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Bobiński A, Tomczyk Ł, Pelc M, Chruścicki D, Śnietka B, Wójcik J, Morasiewicz P. Gait Analysis in Patients with Symptomatic Pes Planovalgus Following Subtalar Arthroereisis with the Talus Screw. Indian J Orthop 2024; 58:696-704. [PMID: 38812857 PMCID: PMC11130113 DOI: 10.1007/s43465-024-01122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/11/2024] [Indexed: 05/31/2024]
Abstract
Background Pes planovalgus is one of the most common pediatric skeletal deformities. There have been no studies to analyze in detail the spatiotemporal variables of gait following arthroereisis. Purpose of the study The purpose of our study was to assess gait parameters in patients with symptomatic flexible flatfoot following treatment with the talus screw. Methods This was a prospective study assessing the 22 patients treated surgically due to symptomatic flexible flatfoot with the talus screw. Patients underwent gait assessment with a G-Sensor. We analyzed the following gait parameters: gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, cadence, velocity, step length. Results The post-operative gait parameter assessment for the operated and non-operated foot showed a significant difference only in terms of step length. Cadence increased from the pre-operative mean of 82.29 steps/min to a post-operative mean of 102.94 steps/min. Gait velocity increased significantly from 0.81 m/s before to 0.96 m/s after surgery. Discussion Arthroereisis with the talus screw helps improve gait parameters following surgery. Post-operatively, we observed increased gait velocity and cadence and decreased gait cycle duration in the operated limb. Conclusion Short-term biomechanical outcomes of pes planovalgus treatment with the talus screw are good.
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Affiliation(s)
- Andrzej Bobiński
- Department of Orthopaedic and Trauma Surgery, Institute of Medical Sciences, University of Opole, al. Witosa 26, 45-401 Opole, Poland
| | - Łukasz Tomczyk
- Department of Food Safety and Quality Management, Poznan University of Life Sciences, Wojska Polskiego 31, 60-624 Poznań, Poland
| | - Marcin Pelc
- Faculty of Medicine, Institute of Medical Sciences, University of Opole, ul. Oleska 48, 45-052 Opole, Poland
| | - Damian Chruścicki
- Faculty of Medicine, Institute of Medical Sciences, University of Opole, ul. Oleska 48, 45-052 Opole, Poland
| | - Bartosz Śnietka
- Faculty of Medicine, Institute of Medical Sciences, University of Opole, ul. Oleska 48, 45-052 Opole, Poland
| | - Jarosław Wójcik
- University Clinical Hospital in Opole, al. Witosa 26, 45-401 Opole, Poland
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, Institute of Medical Sciences, University of Opole, al. Witosa 26, 45-401 Opole, Poland
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Corradin M, Schiavon R, Micaglio A, Pierantoni S, Luppi V, Canavese F. Simultaneous subtalar arthroeresis, midfoot soft tissue release, and talo-navicular arthrodesis in children with planovalgus neurologic foot. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2163-2170. [PMID: 38565784 DOI: 10.1007/s00590-024-03914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA). METHODS A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6-17). Mean follow-up was 7 ± 2.9 years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01. RESULTS Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing. CONCLUSIONS SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco Corradin
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy.
| | - Roberto Schiavon
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy
- Department of Paediatric Orthopaedic, Policlinic Abano Terme, 35031, Abano Terme, PD, Italy
| | - Andrea Micaglio
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy
| | - Silvia Pierantoni
- Department of Paediatric Orthopaedic, Policlinic Abano Terme, 35031, Abano Terme, PD, Italy
| | - Valentina Luppi
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy
| | - Federico Canavese
- Department of Pediatric Orthopedics, Faculty of Medicine, Jeanne de Flandre Hospital, Lille University Hospital, Rue Eugène Avinée, 59800, Lille, France
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Szesz A, Małecki K, Sibiński M, Niedzielski KR. An evaluation of subtalar titanium screw arthroereisis for the treatment of symptomatic paediatric flatfeet - early results. BMC Musculoskelet Disord 2023; 24:825. [PMID: 37858058 PMCID: PMC10585733 DOI: 10.1186/s12891-023-06937-2] [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: 08/05/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Idiopathic flexible flatfoot is a common condition in children which typically improves with age and remains asymptomatic. However, the condition can sometimes be more severe, and cause mechanical impairment or pain. The aim of the study was to perform a prospective clinical, radiological, podoscopic and pedobarographic assessment (static and dynamic) of subtalar titanium screw arthroereisis for the treatment of symptomatic, idiopathic, flexible flatfeet. METHODS A prospective, consecutive, non-controlled, cohort, clinical follow-up study was performed. In total, 30 patients (41 feet), mean age 10 (6 to 16 years), were evaluated. Clinical and standing radiological assessments, static and dynamic pedobarography, as well as podoscopy, were performed before surgery and at final follow-up. RESULTS Treatment was associated with significant improvements in heel valgus angle, radiographic parameters (lateral and dorso-planar talo-first metatarsal angle, calcaneal inclination angle, talar declination angle, longitudinal arch angle) and podoscopic parameters (Clark's angle, Staheli's arch index and Chippaux-Smirak index). Significant increases were noted for lateral loading, forefoot contact phase and double support / swing phase, and reduced medial loading (dynamic pedobarography), as well as lateral midfoot area and loading, but decreased were observed for medial forefoot loading (static pedobarography). Four patients reported persistent pain in the sinus tarsi region (six feet), and in one case, the implant was replaced for a larger one due to undercorrection. No overcorrections or infection complications were noted in the study group. CONCLUSIONS Subtalar arthroereisis is a minimally-invasive and effective surgical method for treating symptomatic, idiopathic, flexible flatfeet; it has an acceptable complication rate with good early clinical results. LEVEL OF EVIDENCE II b.
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Affiliation(s)
- Anna Szesz
- Clinic of Orthopaedics and Traumatology, Polish Mother's Hospital Research Institute, Lodz, Poland
| | - Krzysztof Małecki
- Clinic of Orthopaedics and Traumatology, Polish Mother's Hospital Research Institute, Lodz, Poland
| | - Marcin Sibiński
- Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, ul Pomorska 251, Lodz, 92-213, Poland.
| | - Kryspin R Niedzielski
- Clinic of Orthopaedics and Traumatology, Polish Mother's Hospital Research Institute, Lodz, Poland
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Vescio A, Testa G, Caldaci A, Sapienza M, Pavone V. Catania flatfoot score: A diagnostic-therapeutic evaluation tool in children. World J Orthop 2023; 14:755-762. [PMID: 37970624 PMCID: PMC10642399 DOI: 10.5312/wjo.v14.i10.755] [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: 01/03/2023] [Revised: 04/26/2023] [Accepted: 06/09/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Flexible flatfoot (FFF) is a very common condition in children, but no evidence-based guidelines or assessment tools exist. Yet, surgical indication is left to the surgeon's experience and preferences. AIM To develop a functional clinical score for FFF [Catania flatfoot (CTF) score] and a measure of internal consistency; to evaluate inter-observer and intra-observer reliability of the CTF Score; to provide a strong tool for proper FFF surgical indication. METHODS CTF is a medically compiled score of four main domains for a total of twelve items: Patient features, Pain, Clinical Parameters, and Functionality. Each item refers to a specific rate. Five experienced observers answered 10 case reports according to the CTF. To assess inter- and intra-observer reliability of the CTF score, the intra-class correlation coefficients' (ICCs) statistics test was performed, as well as to gauge the correlation between the CTF score and the surgical or conservative treatment indication. Values of 75% were chosen as the score cut-off for surgical indication. Sensitivity, specificity, positive likelihood ratio (PLHR), negative likelihood ratio (NLHR), positive predictive value (PPV), and negative predictive value (NPV). RESULTS Overall interobserver reliability ICC was 0.87 [95% confidence interval (CI): 0.846-0.892; P < 0.001]. Overall intra-observer reliability ICC was 0.883 (95%CI: 0.854-0.909; P < 0.001). A direct correlation between the CTF score and surgical treatment indication [Pearson correlation coefficient = 0.94 (P < 0.001)] was found. According to the 75% cut-off, the sensitivity was 100% (95%CI: 83.43%-100%), specificity was 85.71% (95%CI: 75.29%-92.93%), PLHR was 7 (95%CI: 3.94-12.43), NLHR was 0 (95%CI: 0-0), PPV was 75% (95%CI: 62.83%-84.19%) and NPV was 100% (95%CI: 100%-100%). CONCLUSION CTF represents a useful tool for orthopedic surgeons in the FFF evaluation. The CTF score is a quality questionnaire to reproduce suitable clinical research, survey studies, and clinical practice. Moreover, the 75% cut-off is an important threshold for surgical indication and helps in the decision-making process.
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Affiliation(s)
- Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
| | - Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
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Bobiński A, Tomczyk Ł, Reichert P, Morasiewicz P. Short-Term and Medium-Term Radiological and Clinical Assessment of Patients with Symptomatic Flexible Flatfoot Following Subtalar Arthroereisis with Spherus Screw. J Clin Med 2023; 12:5038. [PMID: 37568440 PMCID: PMC10420212 DOI: 10.3390/jcm12155038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND There have been no reports on arthroereisis screw insertion into the talus in patients with flexible flatfoot. We aimed to conduct a clinical and radiological assessment in patients with symptomatic pes planovalgus deformity treated with a talar screw. METHODS This study involved a prospective assessment of 27 patients treated surgically for symptomatic flexible flatfoot deformity in the period 2021-2022. The following parameters were assessed in this study: Meary's angle, the Costa-Bartani angle, the calcaneal pitch angle, surgery duration, the length of hospital stay, patient satisfaction, patients' retrospective willingness to consent to the treatment they received, postoperative complications, and the use of analgesics. RESULTS The mean follow-up period was 14.76 months. Meary's angle decreased from 18.63° before surgery to 9.39° at follow-up (p = 0.004). The Costa-Bartani angle decreased significantly from 154.66° before surgery to 144.58° after surgery (p = 0.012). The calcaneal pitch angle changed from 16.21° before to 19.74°. Complications were reported in three patients (11.11%). The mean surgery duration was 32 min. The mean hospital stay was 2.2 days. Fourteen patients (51.85%) were highly satisfied with the treatment, and 12 patients (44.44%) were quite satisfied with treatment. Twenty-five (92.59%) of the evaluated patients would choose the same type of treatment again. Six patients (22.22%) needed to use analgesics prior to surgical treatment, whereas none of the patients needed to use them by the final follow-up. CONCLUSION Spherus screw arthroereisis helps improve radiological parameters in patients with flexible flatfoot. We observed good clinical outcomes after treatment with a talar screw, with a majority of patients reporting moderate-to-high levels of satisfaction with treatment. Both short- and medium-term treatment outcomes of pes planovalgus treatment with the use of Spherus screw are good.
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Affiliation(s)
- Andrzej Bobiński
- Department of Orthopaedic and Trauma Surgery, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland;
| | - Łukasz Tomczyk
- Department of Food Safety and Quality Management, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637 Poznan, Poland;
| | - Paweł Reichert
- Department of Trauma and Hand Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland;
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Žukauskas S, Barauskas V, Degliūtė-Muller R, Čekanauskas E. Really Asymptomatic? Health-Related Quality of Life and Objective Clinical Foot Characteristics among 5-10-Year-Old Children with a Flexible FlatFoot. J Clin Med 2023; 12:jcm12093331. [PMID: 37176771 PMCID: PMC10179374 DOI: 10.3390/jcm12093331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
The potential effects of asymptomatic flexible flatfoot (FF) on children's health-related quality of life (QoL) and objective clinical foot characteristics have been poorly investigated in the literature. Therefore, this study aimed to analyse these indicators, comparing the children with asymptomatic FF and a control group. METHODS In total, 351 children were enrolled in this cross-sectional study-160 children with asymptomatic FF and 191 controls (children with normal feet). The children and their parents completed the Paediatric Quality of Life Inventory (PedsQLTM 4.0). The objective foot characteristics included clinical foot posture measures, footprints, general hyperlaxity, and X-ray measurements. RESULTS Children with asymptomatic FF had a significantly lower QoL (overall and all four dimensions). The parents' assessment of the QoL of their children with asymptomatic FF in most cases was lower compared to their children's self-reported QoL. Moreover, almost all clinical foot measures also had significantly worse profiles among asymptomatic FF cases compared to the controls. This was observed with the Foot Posture Index-6 (FPI-6), the navicular drop (ND) test, the Chippaux-Smirak Index (CSI), Staheli's Index (SI), the Beighton scale, and radiological angles (except the talo-first metatarsal angle). CONCLUSION The findings suggest that asymptomatic FF not always reflects a normal foot development. This condition is related to decreased health-related quality of life, so the 5-10-year-old children's and their parents' complaints should be considered more closely in identification, treatment, and monitoring plans.
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Affiliation(s)
- Saidas Žukauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Vidmantas Barauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Ramunė Degliūtė-Muller
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Emilis Čekanauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Chen C, Jiang J, Fu S, Wang C, Su Y, Mei G, Xue J, Zou J, Li X, Shi Z. HyProCure for Pediatric Flexible Flatfoot: What Affects the Outcome. Front Pediatr 2022; 10:857458. [PMID: 35498774 PMCID: PMC9047858 DOI: 10.3389/fped.2022.857458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The high success rate, minimal invasion, and safety of subtalar arthroereisis (SA) have made it a primary mode of surgical management for pediatric flexible flatfoot. The HyProCure procedure is a new surgery for SA, However, very few available studies reported the therapeutic effects of the HyProCure procedure, especially in pediatric flexible flatfoot. The main aim of the present study was to investigate the clinical and radiological outcomes of the HyProCure procedure for pediatric flexible flatfoot and analyze the risk factors for therapeutic outcomes and sinus tarsi pain. METHODS In this retrospective cohort study, 69 pediatric flexible flatfoot patients (107 feet) who underwent the HyProCure procedure were included between July 2015 and September 2020. All patients underwent the HyProCure procedure with or without gastrocnemius recession. The Maryland foot score (MFS), visual analog scale (VAS), radiographic data, and complications were assessed at a minimum 1-year follow-up and statistically analyzed. RESULTS The mean follow-up was 35.9 months (range, 13-73 months). At the last follow-up, VAS (0.64 ± 1.16) was significantly lower than the preoperative VAS (4.06 ± 1.43) (p < 0.001); MFS (90.39 ± 12.10) was significantly higher than the preoperative MFS (71.36 ± 10.25) (p < 0.001). The AP talar-second metatarsal angle (T2MT angle) significantly decreased from 17.0 ± 5.4° preoperatively to 11.4 ± 5.2° at the last follow-up (p < 0.001). The lateral talar-first metatarsal angle (Meary's angle) significantly decreased from 13.8 ± 6.4° preoperatively to 6.3 ± 5.0° at the last follow-up (p < 0.001). The calcaneal declination angle (Pitch angle) significantly increased from 13.5 ± 4.9° preoperatively to 14.8 ± 4.4° at the last follow-up (p < 0.001). Logistic regression analysis indicated that patients with a longer distance from the tail end of the implant exceeding the longitudinal talar bisection line had 275.8% greater odds of MFS < 90. Yet, no risk factors were found in connection with sinus tarsi pain. CONCLUSIONS The HyProCure procedure for pediatric flexible flatfoot achieved satisfactory curative effects with a low complication rate; implant depth was associated with unsatisfactory postoperative outcome.
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Affiliation(s)
- Cheng Chen
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
| | - JianTao Jiang
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
| | - ShaoLing Fu
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
| | - Cheng Wang
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
| | - Yan Su
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
| | - GuoHua Mei
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
| | - JianFeng Xue
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
| | - Jian Zou
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
| | - XueQian Li
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
| | - ZhongMin Shi
- Foot & Ankle Section, Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, China
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