Foot and ankle abnormalities among a cohort of Nigerian school children: an epidemiological study

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.

Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations

BACKGROUND

Clinical assessment of hindfoot alignment (HA) in adult acquired flatfoot deformity (AAFD) can be challenging and weightbearing (WB) cone beam CT (CBCT) may potentially better demonstrate this three-dimensional (3D) deformity. Therefore, we compared clinical and WB CBCT assessment of HA in patients with AAFD.

METHODS

In this prospective study, we included 12 men and 8 women (mean age: 52.2, range: 20-88) with flexible AAFD. All subjects also underwent WB CBCT and clinical assessment of hindfoot alignment. Three fellowship-trained foot and ankle surgeons performed six hindfoot alignment measurements on the CT images. Intra- and Inter-observer reliabilities were calculated using intra-class correlation (ICC). Measurements were compared by paired T-tests, and p-values of less than 0.05 were considered significant.

RESULTS

The mean of clinically measured hindfoot valgus was 15.2 (95% confidence interval [CI]: 11.5-18.8) degrees. It was significantly different from the mean values of all WB CBCT measurements: Clinical Hindfoot Alignment Angle, 9.9 (CI: 8.9-11.1) degrees; Achilles tendon/Calcaneal Tuberosity Angle, 3.2 (CI: 1.3-5.0) degrees; Tibial axis/Calcaneal Tuberosity Angle, 6.1 (CI: 4.3-7.8) degrees; Tibial axis/Subtalar Joint Angle 7.0 (CI: 5.3-8.8) degrees, and Hindfoot Alignment Angle 22.8 (CI: 20.4-25.3) degrees. We found overall substantial to almost perfect intra- (ICC range: 0.87-0.97) and inter-observer agreements (ICC range: 0.51-0.88) for all WB CBCT measurements.

CONCLUSIONS

Using 3D WB CBCT can help characterize the valgus hindfoot alignment in patients with AAFD. We found the different CT measurements to be reliable and repeatable, and to significantly differ from the clinical evaluation of hindfoot valgus alignment.

LEVEL OF EVIDENCE

Level II-prospective comparative study.

Fibular donor site following non vascularized harvest: clinico-radiological outcome at minimal five year follow-up

PURPOSE

The long-term donor site outcome of non vascularized fibular harvest in paediatric age group is not well studied. We evaluated clinical and radiological characteristics of fibular harvest site in children at a minimum five year follow-up.

METHODS

The patients with donor legs underwent both physical and radiographic examination. Clinical parameters evaluated were pain, neuromuscular weakness, and standing tibiocalcaneal hindfoot valgus in the donor limb. Radiologically, longitudinal non continuity in regeneration, medullary canal reformation, Malhotra grading, and lateral distal tibial angle (LDTA) were documented.

RESULTS

Sixteen patients (18 legs) were available for follow-up. The average follow-up was 6.23 ± 1.1 years. None of the patients reported pain or neuromuscular weakness related to the donor leg. Five patients reported cosmesis issues related to exaggerated ankle valgus. Medullary canal restoration was seen in 3/14 regenerated fibulae. Harvested legs had overall higher fibular station than contralateral unintervened ankles. Non continuity in regeneration were seen in 4/18 legs. There was clinical hindfoot valgus, abnormal LDTA, and fibular station in these patients. Clinical valgus matched better with a combination of fibular station and LDTA (83.3%) rather than fibular station or LDTA (75%) alone.

CONCLUSIONS

Fibular regeneration was complete in more than 75% legs at follow-up of > five years but remodeling and reformation of medullary canal was delayed. Long-term fibular non regeneration was persistently responsible for development of ankle valgus deformity. Middle lower third fibular junction is critical area for non restoration of medullary canal and non continuity.