure will simply out-grow it, despite no radiographic evidence to support this claim. Every step on a deformed foot leads to excessive tissue strain and further joint damage. Many forms of conservative and surgical treatments have been offered. This study was aimed at investigating the effectiveness of non-surgical and surgical treatment options. Main Text: faulty-foot structure is the leading cause of many secondary orthopedic deformities. A wide range of treatments for pediatric flatfeet have been recommended from the "do-nothing" approach, observation, to irreversible reconstructive surgery. Most forms of conservative care lack evidence of osseous realignment and stability. A conservative surgical option of extra-osseous talotarsal joint stabilization provides patients an effective form of treatment without the complications associated with other irreversible surgical procedures. Conclusion: Pediatric flatfeet should not be ignored or downplayed. The sooner effective treatment is prescribed, the less damage will occur to other parts of the body. When possible, a more conservative corrective procedure should be performed prior to irreversible, joint destructive options.
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21
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Saito Y, Chikenji TS, Takata Y, Kamiya T, Uchiyama E. Can an insole for obese individuals maintain the arch of the foot against repeated hyper loading? BMC Musculoskelet Disord 2019; 20:442. [PMID: 31604431 PMCID: PMC6790017 DOI: 10.1186/s12891-019-2819-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/09/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Insoles are often applied as preventive therapy of flatfoot deformity, but the therapeutic effects on obese individuals are still controversial. We aimed to investigate the effect of insole use on time-dependent changes in the foot arch during a repeated-loading simulation designed to represent 20,000 contiguous steps in individuals with a BMI value in the range of 30-40 kg/m2. METHODS Eighteen cadaveric feet were randomly divided into the following three groups: normal, obese, and insole. Ten thousand cyclic loadings of 500 N (normal group) or 1000 N (obese and insole groups) were applied to the feet. We measured time-dependent change in arch height and calculated the bony arch index (BAI), arch flexibility, and energy absorption. RESULTS The normal group maintained more than 0.21 BAI, which is the diagnostic criterion for a normal arch, throughout the 10,000 cycles; however, BAI was less than 0.21 at 1000 cycles in the obese group (mean, 0.203; 95% confidence interval [CI] 0.196-0.209) and at 6000 cycles in the insole group (mean, 0.200; 95% CI, 0.191-0.209). Although there was a significant time-dependent decrease in flexibility and energy absorption in both the obese and insole groups (P < 0.001), the difference between 1 and 10,000 cycles were significantly smaller in the insole group than in the obese group (P = 0.024). CONCLUSIONS Use of insoles for obese individuals may help to slow time-dependent foot structural changes. However, the effect was not enough to maintain the foot structure against repeated hyper loadings.
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Affiliation(s)
- Yuki Saito
- Graduate School of Health Sciences, Sapporo Medical University, South 1 West 17, Chuo-ku, Sapporo, 0608556 Japan
| | - Takako S. Chikenji
- Graduate School of Health Sciences, Sapporo Medical University, South 1 West 17, Chuo-ku, Sapporo, 0608556 Japan
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yuichi Takata
- Graduate School of Health Sciences, Sapporo Medical University, South 1 West 17, Chuo-ku, Sapporo, 0608556 Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Eiichi Uchiyama
- Graduate School of Health Sciences, Sapporo Medical University, South 1 West 17, Chuo-ku, Sapporo, 0608556 Japan
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22
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Reply to the letter by Liufu et al. Foot Ankle Surg 2019; 25:704. [PMID: 31421996 DOI: 10.1016/j.fas.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 02/04/2023]
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Sharma V, Coleman S, Nixon J, Sharples L, Hamilton-Shield J, Rutter H, Bryant M. A systematic review and meta-analysis estimating the population prevalence of comorbidities in children and adolescents aged 5 to 18 years. Obes Rev 2019; 20:1341-1349. [PMID: 31342672 PMCID: PMC6851579 DOI: 10.1111/obr.12904] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
Evidence for the health impact of obesity has largely focussed on adults. We estimated the population prevalence and prevalence ratio of obesity-associated comorbidities in children and adolescents aged 5 to 18 years. Five databases were searched from inception to 14 January 2018. Population-based observational studies reporting comorbidity prevalence by weight category (healthy weight/overweight/obese) in children and adolescents aged 5 to 18 years from any country were eligible. Comorbidity prevalence, stratified by weight category, was extracted and prevalence ratios (relative to healthy weight) estimated using random effects meta-analyses. Of 9183 abstracts, 52 eligible studies (1 553 683 participants) reported prevalence of eight comorbidities or risk markers including diabetes and nonalcoholic fatty liver disease (NAFLD). Evidence for psychological comorbidities was lacking. Meta-analyses suggested prevalence ratio for prediabetes (fasting glucose ≥ 100 mg/dL) for those with obesity relative to those of a healthy weight was 1.4 (95% confidence interval [CI], 1.2-1.6) and for NAFLD 26.1 (9.4-72.3). In the general population, children and adolescents with overweight/obesity have a higher prevalence of comorbidities relative to those of a healthy weight. This review provides clinicians with information when assessing children and researchers a foundation upon which to build a comprehensive dataset to understand the health consequences of childhood obesity.
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Affiliation(s)
- Vishal Sharma
- Clinical Effectiveness Team, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Susanne Coleman
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jane Nixon
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Linda Sharples
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Maria Bryant
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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24
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Pavone V, Vescio A, Canavese F, Costa D, Sessa G, Testa G. Effects of body weight on the clinical and radiological outcomes of children with flexible flatfeet managed with the 'calcaneo-stop' procedure. J Pediatr Orthop B 2019; 28:228-234. [PMID: 30664046 DOI: 10.1097/bpb.0000000000000590] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study aimed to evaluate the clinical and radiological outcomes of normal, overweight, and obese children with symptomatic flexible flatfeet managed with the 'calcaneo-stop' procedure (CSP), and to determine whether any correlation exists between patient weight and outcome. One hundred and seventy-four symptomatic flexible flatfeet were managed with CSP during the study period. The patients were divided into three groups according to their BMI and weight Z-scores: normal, overweight, and obese. Their clinical and radiographic outcomes were assessed preoperatively, and at 1 and 5 years after the index procedure. Although the radiographic criteria were comparable between the three groups, the clinical outcome was worse in obese children than in normal and overweight patients (P<0.05). BMI and the Z-score affected the outcomes of obese patients treated with CSP for symptomatic flexible flatfeet. Although the radiographic outcome was similar irrespective of BMI and Z-scores, obese patients had significantly lower clinical scores than the other patients.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
| | - Federico Canavese
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand, France.,Department of Pediatric Orthopedic Surgery, Guangzhou Women and Children Medical Center, Guangzhou, China
| | - Danilo Costa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, University of Catania, Catania, Italy
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25
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Influence of Shoe Characteristics on the Development of Valgus Foot in Children. J Clin Med 2019; 8:jcm8010085. [PMID: 30642069 PMCID: PMC6352257 DOI: 10.3390/jcm8010085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 11/16/2022] Open
Abstract
For thousands of years, shoes have been worn to protect the feet from injury, and the proper choice and use of footwear are directly relevant to foot health, especially that of children. The aim of this study was to evaluate the association between shoe-related factors (type and frequency of use) and the prevalence of valgus foot in children. This analytical cross-sectional observational study was carried out on a population of children in the first, second or third year of primary education, to analyzing the frequency and type of shoes worn, and to determining the presence or not of valgus foot. The sample consisted of 132 children (of 642 potential subjects), with an average age of 7.53 years (Standard Deviation (SD) 0.80), which was composed of 61 boys (46.2%) and 71 girls (53.8%). The overall prevalence of valgus foot was 45.5% (n = 60). The use of boots 2⁻5 days a week was significantly associated, in both sexes, with a lower prevalence of valgus in the left foot (30.5%, p = 0.009). The use of boots could be associated with a lower presence of valgus, depending on the frequency of wear.
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Asencio JMM, Medina-Alcántara MF, Ortega-Avila AB, Jimenez-Cebrian AM, Moguer JP, Cervera-Marin JA, Gijon-Nogueron G. Anthropometric and Psychomotor Development Factors Linked to Foot Valgus in Children Aged 6 to 9 Years. J Am Podiatr Med Assoc 2019; 109:30-35. [PMID: 30964316 DOI: 10.7547/16-108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Planovalgus foot prevalence estimates vary widely (0.6%-77.9%). Among the many factors that may influence planovalgus foot development, much attention has been given to body mass index, especially that of children's feet; factors related to psychomotor development have been less studied. We sought to determine the presence of planovalgus foot in children and its association with anthropometric parameters and psychomotor development. METHODS A case-control study was conducted in Málaga, Spain, 2012-2013, of 104 schoolchildren (mean ± SD age, 7.55 ± 0.89 years; 45.2% were boys). Age, sex, body mass index, presence of valgus (valgus index, by pedigraphy), and personal history related to psychomotor development of the lower limbs (presence/absence of crawling, age at onset of crawling, age at onset of walking, use of mobility aids) were evaluated. RESULTS Of the children with obesity, 53.7% had valgus deformity in the left hindfoot (odds ratio [OR], 6.94; 95% confidence interval [CI], 2.72-17.70; P < .0001). In the right foot, the corresponding values were 54.5% (OR, 9.08; 95% CI, 3.38-24.36; P < .0001). Multivariate logistic regression showed an increased risk of left planovalgus foot in boys, in children with overweight or obesity, and in those who began walking later. For the right foot, the same risk factors applied except age at onset of walking. CONCLUSIONS These results corroborate data from previous studies, which report an association between overweight and obesity and the onset of planovalgus foot in children. In addition, we identify a new risk factor: age at onset of walking.
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Parviainen M, Pihlajamäki H, Kautiainen H, Kiviranta I. Incidence and Risk Factors of Foot and Ankle Disorders in Male Finnish Conscripts. Mil Med 2018; 184:e352-e358. [DOI: 10.1093/milmed/usy297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/31/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mickael Parviainen
- Mehiläinen Medical Centre, Pohjoinen Hesperiankatu 17C, Helsinki, Finland
| | - Harri Pihlajamäki
- Department of Orthopaedics and Traumatology, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Ilkka Kiviranta
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Finland, HUS, Finland
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28
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Banwell HA, Paris ME, Mackintosh S, Williams CM. Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review. J Foot Ankle Res 2018; 11:21. [PMID: 29854006 PMCID: PMC5975578 DOI: 10.1186/s13047-018-0264-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/11/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Flexible flat foot is a normal observation in typically developing children, however, some children with flat feet present with pain and impaired lower limb function. The challenge for health professionals is to identify when foot posture is outside of expected findings and may warrant intervention. Diagnoses of flexible flat foot is often based on radiographic or clinical measures, yet the validity and reliability of these measures for a paediatric population is not clearly understood. The aim of this systematic review was to investigate how paediatric foot posture is defined and measured within the literature, and if the psychometric properties of these measures support any given diagnoses. METHODS Electronic databases (MEDLINE, CINAHL, EMBASE, Cochrane, AMED, SportDiscus, PsycINFO, and Web of Science) were systematically searched in January 2017 for empirical studies where participants had diagnosed flexible flat foot and were aged 18 years or younger. Outcomes of interest were the foot posture measures and definitions used. Further articles were sought where cited in relation to the psychometric properties of the measures used. RESULTS Of the 1101 unique records identified by the searches, 27 studies met the inclusion criteria involving 20 foot posture measures and 40 definitions of paediatric flexible flat foot. A further 18 citations were sought in relation to the psychometric properties of these measures. Three measures were deemed valid and reliable, the FPI-6 > + 6 for children aged three to 15 years, a Staheli arch index of > 1.07 for children aged three to six and ≥ 1.28 for children six to nine, and a Chippaux-Smirak index of > 62.7% in three to seven year olds, > 59% in six to nine year olds and ≥ 40% for children aged nine to 16 years. No further measures were found to be valid for the paediatric population. CONCLUSION No universally accepted criteria for diagnosing paediatric flat foot was found within existing literature, and psychometric data for foot posture measures and definitions used was limited. The outcomes of this review indicate that the FPI - 6, Staheli arch index or Chippaux-Smirak index should be the preferred method of paediatric foot posture measurement in future research.
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Affiliation(s)
- Helen A. Banwell
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia 5001 Australia
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Maisie E. Paris
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Shylie Mackintosh
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Cylie M. Williams
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
- Allied Health, Peninsula Health, Frankston, VIC 3199 Australia
- School of Primary and Allied Health, Monash University, Frankston, VIC 3199 Australia
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29
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Yin J, Zhao H, Zhuang G, Liang X, Hu X, Zhu Y, Zhang R, Fan X, Cao Y. Flexible flatfoot of 6-13-year-old children: A cross-sectional study. J Orthop Sci 2018; 23:552-556. [PMID: 29500001 DOI: 10.1016/j.jos.2018.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 01/23/2018] [Accepted: 02/07/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND This cross-sectional study aims to investigate the flexible flatfoot (FFF) prevalence and related factors in school-aged children. METHODS A total of 1059 children aged 6-13 years were included. Dynamic footprints according to the FootScan system were collected from both feet. The relationship of FFF with age, gender, side, and body mass index (BMI) was investigated. RESULTS FFF percentage decreased from 39.5% at 6 years to 11.8% at 12 years and reached a plateau at 12-13 years. Overweight (OR 1.35, 95%CI 1.03-1.77, P = 0.03) and obese (OR 2.43, 95%CI 1.81-3.26, P<0.01) showed a positive correlation with percentage of FFF children. No correlation was found between FFF prevalence and gender or side. CONCLUSIONS FFF prevalence decreases with age and reaches a plateau at 12-13 years. Moreover, FFF prevalence is positively correlated with increased BMI and body height.
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Affiliation(s)
- Jichao Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China; Xi'an Hospital Of Traditional Chinese Medicine, China.
| | - Hongmou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University College of Medicine, China.
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China.
| | - Xiaojun Liang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University College of Medicine, China.
| | - Xinglv Hu
- Xi'an Hospital Of Traditional Chinese Medicine, China.
| | - Yi Zhu
- The Second Affiliated Hospital of Hainan Medical University, China.
| | - Rongqiang Zhang
- Public Health of Department of Shaanxi University of Chinese Medicine, China.
| | - Xiaochen Fan
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University College of Medicine, China.
| | - Yi Cao
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University College of Medicine, China.
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Dars S, Uden H, Banwell HA, Kumar S. The effectiveness of non-surgical intervention (Foot Orthoses) for paediatric flexible pes planus: A systematic review: Update. PLoS One 2018; 13:e0193060. [PMID: 29451921 PMCID: PMC5815602 DOI: 10.1371/journal.pone.0193060] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background Flexible pes planus (flat feet) in children is a common presenting condition in clinical practice due to concerns amongst parents and caregivers. While Foot Orthoses (FOs) are a popular intervention, their effectiveness remains unclear. Thus, the aim of this systematic review was to update the current evidence base for the effectiveness of FOs for paediatric flexible pes planus. Methods A systematic search of electronic databases (Cochrane, Medline, AMED, EMBASE, CINHAL, SportDiscus, Scopus and PEDro) was conducted from January 2011 to July 2017. Studies of children (0–18 years) diagnosed with flexible pes planus and intervention to be any type of Foot Orthoses (FOs) were included. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. McMaster critical review form for quantitative studies, was used to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis of the included studies was undertaken. Results Out of 606 articles identified, 11 studies (three RCTs; two case-controls; five case-series and one single case study) met the inclusion criteria. A diverse range of pre-fabricated and customised FOs were utilised and effectiveness measured through a plethora of outcomes. Summarised findings from the heterogeneous evidence base indicated that FOs may have a positive impact across a range of outcomes including pain, foot posture, gait, function and structural and kinetic measures. Despite these consistent positive outcomes reported in several studies, the current evidence base lacks clarity and uniformity in terms of diagnostic criteria, interventions delivered and outcomes measured for paediatric flexible pes planus. Conclusion There continues to remain uncertainty on the effectiveness of FOs for paediatric flexible pes planus. Despite a number of methodological limitations, FOs show potential as a treatment method for children with flexible pes planus. PROSPERO registration number CRD42017057310.
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Affiliation(s)
- Sindhrani Dars
- School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
- * E-mail:
| | - Hayley Uden
- School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Helen A. Banwell
- School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Saravana Kumar
- School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Jankowicz-Szymanska A, Mikolajczyk E, Wodka K. Correlations Among Foot Arching, Ankle Dorsiflexion Range of Motion, and Obesity Level in Primary School Children. J Am Podiatr Med Assoc 2017; 107:130-136. [PMID: 28394680 DOI: 10.7547/15-150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study sought to assess the prevalence of flat feet in primary school children and to find correlations among arch height, ankle dorsiflexion range of motion (ROM), and obesity level. METHODS The 400 children aged 10 to 12 years who took part in the study had their body height, weight, and fat percentage measured. Based on these measurements, body mass index was calculated and weight status was categorized for all of the participants. The height of the longitudinal arch of the foot was measured on a computerized podoscope and given in Clarke's angles. Dorsiflexion ROM was assessed with the child in the nonweightbearing sitting position with the knees 90° flexed. The arithmetic mean and standard deviation were implemented to analyze the data. Intergroup differences were assessed by Mann-Whitney U, Kruskal-Wallis, and post hoc Tukey tests. Significance was accepted at P = .05. RESULTS Flat feet were found in 36% of participants; limited ROM was found in both feet in 25% of participants and in one foot in 12%. No significant differences in dorsiflexion ROM in children with high-arched, normal, and flat feet were revealed. Excessive body weight was disclosed in 21% of participants. Overweight and obese children had significantly lower foot arches and notably smaller ankle dorsiflexion ROM than those with normal weight. CONCLUSIONS Ankle dorsiflexion ROM is similar in children with high-arched, normal, and flat feet. However, limited dorsiflexion ROM is more often found in children with excessive weight.
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Affiliation(s)
| | - Edyta Mikolajczyk
- Department of Physiotherapy, University of Physical Education, Krakow, Poland
| | - Katarzyna Wodka
- Institute of Health Sciences, State Higher Vocational School, Tarnow, Poland
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32
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Abstract
BACKGROUND Children with flatfeet are frequently referred to pediatric orthopaedic clinics. Most of these patients are asymptomatic and require no treatment. Care must be taken to differentiate patients with flexible flatfeet from those with rigid deformity that may have underlying pathology and have need of treatment. Rigid flatfeet in infants may be attributable to a congenital vertical talus (CVT); whereas those in older children and adolescents may be due to an underlying tarsal coalition. We performed a review of the recent literature regarding evaluation and management of pediatric flatfeet to discuss new findings and suggest areas where further research is needed. METHODS We searched the PubMed database for all papers related to the treatment of pediatric flatfoot, tarsal coalition, and CVT published from January 1, 2011 to December 31, 2014, yielding 85 English language papers. RESULTS A total of 18 papers contributed new or interesting findings. CONCLUSIONS The pediatric flexible flatfoot (FFF) remains poorly defined, making the understanding, study, and treatment of the condition extremely difficult.Pediatric FFF is often unnecessarily treated. There is very little evidence for the efficacy of nonsurgical intervention to affect the shape of the foot or to influence potential long-term disability for children with FFF. The treatment of tarsal coalition remains challenging, but short-term and intermediate-term outcome studies are satisfactory, whereas long-term outcome studies are lacking. Management of the associated flatfoot deformity may be as important as management of the coalition itself. The management of CVT is still evolving; however, early results of less invasive treatment methods seem promising. LEVEL OF EVIDENCE Level 4-literature review.
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Machluf Y, Fink D, Farkash R, Rotkopf R, Pirogovsky A, Tal O, Shohat T, Weisz G, Ringler E, Dagan D, Chaiter Y. Adolescent BMI at Northern Israel: From Trends, to Associated Variables and Comorbidities, and to Medical Signatures. Medicine (Baltimore) 2016; 95:e3022. [PMID: 27015176 PMCID: PMC4998371 DOI: 10.1097/md.0000000000003022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The increasing prevalence of abnormal body mass index (BMI), mainly obesity, is becoming a significant public health problem. This cross-sectional study aimed to provide a comprehensive view of secular trends of BMI, and the associated socio-demographic variables and comorbidities among adolescents with abnormal BMI. Individuals of the study population were born mainly between 1970 and 1993, and were examined at 16 to 19 years of age during the years 1987 to 2010, at 1 conscription center in the northern district of Israel.The study population included 113,694 adolescents. Univariate and multivariable logistic regression models were used to investigate the associations between BMI categories, socio-demographic variables, and medical conditions.A downward trend in the prevalence of normal BMI among both male and female adolescents was obtained, while trends of overweight and obesity (in both genders) and underweight (only among females) rose. Socio-demographic variables such as religion, education, family-related parameters, residential environment, country of birth, and origin were all associated with different risks for abnormal BMI. Obesity was associated with higher risk for hyperlipidemia, endocrine disorders (only in males), knee disorders, and hypertension type I + II (in both genders). Overweight was associated with knee disorders (only in females). Underweight, exclusively in males, was associated with increased risk for endocrine disorders, proteinuria, and cardiac disorders. Hierarchical clustering analysis revealed the intricate relations between gender, BMI, and medical signatures. It brought to light novel clusters of diseases that were abundant among populations having above-normal BMI or underweight males. Furthermore, above-normal BMI was associated with a lower rate of cardiac anomalies and scoliosis/kyphosis, whereas being underweight was associated with a lower risk for hypertension and flat foot.This study provides a reliable and in-depth view of secular trends in height, weight, and BMI of male and female adolescents. It supports previous associations between abnormal BMI and demographic variables and comorbidities, while uncovering novel associations, mainly regarding medical signatures of each gender-BMI group. This might lead to better monitoring, early detection, prevention, and treatment of various conditions associated to abnormal BMI categories and gender groups.
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Affiliation(s)
- Yossy Machluf
- From the Medical Corps, Israel Defense Forces (IDF) (YM, DF, AP, ER, DD, YC), Tel HaShomer; The Weizmann Institute of Science (YM, RR), Rehovot; Shaare Zedek Medical Center (DF, RF, GW), Jerusalem; Schneider Children Medical Center (AP), Petach Tikvah; Assaf Harofeh Medical Center (OT), Zerifin; Israel Center for Disease Control (TS), Ministry of Health, Tel Aviv; Sackler School of Medicine (TS), Tel Aviv University, Tel Aviv, Israel
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Sadeghi-Demneh E, Azadinia F, Jafarian F, Shamsi F, Melvin JMA, Jafarpishe M, Rezaeian Z. Flatfoot and obesity in school-age children: a cross-sectional study. Clin Obes 2016; 6:42-50. [PMID: 26639935 DOI: 10.1111/cob.12125] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022]
Abstract
Childhood obesity exerts abnormally high stresses on developing foot structures which can lead to structural deformity of the foot. Screening for foot problems in children with overweight helps detect interior risks restricting normal lifestyle in these individuals. The purpose of this study was to investigate the effects of excess weight on the structure and function of the developing foot in students aged 7-14 years. A total of 667 participants were recruited for this cross-sectional study via a multi-level cluster sampling method (randomization was used within each cluster). All subjects (340 boys and 327 girls) attended primary and secondary schools in Isfahan City, Iran. The children's feet were evaluated using clinical assessments and footprint-based measures whilst fully weight bearing. Significant differences were observed in the frequency of flatfoot between normal weight, overweight and obese groups (P < 0.001); participants who were more overweight had flatter feet. Children with higher weight also had a more pronated heel, less dorsiflexion range and higher reported pain within physical activity. This study indicated that childhood obesity is associated with structural foot and ankle deformities and activity-related foot pain.
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Affiliation(s)
- E Sadeghi-Demneh
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Azadinia
- Orthotics and Prosthetics Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Jafarian
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Shamsi
- Orthotics and Prosthetics Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - J M A Melvin
- Biomechanics Research Group, School of Engineering, University of Nottingham, Nottingham, UK
| | - M Jafarpishe
- Orthotics and Prosthetics Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Z Rezaeian
- Orthotics and Prosthetics Department, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
Flatfoot is commonly encountered by pediatric orthopedic surgeons and pediatricians. A paucity of literature exists on how to define a flatfoot. The absence of the medial arch with a valgus hindfoot is the hallmark of this pathology. Flatfoot can be flexible or rigid. This review focuses on the diagnosis and treatment of the flexible flatfoot. Most flatfeet are flexible and clinically asymptomatic, and warrant little intervention. If feet are symptomatic, treatment is needed. Most patients who require treatment improve with foot orthotics and exercises. Only feet resistant to conservative modalities are deemed surgical candidates. The presence of a tight heel cord is often found in patients who fail conservative management.
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Affiliation(s)
- Abdel Majid Sheikh Taha
- Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, NY 10003, USA
| | - David S Feldman
- Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, NY 10003, USA.
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Tashiro Y, Fukumoto T, Uritani D, Matsumoto D, Nishiguchi S, Fukutani N, Adachi D, Hotta T, Morino S, Shirooka H, Nozaki Y, Hirata H, Yamaguchi M, Aoyama T. Children with flat feet have weaker toe grip strength than those having a normal arch. J Phys Ther Sci 2015; 27:3533-6. [PMID: 26696732 PMCID: PMC4681939 DOI: 10.1589/jpts.27.3533] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/19/2015] [Indexed: 01/24/2023] Open
Abstract
[Purpose] This study investigated the relationship between toe grip strength and foot
posture in children. [Subjects and Methods] A total of 619 children participated in this
study. The foot posture of the participants was measured using a foot printer and toe grip
strength was measured using a toe grip dynamometer. Children were classified into 3
groups; flatfoot, normal, and high arch, according to Staheli’s arch index. The
differences in demographic data and toe grip strength among each foot posture group were
analyzed by analysis of variance. Additionally, toe grip strength differences were
analyzed by analysis of covariance, adjusted to body mass index, age, and gender.
[Results] The number of participants classified as flatfoot, normal, and high arch were
110 (17.8%), 468 (75.6%), and 41 (6.6%), respectively. The toe grip strength of flatfoot
children was significantly lower than in normal children, as shown by both analysis of
variance and analysis of covariance. [Conclusion] A significant difference was detected in
toe grip strength between the low arch and normal foot groups. Therefore, it is suggested
that training to increase toe grip strength during childhood may prevent the formation of
flat feet or help in the development of arch.
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Affiliation(s)
- Yuto Tashiro
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takahiko Fukumoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Japan
| | - Daisuke Uritani
- Department of Physical Therapy, Faculty of Health Science, Kio University, Japan
| | - Daisuke Matsumoto
- Department of Physical Therapy, Faculty of Health Science, Kio University, Japan
| | - Shu Nishiguchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan ; Research Fellow of The Japan Society for the Promotion of Science, Japan
| | - Naoto Fukutani
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Daiki Adachi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takayuki Hotta
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Saori Morino
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan ; Research Fellow of The Japan Society for the Promotion of Science, Japan
| | - Hidehiko Shirooka
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuma Nozaki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hinako Hirata
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Moe Yamaguchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Abstract
Twenty-nine male judocas and nontraining peers participated in this study. The arch of the foot (as Clarke's angular values) was measured under non-weight-bearing conditions in two-leg and one-leg stands. Postural balance was assessed by the Flamingo balance test. Judocas presented better static balance and higher arches of the foot. Significant differences in Clarke's angular values in a sitting and standing on two-leg position were found in both groups. After transition to a one-leg stand, the height of the arches of the foot in nontraining participants was still significantly decreased. Weight bearing did not affect Clarke's angular values in judokas. A correlation was found between the Flamingo test and Clarke's angle. Better balance was observed in adolescents with higher arch of the foot.
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38
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Evans AM, Karimi L. The relationship between paediatric foot posture and body mass index: do heavier children really have flatter feet? J Foot Ankle Res 2015; 8:46. [PMID: 26322130 PMCID: PMC4551386 DOI: 10.1186/s13047-015-0101-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/06/2015] [Indexed: 11/30/2022] Open
Abstract
Background Several studies have found positive correlation between flatfeet and increased body mass in children. One study, utilizing a differing method of foot posture assessment, found the inverse. The purpose of this study was to further explore the relationship between children’s foot posture and body mass, utilizing the foot posture index in a large study population, as opposed to the footprint based measures of most previous studies. Methods Data for both foot posture index (FPI) and body mass index (BMI) for healthy children were acquired from five previous studies. The amalgamated dataset comprised observations for both BMI and FPI-6 in 728 children aged from three to 15 years. Three FPI-6 scores levels defined the range of flatfeet detected: FPI-6 ≥ +6; FPI-6 ≥ +8; FPI-6 ≥ +10. BMI cut-points were used to define overweight for each age group. Results In the study population of 728 children, flatfeet (FPI ≥ +6) were found in 290 (40 %) cases and non-flatfeet in 438 (60 %) cases. FPI ≥ +8 yielded flatfeet in 142 (20 %) cases and FPI ≥ +10 yielded flatfeet in 41 (5 %) cases. Whilst 272 (37 %) children were overweight, only 74 (10.1 %) of the overweight children had flatfeet (FPI ≥ +6), which diminished to 36 (4.9 %) at FPI ≥ +8, and 9 (1.2 %) at FPI ≥ +10. Significant and moderate correlation was found between BMI and age (r = 0.384, p < 0.01). Very weak, but significant, correlation was found between BMI and FPI (r = −0.077, p < 0.05). Significant mean differences between gender and BMI were found (t-test = 2.56, p < 0.05). There was strong correlation between FPI scores on left and right sides (r = 0.899, p < 0.01). Conclusions This study found no association between increased body mass and flatfeet in children, a finding in contrast to that repeatedly concluded by many previous studies. Whilst properties of the FPI and BMI are limiting, these findings question the concern about children’s increased body mass as a specific influence on (flatter) foot posture, and also the validity of footprint versus anatomically based foot posture measures.
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Affiliation(s)
- Angela Margaret Evans
- Department of Podiatry, Lower Extremity and Gait Studies (LEGS) Research Program, La Trobe University, Bundoora, Melbourne, Australia
| | - Leila Karimi
- School of Public Health and Human Biosciences, La Trobe University, Bundoora, Melbourne, Australia
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Jankowicz-Szymanska A, Mikolajczyk E. Effect of excessive body weight on foot arch changes in preschoolers a 2-year follow-up study. J Am Podiatr Med Assoc 2015. [PMID: 26218153 DOI: 10.7547/14-101.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND A stable standing posture, and effective and aesthetic gait, depend heavily on correct anatomical construction of the feet, thanks to which they can play their important role. The shape and height of the foot arches are already formed in the preschool and early school years; therefore, abnormalities and disorders in children's feet, and correlations between foot formation and somatic build, are still crucial and interesting issues for orthopedists, pediatricians, physiotherapists, and podiatrists. This study deals with changes in the height of the longitudinal and transverse arches of the foot in 4- to 6-year-old children. METHODS A total of 102 boys and 105 girls took part in a 24-month study in which their body weight, height, body mass index, and Clarke's and gamma angles were measured. The analysis also focused on correlations among sex, nutritional status, and changes in foot arch height. RESULTS It was discovered that sex did not considerably affect Clarke's and gamma angle values. However, it was found that between ages 4 and 6 years, the proportion of overweight and obese boys and girls increased, and the medial longitudinal arch of the foot had a tendency to collapse in those with excessive body weight. The effect of nutritional status on the transverse arch of the foot is rather dubious. CONCLUSIONS In light of these findings, therapeutic programs for preventing foot deformities in children should also focus on body weight control.
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Affiliation(s)
| | - Edyta Mikolajczyk
- University of Physical Education, Department of Physiotherapy, Krakow, Poland
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40
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Stolzman S, Irby MB, Callahan AB, Skelton JA. Pes planus and paediatric obesity: a systematic review of the literature. Clin Obes 2015; 5:52-9. [PMID: 25808780 PMCID: PMC4631254 DOI: 10.1111/cob.12091] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 12/01/2022]
Abstract
Children with obesity report musculoskeletal pain more than normal-weight children; this may be linked with literature suggesting children with obesity have higher prevalence of pes planus (flatfoot). To further elucidate whether this relation occurs, we conducted a systematic literature review on the co-occurrence of pes planus and paediatric obesity. Empirical articles published until September 2013 were obtained through an electronic search of MEDLINE and SPORTDiscus; included articles examined the association between body weight and pes planus in children. Thirteen cross-sectional studies of varied designs were identified. Methods used to diagnose pes planus varied between studies: imaging modalities, anthropometric measurements and clinical examination. Across all studies, pes planus prevalence among children with obesity ranged widely from 14 to 67%. Nearly all studies indicated increasing pes planus in children with increasing weight. No studies evaluated pain/complications related to pes planus. Our review suggests increased prevalence of pes planus among children with obesity or increasing weight status. Because of differing methodologies, lack of consensus regarding the pes planus definition, the dearth of investigation into pain/complications and the few existing studies, more research is needed to determine a relation between children's body weight, pes planus and associated effects on pain and function.
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Affiliation(s)
- S Stolzman
- Clinical and Translational Rehabilitative Health Sciences PhD Program, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
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Jenkins DW, Cooper K, Heigh EG. Prevalence of podiatric conditions seen in Special Olympics athletes: a comparison of USA data to an international population. Foot (Edinb) 2015; 25:5-11. [PMID: 25554566 DOI: 10.1016/j.foot.2014.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/25/2014] [Accepted: 09/21/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Persons with intellectual disabilities frequently have podiatric conditions. Limited information exists on their prevalence in international cohorts of Special Olympics (SO) athletes. Findings from multiple United States (US) venues are compared to those from athletes screened at the 2011 Special Olympics World Summer Games in Athens, Greece (ATHENS). METHODS Data from Fit Feet screenings from 2096 ATHENS participants was compared to 7192 US participants. RESULTS Frequently noted in the ATHENS population were motion restriction in both the ankle and the first metatarsal phalangeal joint (1st MTPJ), pes planus, metatarsus adductus, brachymetatarsia, hallux abducto valgus (HAV), onychomycosis, onychocryptosis, and tinea pedis. ATHENS differed from the US cohort as HAV and restricted ankle joint and 1st MTPJ joint motion was less frequent. Significantly more tinea pedis, xerosis, and hyperhidrosis were present in the ATHENS population. DISCUSSION/CONCLUSION SO athletes have a higher prevalence of podiatric structural conditions compared to the general population, and some vary between ATHENS versus US. Less prevalent in ATHENS was HAV, and restricted motion in both the ankle and 1st MTPJ. This may reflect differences due to varied clinical observers. The higher rates of several dermatological conditions in ATHENS may reflect venue seasonal climate, or social factors.
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Affiliation(s)
- David W Jenkins
- Arizona School of Podiatric Medicine, College of Health Sciences - Midwestern University, Glendale, AZ, USA.
| | - Kimbal Cooper
- Biomedical Sciences Program, Midwestern University, Glendale, AZ, USA
| | - Evelyn G Heigh
- Arizona School of Podiatric Medicine, College of Health Sciences - Midwestern University, Glendale, AZ, USA
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42
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Abstract
This past year has seen an increase in the quality of studies in pediatric orthopaedics, and the completion of BrAIST demonstrated that high-level studies of important questions can be addressed in pediatric orthopaedics. The current commitment of improving quality of care for children promises a healthy future for pediatric orthopaedics.
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Affiliation(s)
- James O Sanders
- University of Rochester, Golisano Children's Hospital at URMC, 601 Elmwood Avenue, Rochester, NY 14625. E-mail address:
| | - Norman Y Otsuka
- Center for Children, NYU Hospital for Joint Diseases, NYU Langone Medical Center, Department of Orthopaedic Surgery, 301 East 17th Street, Suite 301/303, New York, NY 10003
| | - Jeffrey E Martus
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565
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43
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Pita-Fernández S, González-Martín C, Seoane-Pillado T, López-Calviño B, Pértega-Díaz S, Gil-Guillén V. Validity of footprint analysis to determine flatfoot using clinical diagnosis as the gold standard in a random sample aged 40 years and older. J Epidemiol 2014; 25:148-54. [PMID: 25382154 PMCID: PMC4310876 DOI: 10.2188/jea.je20140082] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Research is needed to determine the prevalence and variables associated with the diagnosis of flatfoot, and to evaluate the validity of three footprint analysis methods for diagnosing flatfoot, using clinical diagnosis as a benchmark. Methods We conducted a cross-sectional study of a population-based random sample ≥40 years old (n = 1002) in A Coruña, Spain. Anthropometric variables, Charlson’s comorbidity score, and podiatric examination (including measurement of Clarke’s angle, the Chippaux-Smirak index, and the Staheli index) were used for comparison with a clinical diagnosis method using a podoscope. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained. Results Prevalence of flatfoot in the left and right footprint, measured using the podoscope, was 19.0% and 18.9%, respectively. Variables independently associated with flatfoot diagnosis were age (OR 1.07), female gender (OR 3.55) and BMI (OR 1.39). The area under the receiver operating characteristic curve (AUC) showed that Clarke’s angle is highly accurate in predicting flatfoot (AUC 0.94), followed by the Chippaux-Smirak (AUC 0.83) and Staheli (AUC 0.80) indices. Sensitivity values were 89.8% for Clarke’s angle, 94.2% for the Chippaux-Smirak index, and 81.8% for the Staheli index, with respective positive likelihood ratios or 9.7, 2.1, and 2.0. Conclusions Age, gender, and BMI were associated with a flatfoot diagnosis. The indices studied are suitable for diagnosing flatfoot in adults, especially Clarke’s angle, which is highly accurate for flatfoot diagnosis in this population.
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Affiliation(s)
- Salvador Pita-Fernández
- Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña
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Hershkovich O, Tenenbaum S, Gordon B, Bruck N, Thein R, Derazne E, Tzur D, Shamiss A, Afek A. A large-scale study on epidemiology and risk factors for chronic ankle instability in young adults. J Foot Ankle Surg 2014; 54:183-7. [PMID: 25135102 DOI: 10.1053/j.jfas.2014.06.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Indexed: 02/03/2023]
Abstract
Up to 40% of ankle sprains can result in chronic ankle instability (CAI). The prevalence of CAI and its association with body mass index (BMI) and height in the general young adult population has not been reported. The database records of young adults before recruitment into mandatory military service were studied. Information on the disability codes associated with CAI was retrieved. Logistic regression models were used to assess the association between the BMI and body height with various grades of CAI severity. The study cohort included 829,791 subjects (470,125 males and 359,666 females). The prevalence was 0.7% for mild CAI and 0.4% for severe instability in males and 0.3% and 0.4%, respectively, for females (p < .001). An increased BMI was associated with ankle instability in males (overweight, odds ratio [OR] 1.249, p < .001; obese, OR 1.418, p < .001) and females (overweight, OR 1.989 p < .001; obese, OR 2.754, p < .001). The body height was associated with an increased risk of CAI when the highest height quintile was compared with the lowest height quintile in both males (OR 2.443, p < .001) and females (OR 1.436, p < .001) for all levels of instability severity. The present study has shown a greater prevalence of CAI among males than females in a general healthy young adult population. CAI was associated with an increased BMI and greater body height for all grades of instability severity.
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Affiliation(s)
- Oded Hershkovich
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel HaShomer, Israel; Medical Corps, Israeli Defense Forces, Tel HaShomer, Israel
| | - Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel HaShomer, Israel.
| | - Barak Gordon
- Medical Corps, Israeli Defense Forces, Tel HaShomer, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Nathan Bruck
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Ran Thein
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Estela Derazne
- Medical Corps, Israeli Defense Forces, Tel HaShomer, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Dorit Tzur
- Medical Corps, Israeli Defense Forces, Tel HaShomer, Israel
| | - Ari Shamiss
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel; Central Management, Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Arnon Afek
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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Abstract
PURPOSE OF REVIEW The current review includes the most up to date literature on the cause, epidemiology, diagnosis, and treatment of pediatric flatfeet. RECENT FINDINGS Recent systematic reviews concur that the evidence supporting the use of orthotics in pediatric flexible flatfeet is poor. Multiple studies have recently reported on the results of arthroereisis, yet these are mostly retrospective and do not include a comparative group or long-term follow up. Other options for symptomatic flatfeet may include osteotomies and/or fusions, but similarly high quality comparative studies are lacking. SUMMARY Pediatric flatfeet range from the painless flexible normal variant of growth, to stiff or painful manifestations of tarsal coalition, collagen abnormalities, neurologic disease, or other underlying condition. Most children with flexible flatfeet do not have symptoms and do not require treatment. In symptomatic children, orthotics, osteotomies, or fusions may be considered. Arthroereisis has gained popularity in Europe, but has not been widely adopted in North America. Children with asymptomatic rigid flatfeet may not require treatment, whereas those with pain or functional deficits may benefit from orthotics, osteotomies, or fusions. A careful history, clinical exam, and selective diagnostic testing can be used to determine the appropriate treatment option for each child.
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