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Moisan G, Chicoine D, McBride S, Farahpour N, Isabelle PL, Dagenais C, Griffiths I. Supination resistance variations in foot and ankle musculoskeletal disorders: implications for diagnosis and customised interventions with wedged insoles. J Foot Ankle Res 2023; 16:91. [PMID: 38129924 PMCID: PMC10740238 DOI: 10.1186/s13047-023-00681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Supination resistance is a clinical outcome that estimates the amount of external force required to supinate the foot. A greater supination resistance may indicate greater loads on structures responsible for generating internal supination moments across the subtalar joint during static and dynamic tasks. As such, greater supination resistance may be an expected finding in medial foot and ankle musculoskeletal disorders, such as plantar fasciopathy (PF) and posterior tibial tendon dysfunction (PTTD), whereas reduced supination resistance may be present in lateral ankle disorders, such as chronic ankle instability (CAI). However, no studies have yet investigated the changes in supination resistance across these foot and ankle musculoskeletal disorders. This study aimed to quantify supination resistance in individuals with PF, PTTD and CAI compared to healthy controls. Additionally, this study aimed to explore the changes in supination resistance following the simulation of varus and valgus wedges, which are commonly used interventions for these disorders. METHODS Fourteen participants with PF, fourteen with PTTD, fourteen with CAI and fourteen healthy controls were recruited. Supination resistance was quantified on a level surface and on a 10-degree inclined surface with varus and valgus positions. RESULTS Supination resistance was lower for the injured foot for CAI (p < 0.001) and greater for PTTD (p < 0.001) compared to the healthy foot. There was no significant between-foot difference observed for PF (p = 0.275) and controls (p = 0.970). In the injured foot, CAI exhibited lower supination resistance compared to controls (p < 0.001), PF (p = 0.012) and PTTD (p = 0.014). Regardless of the groups, supination resistance increased when tested on a surface with valgus inclination (p < 0.001) and decreased when tested on a surface with varus inclination (p < 0.001). CONCLUSIONS Varus and valgus inclinations to the surface were effective in modifying supination resistance in PTTD and CAI, respectively. Supination resistance seemed unchanged in PF, and thus inclining the standing surface leads to greater between-feet asymmetries. This study also highlights the potential of wedged insoles as a mean to customise treatments and modify tissue stresses in these disorders. The findings contribute to the understanding of foot and ankle biomechanics and may aid in the development of more effective management and rehabilitation strategies.
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Affiliation(s)
- Gabriel Moisan
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Dominic Chicoine
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Sean McBride
- Department of Physical Therapy, University of Findlay, Findlay, OH, USA
| | - Nader Farahpour
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Department of Sport Biomechanics, Faculty of Sport Sciences, Bu Ali Sina University, Hamedan, Iran
| | - Pier-Luc Isabelle
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Camille Dagenais
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Ian Griffiths
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK.
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Kumar S, Mohanan S, Vattoth AL, Bajaj G, Pandey T. Anatomy and Biomechanics of Lower Extremity Tendons: Imaging Implications. Semin Ultrasound CT MR 2023. [DOI: 10.1053/j.sult.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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Bao B, Wei H, Zhu H, Zheng X. Transfer of Soleus Muscular Branch of Tibial Nerve to Deep Fibular Nerve to Repair Foot Drop After Common Peroneal Nerve Injury: A Retrospective Study. Front Neurol 2022; 13:745746. [PMID: 35222238 PMCID: PMC8873085 DOI: 10.3389/fneur.2022.745746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Common peroneal nerve (CPN) injury that leads to foot drop is difficult to manage and treat. We present a new strategy for management of foot drop after CPN injury. The soleus muscular branch of the tibial nerve is directly transferred to the deep fibular nerve, providing partial restoration of motor function. Methods We retrospectively reviewed eight patients treated for CPN injury between 2017 and 2019. The soleus muscular branch of the tibial nerve was transferred to the deep fibular nerve to repair foot drop. Electrophysiology was conducted, and motor function was assessed. Motor function was evaluated by measuring leg muscle strength during ankle dorsiflexion using the British Medical Research Council (BMRC) grading system and electromyography (EMG). Results In 10–15 months postoperatively, EMG revealed newly appearing electrical potentials in the tibialis anterior, extensor hallucis longus, and extensor toe longus muscle (N = 7). Two patients achieved BMRC grade of M4 for ankle dorsiflexion, 2 patients achieved M3, 1 patient achieved M2, and 2 patients achieved M1. Four patients showed good functional recovery after surgery and could walk and participate in activities without ankle-foot orthotics. Conclusion Surgical transfer of the soleus muscular branch of the tibial nerve to the deep fibular nerve after CPN injury provides variable improvements in ankle dorsiflexion strength. Despite variable strength gains, 50% of patients achieved BMRC M3 or greater motor recovery, which enabled them to walk without assistive devices.
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Won SH, Kim J, Cho J, Chun DI, Kim K, Yi Y. Calcifying aponeurotic fibroma around posterior tibialis tendon in an elderly patient with flatfoot: A case report. Medicine (Baltimore) 2021; 100:e26803. [PMID: 34397738 PMCID: PMC8322532 DOI: 10.1097/md.0000000000026803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/12/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Calcifying aponeurotic fibroma (CAF) is a rare benign fibroblastic tumor that is commonly in the hand or foot of children or adolescents. PATIENT CONCERNS A 74-year-old female presented with a progressive pain on the medial foot for 3 years ago. The pain aggravated while walking or in a standing position for more than 20 minutes. She also complained of skin contact along the medial aspect of the foot while trying to wear a shoe. DIAGNOSIS Physical examination revealed a firm, immobile, nontender mass accompanied with flexible flatfoot. On the single heel raise test, loss of the balance and intensification of the pain were observed. Faintly calcified soft tissue mass is shown in plain radiographs without bone involvement. Magnetic resonance imaging revealed a subcutaneous mass with ill-defined circumscribed subcutaneous mass adherent to the thickened PTT. INTERVENTIONS The patient underwent a complete excisional biopsy, followed by medial displacement calcaneal osteotomy. OUTCOMES The excised mass was diagnosed to be CAF on the histologic examination. At the 1-year follow-up, patient remained asymptomatic with no evidence of recurrence and all the radiographic parameters demonstrating flat foot improved. LESSONS This is the first case of CAF located at PTT presenting with both foot pain and functional disability. In this case, complete excision of the causative structure along with alignment correction can contribute to successful postoperative outcome.
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Affiliation(s)
- Sung Hun Won
- Department of Orthopaedic Surgery, Bone & Joint center, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jahyung Kim
- Department of Orthopaedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Kwonwoo Kim
- Department of Health Administration, Sejong Public Health Center, Sejong, Korea
| | - Young Yi
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Republic of Korea
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Toyooka S, Shimazaki N, Yasui Y, Ando S, Saho Y, Nakagawa T, Kawano H, Miyamoto W. Validity of a simple footprint assessment board for diagnosing the severity of flatfoot: a prospective cohort study. BMC Musculoskelet Disord 2021; 22:285. [PMID: 33736625 PMCID: PMC7977274 DOI: 10.1186/s12891-021-04154-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A simple, non-quantitative, and cost-effective diagnostic tool would enable the diagnosis of flatfoot without need for specialized training. A simple footprint assessment board that investigates which toe the cord passes through from the centre point of the heel to the most lateral point of the medial contour of the footprint has been developed to assess flatfoot. The purpose of this study was to verify the validity of a simple footprint assessment board for flatfoot. METHODS Thirty-five consecutive patients with foot pain, foot injury, or any associated symptoms who underwent computed tomography (CT) were analysed prospectively. At the time of the CT scan, a footprint analysis using a simple footprint assessment board was performed. The navicular index, tibiocalcaneal angle, and calcaneal inclination angle were evaluated by CT to assess flat feet. These three criteria were compared to those evaluated with the simple footprint assessment board by regression analysis. In addition, the same analysis was conducted separately for young, middle-aged, and older patients in order to investigate each age group. RESULTS The navicular index and tibiocalcaneal angle generally decreased as the score of the simple footprint assessment board increased. Calcaneal inclination angle generally increased as the score of the simple footprint assessment board increased. As the scores of the simple footprint assessment board decreased by approaching the great toe, the navicular index and tibiocalcaneal angle were higher and calcaneal inclination angle was lower, which is indicative of a higher likelihood of flatfoot. The scores derived from the simple footprint assessment board was correlated with these three criteria measured by CT, not only when the result of simple footprint assessment board was set as a non-continuous variable but also when the result was set as a continuous variable. The results of the age-stratified survey were similar for all groups. CONCLUSIONS The findings of this study suggest that a simple footprint assessment board can be potentially useful to detect flatfoot. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Seikai Toyooka
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoya Shimazaki
- Department of Orthopaedic Surgery, Shimazaki Hospital, Ibaraki, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Ando
- Department of Information Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yasuaki Saho
- Faculty of Medical Technology, Teikyo University Institute of Sports Science and Medicine, Tokyo, Japan
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
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Haldar A, Bernasconi A, Junaid SE, Lee KHB, Welck M, Saifuddin A. 3D imaging for hindfoot alignment assessment: a comparative study between non-weight-bearing MRI and weight-bearing CT. Skeletal Radiol 2021; 50:179-188. [PMID: 32699951 DOI: 10.1007/s00256-020-03532-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The authors compared measurements of hindfoot alignment on MR imaging with weight-bearing CT (WB-CT) to establish the degree of correlation. Forty-seven feet in 44 patients had weight-bearing CT and MRI studies performed on the same day. MATERIALS AND METHODS Hindfoot alignment on MRI was assessed by two radiologists who calculated tibiocalcaneal angle (TCA) and calcaneofibular ligament angle (CFLA). On WB-CT, foot ankle offset (FAO), calcaneal offset (CO) and hindfoot angle (HA) were assessed by a senior Foot and Ankle Surgeon using dedicated software. Pearson correlation coefficient was used to evaluate the correlation between these measurements. RESULTS The study group comprised 27 males and 17 females with a mean age of 45 years (range 13-79 years). A statistically significant positive correlation was identified between TCA on MRI and all measurements of hindfoot alignment on WB-CT (p = 0.001-0.005). The CFLA on MRI only had significant correlation with CO on WB-CT (p = 0.03). A significant negative correlation was observed between both MRI parameters (p < 0.001). CONCLUSION A highly significant correlation between tibiocalcaneal angle on non-weight-bearing ankle MR imaging and hindfoot alignment measurements on weight-bearing CT was identified.
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Affiliation(s)
- Anil Haldar
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK.
| | - Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Syed Ehtesham Junaid
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Kar Ho Brian Lee
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, 25 Waterloo Road, Yau Ma Tei, Kowloon, Hong Kong
| | - Matthew Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Asif Saifuddin
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
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Mosca M, Caravelli S, Vocale E, Massimi S, Fuiano M, Grassi A, Ceccarelli F, Zaffagnini S. Outcome After Modified Grice-Green Procedure (SAMBB) for Arthritic Acquired Adult Flatfoot. Foot Ankle Int 2020; 41:1404-1410. [PMID: 32779535 DOI: 10.1177/1071100720938665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adult acquired flatfoot deformity is a well-known and recognized cause of pain and disability. The purpose of this retrospective study was to describe radiographic and clinical outcomes of the modified mini bone block distraction subtalar arthrodesis (SAMBB) in adult patients affected by adult flatfoot with subtalar joint osteoarthritis at a midterm mean follow-up. METHODS A retrospective review of our database identified patients. Radiological imaging was used to evaluate angular corrections (Meary's angle [MA], talar coverage angle [TC], and calcaneal pitch angle [CP]) to assess the rate of union and highlight the possible progression of arthritis in nearby joints. Clinical evaluation was performed at the time of surgery and at the final follow-up using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Sixty-two feet were evaluated at a mean follow-up of 6.2 ± 4.2 years. RESULTS The AOFAS score improved from a mean value of 48.1 ± 6.1 to a postoperative average score of 87.7 ± 5. CP, TC, and MA showed a postoperative improvement to 17.7 ± 2.1, 2.9 ± 0.7, and 0.6 ± 0.6 degrees, respectively, at the final follow-up, and all deformities were corrected. Five complications (8%) were reported: 1 major and 4 minor. No graft reabsorption, sural nerve neuralgia, or donor site morbidity was recorded. CONCLUSION To our knowledge, this study is the first report of a modified Grice-Green technique (SAMBB) that is a safe and effective treatment of flatfoot in the adult with subtalar arthritis. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Massimiliano Mosca
- I Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvio Caravelli
- I Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna-Alma Mater Studiorum, Bologna, Italy
| | - Emanuele Vocale
- I Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simone Massimi
- I Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- I Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- I Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Stefano Zaffagnini
- I Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
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Lee S, Oliveira I, Li Y, Welck M, Saifuddin A. Fluid around the distal tibialis posterior tendon on ankle MRI: prevalence and clinical relevance. Br J Radiol 2019; 92:20190722. [PMID: 31596120 DOI: 10.1259/bjr.20190722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE It has been stated that the distal 1-2 cm of the tibialis posterior tendon (TPT) does not have a tendon sheath but rather a paratenon, and that any fluid seen around this segment on ankle MRI is considered to represent paratendonitis. The prevalence and clinical significance of isolated TPT paratendonitis diagnosed on ankle MRI is unknown. This study aims to correlate the presence of isolated distal segment TPT paratendonitis on ankle MRI, with the presence or absence of medial midfoot pain. METHODS A retrospective database of 195 consecutive 3 T ankle MRI studies was assessed for the presence of isolated TPT paratendonitis. Relevant clinical notes were available in 159 of these cases, and were reviewed for the absence or presence of medial midfoot pain. RESULTS Of 133 patients with both ankle MRI studies and clinical notes available, 53 (33.3%) patients had isolated TPT paratendonitis based on MRI. Of these, 37 (69.8%) had reported no medial foot pain on review of clinical records, while medial foot pain was recorded in 16 cases (30.2%). The comparison of TPT paratendonitis with clinically evident medial midfoot pain showed no statistically significant association (p = 0.19). CONCLUSION Fluid signal intensity around the distal 1-2 cm of the TPT is a relatively common finding on ankle MRI. Therefore, care should be taken when reporting ankle MRI studies not to overstate the relevance of this finding. ADVANCES IN KNOWLEDGE There was no statistically significant relationship between medial midfoot pain and the presence of isolated TPT paratendonitis.
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Affiliation(s)
- Sangoh Lee
- Department of Clinical Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Ines Oliveira
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Yueyang Li
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Matthew Welck
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Asif Saifuddin
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.,Everlight Radiology, Level 6, West, 350 Euston Rd, London, UK
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Chicoine D, Bouchard M, Trempe S, Laurendeau S, Belzile EL, Corbeil P. Biomechanical effects of three types of foot orthoses on a posterior tibial tendon dysfunction population during a stair climbing task. FOOTWEAR SCIENCE 2019. [DOI: 10.1080/19424280.2019.1606101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vosoughi AR, Ravanbod H, Gilheany M, Erfani MA, Mozaffarian K. Posterior tibialis tendon rupture associated with closed medial malleolus fracture and avulsion of anterior talofibular ligament: A case report and review of the literature. HONG KONG J EMERG ME 2018; 25:232-235. [DOI: 10.1177/1024907917753441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Introduction:Traumatic rupture of posterior tibialis tendon in association with medial malleolus fracture is extremely rare.Case Presentation:We demonstrate our experience in the management of a complete posterior tibialis tendon (PTT) rupture and anterior talofibular ligament avulsion fracture from the talus in association with medial malleolus fracture in a 30-year-old male motorcyclist without any open wounds.Discussion:We believe this to be the first reported injury of this type in the literature. Closed ankle fractures may obscure surrounding tendon rupture and the clinician may be tempted to focus on the osseous injuries rather than the significance of associated soft tissue injures.Conclusion:This particular case demonstrates the importance of assessing for PTT injury in situations where high velocity impact to the ankle results in malleolar fracture.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mark Gilheany
- School of Podiatry, La Trobe University, Melbourne, VIC, Australia
- East Melbourne Podiatry, Melbourne, VIC, Australia
| | - Mohammad Ali Erfani
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Mozaffarian
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Return to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer. Knee Surg Sports Traumatol Arthrosc 2018; 26:892-896. [PMID: 27744576 DOI: 10.1007/s00167-016-4360-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Medial displacement calcaneal osteotomy with flexor digitorum longus transfer is a common treatment for the management of the adult flatfoot associated with posterior tibial tendon dysfunction. In the literature, there is a paucity of information regarding the ability of patients to return to sport and recreational activities after this surgical procedure. The purpose of this retrospective clinical study was to assess the rate and type of athletic activities that patients participated in before and after medial displacement calcaneal osteotomy with flexor digitorum longus transfer. METHODS A consecutive series of 42 patients with a mean age at surgery of 41 years (range 19-74 years) was evaluated with a minimum follow-up of 24 months (range 18-31 months). Pre- and post-operative sporting activities were assessed. At final follow-up, patients were asked to complete a Sports Athlete Foot and Ankle Score (SAFAS). Each patient was also evaluated with weight-bearing radiographs of the foot before surgery and at final follow-up. RESULTS Preoperatively, 27 of 42 (64.3 %) patients were engaged in athletic activities, participating in an average of 1.4 h/week (range 0-6 h/week); post-operatively, 36/42 (85.7 %) participated in sport and recreational activities for an average of 3.5 h/week (range 0-15 h/week). Meary's angle improved significantly from 11.5 ± 6.2 degrees preoperatively to 7.0 ± 5.7 degrees at final follow-up (p < 0.01); calcaneal pitch improved significantly from 16.5 ± 4.6 degrees to 19.0 ± 5.0 degrees (p < 0.01). At final follow-up, patients demonstrated good SAFASs in symptom tolerance (86.4 %), pain tolerance (89.0 %), daily living performance (96.1 %), and sports performance (86.7 %). CONCLUSION The majority of patients returned to sports and recreational activity after medial displacement calcaneal osteotomy and flexor digitorum longus for the treatment of adult flatfoot associated with posterior tibial tendon dysfunction. LEVEL OF EVIDENCE III.
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Albano D, Martinelli N, Bianchi A, Romeo G, Bulfamante G, Galia M, Sconfienza LM. Posterior tibial tendon dysfunction: Clinical and magnetic resonance imaging findings having histology as reference standard. Eur J Radiol 2017; 99:55-61. [PMID: 29362151 DOI: 10.1016/j.ejrad.2017.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/24/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the correlation between MRI, clinical tests, histopathologic features of posterior tibial tendon (PTT) dysfunction in patients with acquired adult flatfoot deformity surgically treated with medializing calcaneal osteotomy and flexor digitorum longus tendon transposition. MATERIALS AND METHODS Nineteen patients (11 females; age: 46 ± 15 year, range 18-75) were pre-operatively evaluated using the single heel rise (HR) and the first metatarsal rise (FMR) sign tests. Two reviewers graded the PTT tears on a I-III scale and measured the hindfoot valgus angle on the pre-operative MRI of the ankle. The specimens of the removed portion of PTT were histologically analysed by two pathologists using the Bonar and Movin score. Linear regression, Spearman's rank-order, and intraclass correlation coefficient (ICC) statistics were used. RESULTS ICC for MRI was excellent (0.952). Correlation between FMR and HR tests was at limit of significance (r = 0.454; P = 0.051). The HR and FMR tests were significantly correlated to the Movin score (r = 0.581; P = 0.009 and r = 0.538; P = 0.018, respectively) and were not significantly correlated to the Bonar score (both with a r = 0.424; P = 0.070). PTT tendinopathy grading at MRI was significantly correlated to the FMR test (p = 0.041) but not to the hindfoot valgus angle (p = 0.496), the HR test (p = 0.943), the Bonar score (p = 0.937), and the Movin score (p = 0.436). The hindfoot angle was not correlated to any of the other variables (p > 0.264). CONCLUSION For PTT dysfunction, there is high correlation between HR and FMR test and histology evaluated using the Movin score, while no correlation was seen for the Bonar score. Semiquantitative grading of PTT dysfunction at MRI only correlates to the FMR and not to histology. The hindfoot valgus angle is not correlated to any of the considered variables.
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Affiliation(s)
- Domenico Albano
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Nicolò Martinelli
- Foot and Ankle Surgery Unit, Istituto Clinico Città Studi, Milano, Italy
| | - Alberto Bianchi
- Foot and Ankle Surgery Unit, Istituto Clinico Città Studi, Milano, Italy
| | - Giovanni Romeo
- Foot and Ankle Surgery Unit, Istituto Clinico Città Studi, Milano, Italy
| | - Gaetano Bulfamante
- Department of Health Sciences, San Paolo Hospital Medical School University of Milan, Via di Rudinì 8, 20142, Milan, Italy
| | - Massimo Galia
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, University of Milano, Via Pascal 36, 20135, Milano, Italy; Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20166, Milano, Italy.
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Akuzawa H, Imai A, Iizuka S, Matsunaga N, Kaneoka K. The influence of foot position on lower leg muscle activity during a heel raise exercise measured with fine-wire and surface EMG. Phys Ther Sport 2017; 28:23-28. [PMID: 28950148 DOI: 10.1016/j.ptsp.2017.08.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 08/05/2017] [Accepted: 08/19/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Exercises for lower leg muscles are important to improve function. To examine the influence of foot position on lower leg muscle activity during heel raises. DESIGN Cross-sectional laboratory study. SETTING Laboratory. PARTICIPANTS Fourteen healthy men participated in this study. MAIN OUTCOME MEASURES The muscle activity levels of the tibialis posterior (TP), peroneus longus (PL), flexor digitorum longus (FDL) and medial gastrocnemius (MG) were measured. The heel raises consisted of three foot positions: 1) neutral, 2) 30° abduction, and 3) 30° adduction. The EMG data for five repetitions of each foot position were normalized to maximum voluntary contraction. One-way repeated measure ANOVA was employed for statistical analysis. RESULTS The muscle activity level of TP, PL and FDL was significantly different between the three foot positions during the heel raises. TP and FDL showed the highest activity level in 30° foot adduction while PL demonstrated the highest activity level in 30° foot abduction. CONCLUSIONS Heel raises with 30° foot adduction and abduction positions can change lower leg muscle activity; These findings suggest that altering foot posture during the heel raise exercise may benefit patients with impaired TP, PL or FDL function.
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Affiliation(s)
- Hiroshi Akuzawa
- School of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Atsushi Imai
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Satoshi Iizuka
- School of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Naoto Matsunaga
- School of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Koji Kaneoka
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan.
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14
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Sirlyn Q. Ultrasound evaluation of adult-acquired flatfoot deformity: Emphasis on the involvement of spring ligament. Australas J Ultrasound Med 2017; 20:83-90. [PMID: 34760477 PMCID: PMC8409874 DOI: 10.1002/ajum.12050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Adult-acquired flatfoot deformity (AAFD), a condition commonly caused by tibialis posterior tendon (TPT) dysfunction, has recently been recognised to encompass a spectrum of other deformities, including the disruption of the spring ligament complex. This case series reviews eight examples of chronic AAFD, outlines the sonographic assessment of the TPT and spring ligament and depicts various abnormalities of the TPT and spring ligament that are relevant to AAFD. The importance to always include the spring ligament during the assessment of AAFD will be addressed, as misdiagnosis of the involvement of the spring ligament could lead to inappropriate operative management.
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15
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Xu Y, Li XC, Xu XY. Calcaneal Z Lengthening Osteotomy Combined With Subtalar Arthroereisis for Severe Adolescent Flexible Flatfoot Reconstruction. Foot Ankle Int 2016; 37:1225-1231. [PMID: 27402620 DOI: 10.1177/1071100716658975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The timing and strategy for operative treatment of flatfoot are still controversial. The purpose of this study was to evaluate clinical outcomes and radiographic changes following calcaneal Z osteotomy combined with subtalar arthroereisis for severe adolescent flexible flatfoot. METHODS Data were analyzed for 16 patients (20 feet) who had flatfoot without tibialis posterior tendon dysfunction and were treated by calcaneal Z osteotomy combined with arthroereisis between October 2011 and February 2015. The mean age of patients at the time of surgery was 12.8 ± 1.4 years (range, 10-14 years). Preoperative and postoperative measurements included changes in hindfoot valgus angles; changes in talonavicular uncoverage angles on anteroposterior (AP) radiographic view; and changes in talo-first metatarsal angles, talar pitch angles, and calcaneal pitch angles on lateral radiographic view. The American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AH) was used to assess foot function. The mean follow-up was 18.9 ± 6.9 months (range, 13-33 months). RESULTS The hindfoot valgus angle improved from 14.9 ± 4.2 degrees to 2.3 ± 1.7 degrees. On the AP view, the preoperative and postoperative talonavicular uncoverage angles were 30.5 ± 9.4 degrees and 9.8 ± 4.8 degrees, respectively. On lateral radiographs, the preoperative talo-first metatarsal angle, talar pitch angle, and calcaneal pitch angle were -22.1 ± 7.9 degrees, 36.1 ± 4.4 degrees, and 14.4 ± 4.0 degrees, respectively. Postoperative lateral radiographs demonstrated talo-first metatarsal angle, talar pitch angle, and calcaneal pitch angle of -6.2 ± 4.7 degrees, 27.3 ± 4.9 degrees, and 19.0 ± 4.3 degrees, respectively. The AOFAS-AH score improved from 66.8 ± 24.1 preoperatively to 96.5 ± 3.4 postoperatively. CONCLUSIONS For adolescents with flatfoot, calcaneal Z osteotomy combined with subtalar arthroereisis provided satisfactory results. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
| | - Xing-Chen Li
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
| | - Xiang-Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China .,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
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