1
|
Galán-Olleros M, Del Baño Barragán L, Figueroa MJ, Prato de Lima CH, Fraga-Collarte M, Torres-Izquierdo B, Hosseinzadeh P, Martínez-Caballero I. Outcomes of the "Calcaneo-stop" procedure for treating symptomatic flexible flatfoot in children: A systematic review and meta-analysis of 2394 feet. Foot Ankle Surg 2024; 30:535-545. [PMID: 38714453 DOI: 10.1016/j.fas.2024.04.011] [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: 01/19/2024] [Revised: 03/23/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND This study evaluates the efficacy of the calcaneo-stop (C-Stop) procedure's effectiveness in treating symptomatic flexible flatfoot (FFF) in children. METHODS A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane databases to identify studies until 2023 on the outcomes of the C-Stop procedure in children with FFF. The risk of bias was assessed using MINORS criteria. RESULTS Of 85 studies screened, 20 involving 2394 feet from 1415 patients (mean age 11.2 ± 1.3 years) were included. Post-procedure, significant improvements were noted in pain reduction (93.5%), heel alignment (95.21%), and radiological measures, including reductions in Kite (7.32º), Meary (11.65º), Costa-Bartani angles (17.11º), talar declination (12.63º) and increase in Calcaneal Pitch Angle (5.92º). AOFAS scores increased by 22.32 points on average, with 94.83% reporting high satisfaction. Complication rate was low (7.8%). CONCLUSIONS The C-Stop procedure is effective for treating FFF in children, offering significant clinical, radiological, and functional improvements with high patient satisfaction and a low complication rate. LEVEL OF EVIDENCE Level IV, Systematic review of Level-IV studies.
Collapse
Affiliation(s)
- María Galán-Olleros
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Laura Del Baño Barragán
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - María Jesús Figueroa
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos H Prato de Lima
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Manuel Fraga-Collarte
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Beltran Torres-Izquierdo
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Pooya Hosseinzadeh
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ignacio Martínez-Caballero
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| |
Collapse
|
2
|
Zhu D, Cao LM. Letter to the Editor concerning: "Critical evaluation of the study on the use of UCBL foot orthosis with and without kinesio taping in juvenile athletes". INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06304-3. [PMID: 39225787 DOI: 10.1007/s00264-024-06304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Di Zhu
- Center for Rehabilitation Medicine, Department of Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Shangtang Road 158#, Hangzhou, Zhejiang, China
| | - Li-Ming Cao
- Center for Rehabilitation Medicine, Department of Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Shangtang Road 158#, Hangzhou, Zhejiang, China.
- Center for Rehabilitation Medicine, Department of Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Shangtang Road 158#, Hangzhou, Zhejiang, China.
| |
Collapse
|
3
|
Blackwood V, Jeans KA, Zide JR, Riccio AI. Effect of Body Mass Index on Pedobarographic and Patient-Reported Outcome Measures in Adolescent Flexible Flat Feet. J Pediatr Orthop 2024; 44:e732-e737. [PMID: 38708592 DOI: 10.1097/bpo.0000000000002720] [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: 05/07/2024]
Abstract
BACKGROUND Although adolescent flexible flatfoot deformity (FFD) is common, little is known regarding the effect of weight on associated symptomatology. This study uses pedobarography and patient-reported outcome measures (PROs) to determine if overweight adolescents with FFD have more severe alterations in dynamic plantar pressures than normal body mass index percentiles (wnBMI) with FFD and if such alterations correlate with pain and activity. METHODS A retrospective review of patients aged 10 to 18 years with nonsyndromic symptomatic FFD was performed. Overweight (BMI percentile ≥ 85%) patients were compared with wnBMI patients with regard to dynamic plantar pressure measures and PRO scores. Pedobarographic data were subdivided into regions: medial/lateral hindfoot and midfoot, and first, second, and third to fifth metatarsals. Plantar pressure variables were normalized to account for differences in foot size, body weight, and walking speed. Contact area (CA%), maximum force by body weight (MF%), and contact time as a percentage of the rollover process (CT%) were calculated. Two foot-specific PROs were assessed, including the Foot and Ankle Outcome Score and the Oxford Ankle Foot Measure for Children. RESULTS Of the 48 adolescents studied, 27 (56%) were overweight and 21 (44%) were wnBMI. After normalization of the data, overweight patients had significantly greater medial midfoot MF%, whereas CT% was increased across the medial and lateral midfoot and hindfoot regions. Correlations showed positive trends: as BMI percentile increases, so will CA and MF in the medial midfoot, as well as CT in the medial and lateral midfoot and hindfoot. Significant differences were seen between groups, with the overweight group reporting lower sports and recreation subscores than the wnBMI group. No significant differences were seen in the pain and disability subscores. CONCLUSIONS Although overweight adolescents with FFD exhibit greater forces and more time spent during the rollover process in the medial midfoot than normal-weight patients, they did not report worse pain or disability associated with their flat foot deformity. LEVEL OF EVIDENCE Therapeutic level 3.
Collapse
Affiliation(s)
| | | | - Jacob R Zide
- Scottish Rite for Children
- Baylor University Medical Center
| | - Anthony I Riccio
- Scottish Rite for Children
- The University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
4
|
Fadle AA, Khalifa AA, Bahy A, El-Gammal YT, Abubeih H, El-Adly W, Osman AE. Joint preservation surgery for correcting adolescents' spasmodic flatfoot deformity: early results from a specialized North African foot and ankle unit. INTERNATIONAL ORTHOPAEDICS 2024; 48:1543-1552. [PMID: 37861704 PMCID: PMC11076396 DOI: 10.1007/s00264-023-06011-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE We aimed to report early results of performing joint-preserving surgeries for managing spasmodic flatfoot deformity (SFFD) in adolescents. METHODS A prospective case series study including 24 patients (27 feet) diagnosed with idiopathic SFFD not responding to conservative management. After reassessment under anesthesia, surgical procedures included soft tissue releases (Achilles tendon (AT), peroneus brevis (PB), peroneus tertius (PT) (if present), and extensor digitorum longus (EDL)), bony osteotomies (lateral column lengthening (LCL), medial displacement calcaneal osteotomy (MDCO), and double calcaneal osteotomy (DCO)), and medial soft tissue reconstruction or augmentation if needed. Functional evaluation was performed per the American Orthopedic Foot and Ankle Society (AOFAS) score, while radiological parameters included talo-navicular coverage angle (TNCA), talo-first metatarsal angle (AP Meary's angle), calcaneal inclination angle (CIA), talo-calcaneal angle (TCA), talo-first metatarsal angle (Lat. Meary's angle), and tibio-calcaneal angle (TibCA). The preoperative parameters were compared to the last follow-up using the Wilcoxon signed test. RESULTS The mean age was 15.37 ± 3.4 years, 18 (75%) were boys, and the mean BMI was 28.52 ± 3.5 (kg/m2). Release of AT and fractional lengthening of PL, PT, and EDL were performed in all patients. LCL was needed in eight feet (29.6%), MDCO in 5 (18.5%), and DCO in 14 (51.9%). FDL transfer was required in 12 (44.4%) feet, and repair of the spring ligament in seven (25.9%). The mean operative time was 99.09 ± 15.67 min. All osteotomies were united after a mean of 2.3 ± 0.5 months. After a mean follow-up of 24.12 ± 8.88 months (12 and 36 months), the AOFAS improved from a preoperative mean of 43.89 ± 11.49 to a mean of 87.26 ± 9.92 (P < 0.001). All radiological parameters showed significant improvement, AP Meary's angle from a mean of 20.4 ± 5.3 to a mean of 9.2 ± 2.1, Lat. Meary's angle from - 15.67° ± 6.31 to - 5.63° ± 5.03, TNCA from - 26.48° ± 5.94 to 13.63° ± 4.36, CIA from 12.04° ± 2.63 to 16.11° ± 3.71, TibCA from - 14.04° ± 3.15 to - 9.37° ± 3.34, and TCA Lat. from 42.65° ± 10.68 to 25.60° ± 5.69 (P ≤ 0.001). One developed wound dehiscence (over an MDCO), managed with daily dressings and local antibiotics. Another one developed lateral foot pain after having LCL managed by metal removal. CONCLUSION Careful clinical and radiological evaluation for the correct diagnosis of SFFD is paramount. Joint-preserving bony osteotomies combined with selective soft tissue procedures resulted in acceptable functional and radiological outcomes in this young age group.
Collapse
Affiliation(s)
- Amr A Fadle
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
| | - Ahmed Bahy
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | | | - Hossam Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Wael El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed E Osman
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| |
Collapse
|
5
|
Xu Y, Zhu Y, Cao Y, Chen G, Xu X. Does the Sagittal Radiographic Morphology of Subtalar Joint Affect the Alignment of Foot? Orthop Surg 2024; 16:1269-1276. [PMID: 38618706 PMCID: PMC11144509 DOI: 10.1111/os.14054] [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: 12/28/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVES The etiology of flatfoot and cavus foot is multicausal and controversial. So far, no literature reports the relationship between the sagittal morphology of subtalar joint and the alignment of foot. The purpose of this study was to explore whether the subtalar alignment would influence the configuration of foot. METHODS From January 2017 to January 2020, we included 109 feet in the flatfoot group, 95 feet in the cavus group, and 104 feet in the control group in this retrospective comparative study. The Gissane angle and calcaneal posterior articular surface inclination angle represented the sagittal morphology of the subtalar joint. Meary's angle, calcaneal pitch angle, and talar pitch angle reflected the alignment of foot. They were measured in the weightbearing foot X-rays. The angles in different groups were compared via Mann-Whitney U test. We calculated the correlation between the sagittal alignment of subtalar joint and the alignment of foot using Spearman's correlation analysis. Interobserver and intraobserver reliability were calculated. RESULTS The Gissane angle, calcaneal posterior articular surface inclination angle, Meary's angle, talar pitch angle, and calcaneal pitch angle were significantly different in the three groups. The Gissane angle had an excellent correlation with the Meary's angle (r = 0.850, p < 0.0001), and the talar pitch angle (r = -0.825, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = 0.638, p < 0.0001). The calcaneal posterior articular surface inclination angle had an excellent correlation with the Meary's angle (r = -0.902, p < 0.001), and the talar pitch angle (r = 0.887, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = -0.702, p < 0.0001). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent. CONCLUSION A subtalar joint with a larger Gissane angle and a more horizontal calcaneal posterior articular surface angle tended to have a higher foot arch and vice versa. The inspiration from this study was that the deformities of flatfoot and cavus foot may relate to the subtalar deformity.
Collapse
Affiliation(s)
- Yang Xu
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yuan Zhu
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yong‐xing Cao
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Gang Chen
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Xiang‐yang Xu
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| |
Collapse
|
6
|
Raj V, Barik S, Kumar V. Analysis of risk factors for nonunion in pediatric lateral column lengthening' by Torrez et al. J Pediatr Orthop B 2024; 33:304. [PMID: 38874384 DOI: 10.1097/bpb.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Affiliation(s)
- Vikash Raj
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, Jharkhand
| | - Sitanshu Barik
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, Jharkhand
| | - Vishal Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Sharath HV, Rathi SG, Kolhe PD. The Effect of Foot Rehabilitation Protocol in Adults With Congenital Deformity of Foot: An Analytical Case Series. Cureus 2024; 16:e59102. [PMID: 38803723 PMCID: PMC11129531 DOI: 10.7759/cureus.59102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Congenital deformities of the foot significantly challenge the mobility and quality of life of affected individuals. While surgical interventions are common, rehabilitation protocols tailored to address the specific needs of adults with congenital foot deformities are less explored. This case series aims to evaluate the effectiveness of a specialized foot rehabilitation protocol in improving functional outcomes and quality of life in adults with congenital foot deformities. A series of cases involving adults diagnosed with congenital foot deformities were enrolled in a structured rehabilitation program. The protocol incorporated a combination of therapeutic exercises, manual therapy, gait training, and orthotic management tailored to individual needs. Outcome measures included functional assessments, gait analysis, pain levels, and patient-reported outcomes at baseline, midpoint, and endpoint of the rehabilitation program. Preliminary findings from the case series indicate significant improvements in various outcome measures following the foot rehabilitation protocol. Participants demonstrated enhanced gait parameters, reduced pain levels, increased range of motion, and improved functional capacity. Moreover, subjective assessments revealed enhanced satisfaction and perceived improvements in quality of life among participants. The findings suggest that a tailored foot rehabilitation protocol can be beneficial in improving functional outcomes and quality of life in adults with congenital foot deformities. This underscores the importance of integrating comprehensive rehabilitation strategies alongside surgical interventions to optimize long-term outcomes and enhance the overall well-being of individuals with congenital foot deformities. Further research with larger sample sizes and controlled study designs is warranted to validate these findings and establish evidence-based rehabilitation guidelines for this population.
Collapse
Affiliation(s)
- H V Sharath
- Department of Pediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, IND
| | - Siddhi G Rathi
- Department of Pediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, IND
| | - Pradhyum D Kolhe
- Department of Pediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, IND
| |
Collapse
|
8
|
Kolhe PD, Sharath HV, Rathi SG, Patil DS. Effect of Foot Rehabilitation Exercises for Painful Flat Foot in a 20-Year-Old Female: A Case Study Analysis. Cureus 2024; 16:e59377. [PMID: 38817516 PMCID: PMC11139060 DOI: 10.7759/cureus.59377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Pes planus, commonly referred to as flatfoot, is a congenital foot deformity characterized by the descent of the medial longitudinal arch, resulting in reduced spring action and increased stress on the foot during ambulation. This condition, opposite to pes cavus, typically lacks symptomatic presentation despite its structural abnormality. This case report discusses a 20-year-old female presenting to the musculoskeletal department of physiotherapy with impaired gait attributed to developmental flatfeet and an underdeveloped heel on one foot since birth. Apart from these foot deformities, no other significant abnormalities were noted upon examination. Orthotic management and ongoing monitoring have been initiated to facilitate functional independence. The prognosis for the patient's gait impairment remains optimistic with continued rehabilitation efforts aimed at dispelling misconceptions and barriers surrounding the correction of flatfoot deformities. This report underscores the importance of comprehensive rehabilitation strategies in managing flatfoot conditions to optimize patient outcomes and quality of life.
Collapse
Affiliation(s)
- Pradhyum D Kolhe
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe, Wardha, IND
| | - H V Sharath
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe, Wardha, IND
| | - Siddhi G Rathi
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe, Wardha, IND
| | - Deepali S Patil
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe, Wardha, IND
| |
Collapse
|
9
|
Wong C, Bjerge CY, Jurca A, Petersen MM, Boedtker S, Balslev-Clausen A, Harsted S. Protocol Article: A Cross-Sectional Evaluation of Children's Feet and Lower Extremities. Methods Protoc 2023; 6:115. [PMID: 38133135 PMCID: PMC10745981 DOI: 10.3390/mps6060115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The health of children's lower extremities and feet is a focus area for caregivers and healthcare professionals such as doctors, school nurses, and podiatrists. Our study aims to investigate the general health status of Danish children's lower extremities and feet to identify anthropometric parameters that might be preconditions for pain and evaluate for foot diseases and whether they are associated with pain intensity and location, three-dimensional foot dimensions and foot pressure mapping, shoe dimensions, types and intensity of sports activity, quality of life, and foot health. The aim is that we will be able to identify parameters pre-dispositioning for pain, thus providing recommendations for sports activities in relation to the anthropometric conditions of a child as a potential preventive measure for pain. This analysis will be stratified by socioeconomic status on a group level, and this perspective will be able to provide preventative recommendations to prevent pain. METHODS This study is a cross-sectional examination of a thousand children in the first, fifth, and ninth grades in randomized selected Danish primary schools. We will perform a clinical examination of the lower extremities and feet for misalignments, deformities, and diseases as well as rotational status and range of motion. Moreover, we will evaluate their pain levels, sports activities, three-dimensional foot dimensions, plantar pressure, footwear, and patient-related outcome measures (PROMs) for foot health and quality of life. RESULTS We aim to provide an anthropometrical overview of the lower extremities and feet in children. The obtained basic understanding of healthy normal material in children will be analyzed for its relationships with pain level, sports activities, and socioeconomic status on a group level. This could potentially provide us with an understanding of the factors that impact lower extremity and foot diseases in children. In conclusion, examining children's lower extremities and feet in Danish primary schools is a step toward identifying areas of improvement in self-care and shoe fitting, mapping podiatry-related needs of care in children's feet, and providing parental recommendations for preventive actions on shoe fitting and the choice and intensity of sports activity concerning pain. CONCLUSIONS The tenet of this study is a long-term follow-up to evaluate the long-term socioeconomic course on a group level, foot status, and sports activity, using patient-related outcome measures evaluating quality of life and other lifestyle factors such as emotional functioning, social functioning and interaction, and school functioning. Potentially, this will improve children's quality of life and prevent future diseases.
Collapse
Affiliation(s)
- Christian Wong
- Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Hvidovre, Denmark (A.B.-C.)
- Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;
| | | | - Ales Jurca
- Volumental AB, 118 72 Stockholm, Sweden;
- Jozef Stefan International Postgraduate School, 1000 Ljubljana, Slovenia
| | - Michael Mørk Petersen
- Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Soren Boedtker
- Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Hvidovre, Denmark (A.B.-C.)
| | - Andreas Balslev-Clausen
- Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Hvidovre, Denmark (A.B.-C.)
| | - Steen Harsted
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark;
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, 5500 Middelfart, Denmark
| |
Collapse
|
10
|
Pasquinelly A, Blood D, Elattar O, Hanna M. Optimal Sequence of Corrective Surgeries for Concomitant Valgus Knee and Rigid Pes Planus Deformities: The Knee-First Approach. Arthroplast Today 2023; 24:101265. [PMID: 38023651 PMCID: PMC10652122 DOI: 10.1016/j.artd.2023.101265] [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: 08/31/2023] [Revised: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
In patients requiring surgical correction of ipsilateral valgus knee and rigid pes planovalgus deformities, the optimal operative sequence is controversial. Growing evidence suggests these 2 deformities are related in etiology and interrelated in disease course. We present the case of a 72-year-old female with concomitant valgus knee and rigid pes planovalgus deformities successfully treated with total knee arthroplasty followed by triple arthrodesis and Achilles lengthening. Surgical correction of these deformities must be carefully planned between the operating surgeons to avoid over- or under-correction of alignment that could further impact gait. In contrast with the limited available literature, the authors recommend correction at the knee first and the foot and ankle second. Further prospective studies are needed to elucidate the best operative sequence in these patients.
Collapse
Affiliation(s)
- Adam Pasquinelly
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Dalton Blood
- Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Osama Elattar
- Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Maged Hanna
- Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| |
Collapse
|
11
|
Pourghazi F, Nabian MH, Bakht SS, Laripour R, Zoshk MY. Changes in gait pattern and quality of life of adolescents with flexible flat foot after Calcaneal Lengthening Osteotomy. Foot (Edinb) 2023; 57:101962. [PMID: 37865070 DOI: 10.1016/j.foot.2023.101962] [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: 11/08/2022] [Revised: 01/08/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Calcaneal Lengthening Osteotomy is a surgical technique to correct flexible flat foot deformities in patients who did not show any change in their symptoms after conservative treatment. In this study, the effects of CLO on the kinematic and kinetic changes of gait was analyzed and the clinical and quality of life improvements in children treated by CLO for moderate to severe symptomatic flexible flat foot deformities were assessed. METHODS Participants were seven adolescents (13 feet) with symptomatic FFF who underwent during 2019-2022 and seven (10 feet) healthy children as control group. Three items were evaluated in each foot before and after surgery including: 1. Clinical examination 2.quality of life (using Pediatric Quality of Life Inventory version 4 questionnaire) 3. Gait analysis (Vicon motion systems, Oxford metrics Inc., UK). Also, the kinetic and kinematic analysis between patients and healthy groups were compared. RESULTS Kinematic results of control was significantly better than FFF group. Ankle range of motion(32.94 ± 13.39 compared to 32.94 ± 13.39,P-Value:0.01),foot progression angle (-9.26 ± 7.67 compared to -16.07 ± 9.00,P-Value:0.01),and internal rotation of ankle was higher in control group compared to FFF. FFF patients demonstrated improvement in kinematic results after CLO surgery. Foot progression angle was improved after surgery (-11.31 ± 6.07 compared to -16.19 ± 7.06, P-value:0.00), maximum plantar flexion decreased after CLO surgery due to achil tendon procedure during CLO surgery. Kinetic results of FFF patients showed significant increase in ankle Power in coronal and transverse plane, Also knee and hip power showed similar results.Quality of life parameters showed significant improve in all parameters (Physical,Social, emotional and school function), Also ADKE and ADKF improved after surgery. CONCLUSION CLO surgery significantly improved patients' quality of life of patients with symptomatic FFF. Also, kinetic results showed improvement in some parameters of gait results after CLO surgery. Thus, our study suggested CLO surgery as an excellent surgical option for symptomatic FFF.
Collapse
Affiliation(s)
- Farzad Pourghazi
- Surgery and Trauma Research Center, AJA University of Medical Science, Iran
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-disciplinary Applied Research, Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Laripour
- Surgery and Trauma Research Center, AJA University of Medical Science, Iran
| | | |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Karatekin YS, Altinayak H, Karatekin Ş, Karadağ H, Usta E, Karaismailoğlu B, Seker A. Exploration of Flexible Pes Planus as a Potential Risk Factor for Cardiac Pathologies in Pediatric Cases. Cureus 2023; 15:e46139. [PMID: 37779679 PMCID: PMC10538805 DOI: 10.7759/cureus.46139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE The aim of this study is to investigate the relationship between flexible pes planus (FPP) and cardiac pathologies in pediatric patients, with a particular emphasis on hypermobility status. METHODS Between January and June 2022, a retrospective screening was conducted on a total of 68 patients aged between 6 and 18 years who had been diagnosed with FPP. Eight patients were excluded from the study due to suspicion of connective tissue or neuromuscular diseases following systemic examinations conducted by a pediatric specialist. The included 60 patients underwent comprehensive cardiac examinations conducted by pediatric cardiology specialists and were evaluated through echocardiography (ECHO) as part of the study. Simultaneously, a control group of healthy individuals aged 6 to 18, without a diagnosis of pes planus (PP), was selected from those who applied for health reports for the purpose of obtaining sports licenses. Patients diagnosed with FPP were compared to a control group in terms of the presence of cardiac pathology. Furthermore, the Beighton Hypermobility Scores (BHSs) of patients diagnosed with FPP were compared based on the presence of cardiac pathology. RESULTS A total of 60 patients (40 males, 20 females) diagnosed with FPP were included in the study, and a control group consisting of 453 healthy individuals (287 males, 166 females) was selected. The incidence of cardiac pathology in patients diagnosed with FPP (23.3%) was found to be significantly higher compared to the control group (7%) (p <0.01). The risk of cardiac pathology in patients diagnosed with FPP was determined to be four times higher compared to the control group (Odds ratio: 4 (1.993-8.046), p<0.01). Among patients with FPP, individuals who were found to have cardiac pathology had statistically significantly higher average BHSs compared to those without cardiac pathology (p: 0.043). CONCLUSIONS Our study suggested that there may be a significant relationship between FPP and high cardiac pathology risk in pediatric patients. We observed a significant increase in the incidence of cardiac pathologies among patients diagnosed with FPP. Additionally, the presence of higher hypermobility scores among patients diagnosed with FPP suggests a potential connection between the two. In the evaluation of FPP in the pediatric population, it should be considered as a potential risk factor for cardiac pathologies and its potential association with hypermobility.
Collapse
Affiliation(s)
| | - Harun Altinayak
- Orthopaedics and Traumatology, Samsun Training and Research Hospital, Samsun, TUR
| | - Şeyma Karatekin
- Pediatrics, Faculty of Medicine, Samsun University, Samsun, TUR
| | - Hüseyin Karadağ
- Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Emre Usta
- Pediatric Cardiology, Faculty of Medicine, Samsun University, Samsun, TUR
| | - Bedri Karaismailoğlu
- Orthopaedics and Traumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, TUR
| | - Ali Seker
- Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, TUR
| |
Collapse
|
14
|
Sakr SAH, Zayda AI, Mesregah MK, Abosalem AA. Tibialis anterior rerouting combined with calcaneal lengthening osteotomy as a single-stage reconstruction of symptomatic flexible flatfoot in children and adolescents. J Orthop Surg Res 2023; 18:429. [PMID: 37312166 PMCID: PMC10262376 DOI: 10.1186/s13018-023-03890-7] [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: 03/27/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Symptomatic flexible flatfoot in children and adolescents should be surgically managed only if conservative measures have failed. The aim of this study was to assess functional and radiological results of tibialis anterior rerouting combined with calcaneal lengthening osteotomy as s single-stage reconstruction of symptomatic flexible flatfoot. METHODS The current study was a prospective study of patients with symptomatic flexible flatfoot treated by single-stage reconstruction in the form of tibialis anterior tendon rerouting combined with calcaneal lengthening osteotomy. The American Orthopaedic Foot and Ankle Society score (AOFAS) was utilized to evaluate the functional outcomes. The evaluated radiological parameters included the standing anteroposterior (AP) and lateral talo-first metatarsal angle, talar head coverage angle, and calcaneal pitch angle. RESULTS The current study included 16 patients (28 feet) with a mean age of 11.6 ± 2.1 years. There was a statistically significant improvement in the mean AOFAS score from 51.6 ± 5.5 preoperatively to 85.3 ± 10.2 at final follow-up. Postoperatively, there was a statistically significant reduction in the mean AP talar head coverage angle from 13.6 ± 4.4° to 3.9 ± 3°, the mean AP talo-first metatarsal angle from 16.9 ± 4.4° to 4.5 ± 3.6°, and the mean lateral talo-first metatarsal angle from 19.2 ± 4.9° to 4.6 ± 3.2°, P < 0.001. Additionally, the mean calcaneal pitch angle increased significantly from 9.6 ± 1.9° to 23.8 ± 4.8°, P < 0.001. Superficial wound infection occurred in three feet and was treated adequately by dressing and antibiotics. CONCLUSION Symptomatic flexible flatfoot in children and adolescents can be treated with combined lateral column lengthening and tibialis anterior rerouting with satisfactory radiological and clinical outcomes. Level of evidence Level IV.
Collapse
Affiliation(s)
- Samy Abdel-Hady Sakr
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Ahmed Ibrahim Zayda
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt.
| | - Ahmed Abdelazim Abosalem
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| |
Collapse
|
15
|
Catanzano AA, Akoh CC, Easley ME, Mosca VS. Decision-Making and Management of Tarsal Coalition in the Young Adult Patient: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202306000-00010. [PMID: 37307332 DOI: 10.2106/jbjs.rvw.23.00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
» Tarsal coalitions most commonly affect the calcaneonavicular and talocalcaneal joints in up to 13% of the general population. They alter the mechanics of the subtalar joint, limiting inversion and eversion, and place excessive stress on neighboring joints causing pain, recurrent ankle sprains, and/or progressive pes planus during the adolescent growth spurt.» While many coalitions are identified on radiographs, advanced imaging with computed tomography or magnetic resonance imaging is sometimes required. These advanced imaging modalities also serve an essential role for surgical planning to quantify coalition involvement, identify fibrous or cartilaginous coalitions, and aid in determining the degree of deformity within the foot.» Surgical treatment is reserved for feet with persistent activity-related pain not relieved by prolonged attempts at nonoperative management, which include nonsteroidal anti-inflammatory drugs, shoe orthotics, and periods of non-weight-bearing in a cast. These conservative modalities may be successful in up to 85% of cases.» For adolescent patients, recent surgical options attempt to avoid arthrodesis and focus on coalition resection and interposition grafting with or without deformity correction. The ultimate decision is based on the location of the pain, the size and histology of the coalition, the health of the posterior subtalar facet, the degree of flatfoot deformity, and the presence of degenerative changes in the subtalar and/or adjacent joints.» While many studies focus on subtalar motion and gait kinematics, the critical outcomes remain pain relief and future need for arthrodesis, which may be related not only to resection of the coalition but assessment of deformity, including after the resection has been performed.
Collapse
Affiliation(s)
- Anthony A Catanzano
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina
| | - Craig C Akoh
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina
| | - Vincent S Mosca
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
16
|
Vergillos Luna M, Khal AA, Milliken KA, Solla F, Rampal V. Pediatric Flatfoot: Is There a Need for Surgical Referral? J Clin Med 2023; 12:jcm12113809. [PMID: 37298004 DOI: 10.3390/jcm12113809] [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: 03/20/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Pediatric foot deformities are a common finding, concerning up to 44% of preschool aged children. The absence of accepted international guidelines, as well as heterogeneity in definitions and measurements, makes management of pediatric flatfoot a challenge, and decisions surrounding specialized care referral confusing and biased. The objective of this narrative review is to provide guidance to primary care physicians treating these patients. A non-systematic review of the literature regarding the development, etiology, and clinical and radiographic assessment of flatfeet using the PubMed and Cochrane Library databases was performed. The exclusion criteria for the review were adult populations, papers detailing the outcome of a specific surgical procedure, and publications prior to 2001. The included articles showed great heterogeneity in definition and proposed management, which makes the study of pediatric flatfoot challenging. Flatfoot is a common finding in children under 10 years old, and should not be considered pathological unless stiffness or functional limitation are present. Surgical referral should be reserved to children with stiff or painful flatfoot, while simple observation is indicated for flexible, asymptomatic flatfeet.
Collapse
Affiliation(s)
- Manuel Vergillos Luna
- Department of Orthopedics, Regina Montis Regalis Hospital, 12084 Mondovì, Italy
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Adyb-Adrian Khal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Kara A Milliken
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Federico Solla
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Virginie Rampal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
- Laboratoire Motricité Humaine Expertise Sport Santé, Unité de Formation et Recherche Sciences et Techniques des Activités Physiques et Sportives, 06205 Nice, France
| |
Collapse
|
17
|
Yasin MS, Al-Labadi GM, Alshrouf MA, AlRaie BA, Ibrahim RA, AlRaie LA. Pediatric and Adolescent Flatfoot: A Questionnaire Based Middle East and North Africa Study. Int J Gen Med 2023; 16:2055-2061. [PMID: 37275331 PMCID: PMC10237185 DOI: 10.2147/ijgm.s400720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/07/2023] [Indexed: 06/07/2023] Open
Abstract
Background Flatfoot is commonly seen in the community and is a common cause of concern for parents because it could become symptomatic and lead to decreased quality of life. One of the most used management approaches is foot orthoses, although no clear evidence supports their use. We aimed to study flatfoot symptoms' prevalence, effect on activities of daily living, and the use and effectiveness of orthoses. Methodology This was a cross-sectional study that included five countries from the Middle East and North Africa region (Jordan, Palestine, Syria, Egypt, and Iraq). Data were collected using an online questionnaire directed toward parents of children aged 0 to 16 from September to December 2020. The demographic factors were expressed as frequencies (percentages) using standard descriptive statistical parameters, and Pearson's chi-square test was used to examine the relationship between study factors. Results 1256 participants were recruited using this online survey. The majority (29.6%) of children were diagnosed in the age group of 0 to 2. The abnormal appearance of the foot was the most common (78.7%) complaint. Overall, 54.2% of patients were prescribed orthoses, of which 36.8% noticed improvement in flatness and 37.6% reported relief of symptoms. Conclusion This study demonstrated that most participants have no or minimal symptoms and that there is a mismatch between participants' expectations and the actual effectiveness of orthoses. Taking into consideration that there is no clear evidence to support the corrective effect of orthoses, we recommend that physicians prescribing them adhere more to their proper indications and spend more time and effort counseling and addressing patients' and parents' concerns about this developmental stage.
Collapse
Affiliation(s)
- Mohamad S Yasin
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Ghayda’a M Al-Labadi
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Ali Alshrouf
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Bayan A AlRaie
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Raneem A Ibrahim
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| | - Lana A AlRaie
- Department of Special Surgery, Division of Orthopedics, The University of Jordan, Amman, 11942, Jordan
| |
Collapse
|
18
|
Blümel S, Stephan A, Stadelmann VA, Manner HM, Velasco R. Percutaneous minimal invasive Achilles tendon lengthening improves clinical and radiographic outcomes in severe flexible flatfeet with shortened triceps sureae complex in early childhood: A retrospective study. Foot Ankle Surg 2023; 29:158-164. [PMID: 36566121 DOI: 10.1016/j.fas.2022.12.009] [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: 08/02/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Severe flexible flatfeet with triceps surae complex shortening are prognostically unfavorable in early childhood and may compromise normal foot development. METHODS This retrospective, IRB-approved study included 20 children (38 feet) under 6 years with severe flexible flatfeet and triceps surae complex shortening. Treatment included minimally invasive percutaneous achilles tendon lengthening followed by a 4-week cast fixation and corrective orthotic therapy under talo-navicular reposition for at least 6-months. Preoperative weightbearing x-rays and at the last available follow-up included anteroposterior talus-first metatarsal angle and lateral talus pitch, Meary's and talocalcaneal angle and were compared to reference values. ROM, surgeon-rated clinical outcomes and complications/re-interventions were evaluated. RESULTS Age at surgery was 3.7 years (1.3-5.9 y) and follow-up time was 4.3 years (1.1-8.9 y). No complications occurred. Clinical outcome was good (68 %) to very good (26 %). Ratio of normal angles increased significantly for three angles. Dorsiflexion ROM improved from -5.0 ± 6.8° at baseline to 15.7 ± 7.6°. CONCLUSIONS With significant improvements in clinical and radiographic outcomes, minimal-invasive percutaneous Achilles tendon lengthening followed by orthotic therapy seems to be a valuable treatment option for selected preschool-aged patients with severe, flexible flatfeet with significantly shortened triceps surae. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Stefan Blümel
- Department of Pediatric Orthopaedics, Schulthess Klinik, Zürich, Switzerland.
| | - Anika Stephan
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland.
| | - Vincent A Stadelmann
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland.
| | - Hans M Manner
- Department of Pediatric Orthopaedics, Schulthess Klinik, Zürich, Switzerland.
| | - Rafael Velasco
- Department of Pediatric Orthopaedics, Schulthess Klinik, Zürich, Switzerland.
| |
Collapse
|
19
|
Sun N, Chen J, Chen Z, Zeng C, Guo H. Clinical Outcomes of Fusion in Type II Accessory Naviculars With or Without Asymptomatic Flatfeet. Foot Ankle Int 2023; 44:139-147. [PMID: 36564915 DOI: 10.1177/10711007221140847] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND Few studies have reported the clinical outcomes of fusion surgeries for type II accessory naviculars. Whether the combination of accessory naviculars and asymptomatic flatfoot will result in worse outcomes in accessory navicular surgeries remains to be elucidated. Our study aims to report the clinical outcomes of fusion for type II accessory naviculars and make a subgroup comparison among accessory navicular patients with or without asymptomatic flatfeet. METHODS From May 2017 to June 2021, all painful type II accessory naviculars with or without asymptomatic flatfeet in our inpatient center were reviewed, and those who only underwent fusion surgeries were included in the retrospective study. Visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores, Tegner activity level scores, complications, patient-reported satisfaction, and imaging results (Meary angle in the weightbearing lateral view, talo-first metatarsal angle and talonavicular coverage angle in the weightbearing anteroposterior view) were used to describe outcomes. RESULTS Thirty-two eligible patients responded to the latest follow-up request and were included in this study. The mean follow-up duration was 37.1 ± 16.0 months. The average VAS pain score improved from 4.7 ± 1.8 preoperatively to 0.9 ± 1.2 at the latest follow-up (P<.001). The average AOFAS midfoot score improved from 67.1 ± 8.5 preoperatively to 90.2 ± 10.7 at the latest follow-up (P<.001). The preoperative and postoperative Tegner activity level scores were similar (3.3 ± 1.5 vs 3.5 ± 1.6, P=.136). The overall complication rate was 37.5%. The most common complication was nonunion (31.3%). The overall satisfaction rate was 90.6%. Similar outcomes were observed between the flatfoot and the nonflatfoot subgroups. CONCLUSION Fusion for painful type II accessory naviculars resulted in good symptom relief, function improvement, and patient satisfaction at midterm follow-up, but the nonunion rate was relatively high. Fusion for painful type II accessory naviculars with or without asymptomatic mild to moderate flatfoot brought about similar clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Nian Sun
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
| | - Junjian Chen
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
| | - Zhuhong Chen
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
| | - Canjun Zeng
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
| | - Hao Guo
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
| |
Collapse
|
20
|
Impact of night orthotic managements on gastroc-soleus complex tightness in pediatric with flexible flatfoot: Systematic review. Prosthet Orthot Int 2023; 47:112-116. [PMID: 36791382 DOI: 10.1097/pxr.0000000000000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/14/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Equinus generally is linked to many foot and ankle pathologies. A reasonably convincing relationship was found between isolated gastrocnemius or Achilles contracture and the flatfoot deformity. Achilles' tightness in flatfoot children can lead to future pain and disability, which makes it more important than other types of flatfeet. Findings in the literature suggest stretching and orthotic management as a conservative treatment for this compound disorder. OBJECTIVE This review aimed to examine the impact of orthotic managements on gastroc-soleus complex tightness in pediatric with flexible flatfoot. STUDY DESIGN Systematic review. METHODS A systematic search of electronic databases (PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science) was performed to find relevant articles. The level of evidence and quality was identified using Downs and Black (1998). This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS Three hundred fifty-seven studies were found by searching electronic databases. After removing duplicate documents, 190 documents remained. Three other articles were identified from the screened of related references. During title/abstract screening, 193 studies were excluded and no study was selected for full consideration for the present review. CONCLUSIONS In conclusion, no study assessed the impact of orthotic management on gastroc-soleus complex tightness in children with flexible flatfoot. These devices have been proposed in spastic and nonspastic patients. Hence, researches that show whether these devices can be effective on gastrocnemius or Achilles tendon tightness in flatfoot children or not will be worthwhile.
Collapse
|
21
|
Aparisi Gómez MP, Bazzocchi A, Simoni P, Inarejos Clemente EJ. Postsurgical Evaluation of the Pediatric Foot and Ankle. Semin Musculoskelet Radiol 2022; 26:755-776. [PMID: 36791743 DOI: 10.1055/s-0042-1760244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This article reviews situations in which surgical treatment is required in the context of different types of pathology in the foot and ankle of children, focusing on the role of imaging in surgical planning and postsurgical assessment. The types of pathology analyzed from this perspective are congenital pathology, neuromuscular disorders, osteochondral lesions, fractures and infection, ligament injuries, and tumors.We address the most common pitfalls of postsurgical imaging of the ankle and foot in children. With some exceptions, postsurgical follow-up focuses on clinical assessment, with imaging follow-up only needed in patients where complications are suspected or symptoms recur. Postoperative assessment of the foot and ankle in children and adolescents requires knowing the indications for surgery and the most common types of interventions, along with their imaging characteristics. The radiologist needs to be aware of the normal sequence of development of structures and how to select adequate imaging techniques to assess anatomy at various stages or in different postsurgical scenarios.
Collapse
Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology. IMSKE, València, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Simoni
- Diagnostic Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | |
Collapse
|
22
|
Torrez TW, Kothari EA, Andrews N, Seidenstein AH, Strom S, McGwin G, Gilbert SR, Shah A, Doyle JS, Conklin MJ. Analysis of risk factors for nonunion in pediatric lateral column lengthening. J Pediatr Orthop B 2022:01202412-990000000-00057. [PMID: 36445378 DOI: 10.1097/bpb.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The lateral column lengthening procedure is a commonly used osteotomy for correction of pes planus performed by inserting a graft in the anterior aspect of the calcaneus through a transverse osteotomy. Though nonunion and calcaneo-cuboid subluxation have been previously reported, these complications have not been extensively studied in pediatric patients. After IRB approval, 111 patients (151 feet) who underwent lateral column lengthening at a single institution were identified. Fifty-three females (70 feet) and 58 males (81 feet) with an average age of 11.4 years (2.6 SD; range 5-17) were analyzed. The primary outcome was nonunion defined as a lack of radiographic evidence of osteotomy healing by 9 months. Underlying diagnosis, pre and postoperative radiographic measurements, age, operative technique, fixation, calcaneo-cuboid subluxation, graft material and concomitant procedures were analyzed for their relationship to nonunion. Nonunion occurred in 7 of 151 feet (4.6%). Patient age at the time of surgery and calcaneo-cuboid subluxation trended toward a significant association with nonunion ( P = 0.053, 0.054, respectively). The degree of surgical correction, as determined by radiographic analysis, and the use of calcaneo-cuboid fixation were not significantly associated with nonunion. None of the other factors evaluated were significantly associated with nonunion. There were three cases of postoperative infections (2.0%), two were superficial and 1 (0.7%) was deep. Thirty-five of 151 feet disclosed radiographic evidence of subluxation. Excluding subluxation, the overall complication rate was 8.6%. Nonunion occurred in 4.6% of pediatric feet undergoing lateral column lengthening. Fixation type was not significantly associated with nonunion. Older age at the time of surgery and calcaneocuboid subluxation trended towards significance. The placement of a calcaneo-cuboid pin was not found to be a significant factor in preventing calcaneo-cuboid subluxation or nonunion.
Collapse
Affiliation(s)
- Timothy W Torrez
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Ezan A Kothari
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicholas Andrews
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | | | - Shane Strom
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald McGwin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shawn R Gilbert
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - John S Doyle
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J Conklin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
23
|
Li J, Yang Z, Rai S, Li X, Jiang G, Pan X, Tang X. Effect of Insoles Treatment on School-Age Children with Symptomatic Flexible Flatfoot: A 2-Year Follow-Up Study. Indian J Orthop 2022; 56:1985-1991. [PMID: 36310549 PMCID: PMC9561439 DOI: 10.1007/s43465-022-00698-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 07/02/2022] [Indexed: 02/04/2023]
Abstract
Background Flatfoot is common among children. Symptomatic flexible flatfoot is one of the various types which needs treatment. Wearing insoles is considered one of the conservative therapies, but its effects are still uncertain. This study aims to provide evidence for the efficacy of insoles treatment among school-aged children with symptomatic flexible flatfoot. Methods Patient who were Children who were diagnosed with symptomatic flexible flatfoot and received insoles treatment in authors' institute were retrospectively included. Their ages, body mass index, pain positions, pain frequency, valgus angle, arch index and visual analogue scale (VAS) score were collected before and after insole treatment. Results A total of 32 children were included in this study. The results showed that wearing insoles for 2 years caused a significant improvement in pain frequency, valgus angle, arch index and VAS score. Conclusions This study indicated that pediatric symptomatic flexible flatfoot could be relieved by wearing insoles for 2 years. Insole treatment might be a workable option for pediatric symptomatic flexible flatfoot in children older than 6 years old.
Collapse
Affiliation(s)
- Jin Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Zimo Yang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, National Academy of Medical Sciences, Mahankal, Kathmandu, 44600 Nepal
| | - Xiangrui Li
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Guoyong Jiang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Xiaofei Pan
- Shafeile Rehabilitation Devices Co Ltd, Wuhan, 430000 China
| | - Xin Tang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| |
Collapse
|
24
|
Zairi M, Msakni A, Mohseni AA, Othmen A, Mensia K, Saied W, Bouchoucha S, Boussetta R, Nessib MN. Calcaneal lengthening osteotomy in the management of idiopathic flatfoot in children: cCase series of twenty-one feet. Int J Surg Case Rep 2022; 99:107634. [PMID: 36099766 PMCID: PMC9568701 DOI: 10.1016/j.ijscr.2022.107634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Flatfoot is a frequent reason for consultation in pediatric orthopedics. The calcaneal lengthening osteotomy according to the EVANS technique is a therapeutic alternative. The objective of this work was to evaluate the short and medium term clinical and radiological results of calcaneal lengthening osteotomy in children with idiopathic flat foot valgus. Methods This study concerned 12 children and 15 ft treated surgically by calcaneal lengthening osteotomy by an orthopedic surgeon in a pediatric orthopedic surgery center. The evaluation of the results was clinical according AOFAS score and radiological. Results The deformity was reducible in all of our patients. The mean preoperative AOFAS score was 61, postoperatively 90. The overall result was excellent in 11 cases (11 ft) and good in 4 cases. The postoperative radiological result was close to normal values. Conclusion Calcaneal lengthening osteotomy is a reliable and recommended technique for the correction of symptomatic idiopathic flatfoot. Level of evidence: IV, Case series. Flatfoot is a frequent reason for consultation in pediatric orthopedics. Orthopedic management was recommended up to 9 years old. Knowing how to choose the feet to be operated on is important. Calcaneal lengthening osteotomy is a reliable and recommended technique for the correction of symptomatic idiopathic flatfoot.
Collapse
|
25
|
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.
Collapse
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
| | | |
Collapse
|
26
|
Bouchard M, Ross TD. Bony Procedures for Correction of the Flexible Pediatric Flatfoot Deformity. Foot Ankle Clin 2021; 26:915-939. [PMID: 34752244 DOI: 10.1016/j.fcl.2021.09.001] [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] [Indexed: 02/02/2023]
Abstract
The pediatric flexible flatfoot is a common foot shape that is most often asymptomatic and may be a physiologic variant of normal. Surgery is only indicated when nonoperative interventions have failed to resolve symptoms. The goal of surgery is to alleviate symptoms by improving hindfoot alignment and restoring the medial arch while preserving joint mobility. This article focuses on the common bony techniques for surgical correction of the pediatric flexible flatfoot that has failed nonoperative management, including calcaneal, midfoot, and supramalleolar osteotomies and distal tibial hemiepiphyseodesis.
Collapse
Affiliation(s)
- Maryse Bouchard
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada; Division of Orthopaedic Surgery, The University of Toronto, Toronto, Canada.
| | - Tayler Declan Ross
- Division of Orthopaedic Surgery, The University of Toronto, 500 University Avenue #602, Toronto, Ontario M5G 1V7, Canada
| |
Collapse
|
27
|
Attia E, Heldt B, Roepe IG, Shenava VR, Hill JF. Does the stabilization of the calcaneocuboid joint with Steinmann pin in Evans osteotomy affect its incidence of arthritis? Foot (Edinb) 2021; 49:101846. [PMID: 34560432 DOI: 10.1016/j.foot.2021.101846] [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: 10/29/2020] [Revised: 05/29/2021] [Accepted: 06/24/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to determine the effect of retaining a Steinmann pin in the calcaneocuboid joint on its rates of arthritis following Evans calcaneal osteotomy lengthening procedure. The study hypothesized that leaving the pin across the calcaneocuboid joint post-operatively would lead to higher rates of arthritis. METHODS This is a retrospective review of patients under 18 years of age who underwent Evans osteotomy at our hospital from January 2015 to May 2020. The Patients were stratified into 2 groups: Group 1 (pin was left post-operatively across the joint and removed on follow-up) and Group 2 (pin was removed during surgery). Demographic data were recorded, including age, sex, and body mass index. Calcaneocuboid arthritis was determined by radiographic imaging at least one-year follow-up. Time to pin removal, size of the pin and graft, and subluxation were analyzed as possible risk factors for arthritis. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were estimated. RESULTS 39 patients were included in the study: 24 patients had the pin removed post-operatively, and 15 had the pin removed intra-operatively. There were no significant differences between the 2 groups regarding body mass index, age, sex, or laterality. Calcaneocuboid arthritis rates were significantly higher in the Group 1 than Group 2 (12(50%) vs. 2(13.3%), respectively; p = 0.02). On multivariate regression, both age (OR, 1.305 [95%CI: 1.009-1.696]; p = 0.044) and leaving the pin in the joint postoperatively (OR, 7.661 [95%CI: 1.208-48.570]; p = 0.031) were found as risk factors for arthritis at follow-up. The mean time to pin removal, the size of the pin, and the size of the graft were not found to be significant predictors of arthritis (p > 0.05). CONCLUSIONS This study shows that leaving the Steinmann pin in the calcaneocuboid joint in children post-operatively is associated with an increased risk of developing early radiographic signs of calcaneocuboid joint arthritis.
Collapse
Affiliation(s)
- Elsayed Attia
- Texas Children's Hospital, Department of Orthopedic Surgery, 6701 Fannin Street, Houston, TX, 77030, USA; Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Brett Heldt
- Texas Children's Hospital, Department of Orthopedic Surgery, 6701 Fannin Street, Houston, TX, 77030, USA; Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Isaiah G Roepe
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Vinitha R Shenava
- Texas Children's Hospital, Department of Orthopedic Surgery, 6701 Fannin Street, Houston, TX, 77030, USA; Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Jaclyn F Hill
- Texas Children's Hospital, Department of Orthopedic Surgery, 6701 Fannin Street, Houston, TX, 77030, USA; Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| |
Collapse
|
28
|
De Pellegrin M, Moharamzadeh D. Subtalar Arthroereisis for Surgical Treatment of Flexible Flatfoot. Foot Ankle Clin 2021; 26:765-805. [PMID: 34752238 DOI: 10.1016/j.fcl.2021.07.007] [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] [Indexed: 02/02/2023]
Abstract
Various surgical techniques are known for the treatment of flexible flatfoot in children after failure of nonsurgical attempts. Data collected in a review of the last 10-year period (2010-2020) show that among the 691 feet undergoing subtalar arthroereisis with endorthesis, average age at surgery was 11.40 years and in the 1856 feet that underwent subtalar arthroereisis with calcaneo-stop 11.69 years, while the complications rate was 9.00% and 6.38%, respectively. These data confirm that subtalar arthroereisis with calcaneo-stop may have an advantage over subtalar arthroereisis with endorthesis as the screw is not placed across the subtalar joint but instead into the calcaneus.
Collapse
Affiliation(s)
- Maurizio De Pellegrin
- Pediatric Orthopedic and Traumatology Unit, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy
| | - Désirée Moharamzadeh
- Orthopedic and Traumatology Unit, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy.
| |
Collapse
|
29
|
Lai CC, Wang TM, Chang CH, Pao JL, Fang HW, Chang CC, Lin SM, Lan TY. Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents. BMC Musculoskelet Disord 2021; 22:977. [PMID: 34814872 PMCID: PMC8609868 DOI: 10.1186/s12891-021-04855-9] [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: 08/13/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. Methods We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites. Results The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001). Conclusions Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.
Collapse
Affiliation(s)
- Chien-Cheng Lai
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Chien Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Shang-Ming Lin
- Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Tsung-Yu Lan
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan. .,Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan.
| |
Collapse
|
30
|
Wang S, Yu J, Helili M, Zhang C, Huang J, Wang X, Chen L, Ma X. Biomechanical assessment of two types and two different locations of subtalar arthroereisis implants for flexible flatfoot: A cadaveric study. Clin Biomech (Bristol, Avon) 2021; 89:105475. [PMID: 34525448 DOI: 10.1016/j.clinbiomech.2021.105475] [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: 11/09/2020] [Revised: 07/30/2021] [Accepted: 08/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Subtalar arthroereisis refers to the implantation of a sinus tarsi implant for the treatment of flexible flatfoot. The purpose of this study was to compare the ability to correct the flatfoot deformity and contact pressure of the posterior subtalar joint between two types of self-locking wedge implants and between two different positions for the same device in a cadaveric flatfoot model. METHODS The flatfoot model was created in ten cadaver feet through ligament sectioning and cyclic loading. Three kinds of arthroereisis procedures were evaluated: Talar-Fit (type I self-locking wedge implant) anchored in the sinus portion of the tarsal sinus (T-sinus group), Talar-Fit in the canalis portion (T-canalis group), and HyProCure (type II) in the canalis portion (H group). Corrective ability in the sagittal and transverse planes were measured with clinometers. Contact pressure was measured with pressure-sensitive films. FINDINGS T-canalis group provided more sagittal (mean difference for size 10 mm: 1.9°, P = 0.014; mean difference for size 11 mm: 3.1°, P = 0.037) and transverse (mean difference for size 8 mm: 1.8°, P = 0.049; mean difference for size 11 mm: 2.2°, P = 0.049) corrections than T-sinus group. The flattening process shifted the peak pressure of the posterior subtalar joint to the posteromedial side (P < 0.05) and arthroereisis helped the distribution of contact pressure restore uniformity (all P > 0.05). INTERPRETATION A self-locking wedge implant inserted in the canalis portion of the tarsal sinus achieved better correction than an implant inserted in the sinus portion.
Collapse
Affiliation(s)
- Sen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Jian Yu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Maimaitirexiati Helili
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Li Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Department of Orthopedics, Huashan Hospital North, Fudan University, 108 Luxiang Road, Shanghai 200040, China.
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China.
| |
Collapse
|
31
|
Pavone V, Testa G, Vescio A, Wirth T, Andreacchio A, Accadbled F, Canavese F. Diagnosis and treatment of flexible flatfoot: results of 2019 flexible flatfoot survey from the European Paediatric Orthopedic Society. J Pediatr Orthop B 2021; 30:450-457. [PMID: 33399292 DOI: 10.1097/bpb.0000000000000849] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of the study was to evaluate flexible flatfoot (FFF) diagnostic and current therapeutic modalities, as well as treatment expectations, among members of the European Paediatric Orthopaedic Society (EPOS). A 59-questions survey on FFF diagnosis and treatment preferences was distributed to EPOS members. The survey consisted of six sections (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; and (6) management options. Descriptive statistics were performed. A total of 93 responses were analysed. In general, clinical parameters, age (91.4% of cases), laxity (81.7%), diffuse pain (84.9%), and pain at the ankle joint (81.7%) were rated as 'average' and 'crucial importance' by the vast majority of respondents. Meary's angle (47.3% of cases), talonavicular coverage (35.5%), and lateral talocalcaneal angle (35.5%) were assessed as main radiological tools in the FFF evaluation. Among respondents, 61.3% rated 'improved ability to walk longer without symptoms' as of 'crucial importance'. Eighty-two percent of the respondents felt less than 10% of patients with FFF are candidates for corrective surgery. Arthroereisis (29.3%) was the most common surgical procedure (16.4% for subtalar and 12.9% for extra-articular arthroereisis, respectively), followed by lateral column lengthening (17.9%) and medializing calcaneal osteotomy (12.3%). There is great variation among respondents in diagnostic and treatment preferences in the management of children with FFF. The results of the EPOS 2019 FFF survey clearly show that large-scale, multicentric, international studies are necessary to elucidate which diagnostic and treatment practices lead to the best outcomes.
Collapse
Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Thomas Wirth
- Orthopaedic Department, Olgahospital, Stuttgart, Germany
| | - Antonio Andreacchio
- Department of Pediatric Orthopedic Surgery, "V. Buzzi" Children Hospital, Milan, Italy
| | - Franck Accadbled
- Department of Orthopaedics, Children's Hospital, Toulouse University Hospital, Toulouse
| | - Federico Canavese
- Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand, France
| |
Collapse
|
32
|
Sapogovskiy A, Hassanein MY, Kenis V. Lateral Column Lengthening Revisited: A Simple Intraoperative Approach to Ensure a True Extra-Articular Osteotomy. J Foot Ankle Surg 2021; 59:1318-1321. [PMID: 32828629 DOI: 10.1053/j.jfas.2020.02.007] [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: 01/05/2020] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 02/03/2023]
Abstract
Lateral column lengthening is a common method for treatment of patients with symptomatic flat feet. Although variations of the technique have been described by many authors, there is a lack of agreement about the exact location of the osteotomy. Most authors tried to find the interval between the anterior and middle talocalcaneal facets but did not offer a reproducible method to achieve this purpose. The use of a plantarflexion anteroposterior view of the foot provides better visualization of the anatomic landmarks and helps to precisely perform the osteotomy anterior to the sustentaculum tali, with protection of the anterior and middle talocalcaneal facets.
Collapse
Affiliation(s)
- Andrey Sapogovskiy
- Orthopedic Surgeon, Department of Foot and Ankle Surgery, Neuroorthopaedics and Skeletal Dysplasias, H. Turner National Medical Research Center for Сhildren's Orthopedics and Trauma Surgery, Saint-Petersburg, Russia.
| | - Mohamed Y Hassanein
- Orthopedic Surgeon, Department of Orthopaedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt.
| | - Vladimir Kenis
- Professor, Department of Foot and Ankle Surgery, Neuroorthopaedics and Skeletal Dysplasias, H. Turner National Medical Research Center for Сhildren's Orthopedics and Trauma Surgery, Saint-Petersburg, Russia
| |
Collapse
|
33
|
The outcomes of subtalar arthroereisis in pes planus: a systemic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141:761-773. [PMID: 32377845 DOI: 10.1007/s00402-020-03458-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Subtalar arthroereisis has been increasingly accepted as a solution to manage symptomatic pes planus. However, despite the recent developments related to arthroereisis, no other published literature has aimed to review the outcomes in paediatric patients since 2010. This systematic review and meta-analysis, therefore, aims to evaluate the current outcomes of subtalar arthroereisis in the treatment of symptomatic pes planus among the paediatric population. MATERIALS AND METHODS The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reported on the clinical outcomes of subtalar arthroereisis in children aged 21 or younger were included. RESULTS A total of 17 publications were included, with 1536 feet. The average duration of follow-up of the studies included in the review is 43.52 months. The studies consistently reported improvement in the radiological outcomes, approximating that of a normal population. Subtalar arthroereisis has shown to restore the collapsed medial longitudinal arch, supported by the decrease in Meary's angle to 5.267° (95% CI: 4.695°-5.839°, normal: 0°-10.0°) post-operatively and an increased calcaneal pitch of 15.70° (95% CI: 15.41°-15.99°, normal 18.0°-20.0°). Deformities associated with pes planus such as heel valgus was also significantly reduced, evident by the post-operative lateral talocalcaneal angle of 27.19° (95% CI: 26.44°-27.93°, normal: 25.0°-45.0°) and a post-operative Kite's angle of 18.13° (95% CI: 17.73°-18.52°, normal: 15.0°-30.0°). Subjectively, subtalar arthroereisis has generally resulted in an improvement in the grading of outcomes postoperatively from the patient's point of view. CONCLUSIONS Subtalar arthroereisis could serve as a procedure to correct radiological abnormalities, as well as relieve pain in selected patients with symptomatic pes planus.
Collapse
|
34
|
Tahririan MA, Ramtin S, Taheri P. Functional and radiographic comparison of subtalar arthroereisis and lateral calcaneal lengthening in the surgical treatment of flexible flatfoot in children. INTERNATIONAL ORTHOPAEDICS 2021; 45:2291-2298. [PMID: 33796883 DOI: 10.1007/s00264-020-04899-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE One of the most widespread diseases of children's orthopaedic problems is flatfoot. If conservative therapy failed, surgical treatment would be indicated. Lateral calcaneal lengthening (LCL) and subtalar arthroereisis (SA) are two types of operations used to correct symptomatic flexible flatfoot (FFF). The purpose of this study is to compare the functional and radiographic features of these two surgical procedures. PATIENTS AND METHODS In this prospective randomized clinical trial study, we recruited 66 patients between 2018 and 2019. For clinical assessment, American Orthopedics Foot and Ankle Society (AOFAS), visual analog scale (VAS), subtalar motion, presence of medial longitudinal arch, and family satisfaction were measured. Evaluation of radiographic angles was based on AP (AP Tal-1Met) and Lat (Lat Tal-1Met) view of Talus-1st metatarsal angle (Meary's angle) and calcaneal pitch. RESULT There was no significant difference between the two types of surgery regarding Lat Tal-1Met and AP Tal-1Met. The significantly larger angle in the LCL group was calcaneal pitch (P value < 0.001). AOFAS significantly increased from 68.71 ± 5.70 to 87.87 ± 7.14 (P value < 0.001) and from 67.28 ± 6.01 to 86.14 ± 7.56 (P value < 0.001) in LCL and SA respectively. Family satisfaction was significantly higher in the SA (8.14 ± 0.97) comparing to LCL (7.29 ± 0.86) at the latest follow-up (P value < 0.001). CONCLUSION While both groups have substantial improvement in clinical and radiographic aspects, the SA technique is less-invasive, rapid symptom relief, and has early weight-bearing capacity. TRIAL REGISTRATION IRCT20180823040853N1.
Collapse
Affiliation(s)
- Mohammad Ali Tahririan
- Department of Orthopedics, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sina Ramtin
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pegah Taheri
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
35
|
Smith C, Zaidi R, Bhamra J, Bridgens A, Wek C, Kokkinakis M. Subtalar arthroereisis for the treatment of the symptomatic paediatric flexible pes planus: a systematic review. EFORT Open Rev 2021; 6:118-129. [PMID: 33828855 PMCID: PMC8022013 DOI: 10.1302/2058-5241.6.200076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Subtalar arthroereisis has a controversial history and has previously been associated with high failure rates and excessive complications.A database search for outcomes of arthroereisis for the treatment of symptomatic paediatric flexible pes planus provided 24 articles which were included in this review, with a total of 2550 feet operated on.Post-operative patient-reported outcome measures recorded marked improvement. Patient satisfaction was reported as excellent in 79.9%, and poor in 5.3%. All radiological measurements demonstrated improvement towards the normal range following arthroereisis, as did hindfoot valgus, supination, dorsiflexion and Viladot grade.Complications were reported in 7.1% of cases, with a reoperation rate of 3.1%.Arthroereisis as a treatment for symptomatic paediatric flexible pes planus produces favourable outcomes and high patient satisfaction rates with a reasonable risk profile. There is still a great deal of negativity and literature highlighting the complications and failures of arthroereisis, especially for older implants.The biggest flaws in the collective literature are the lack of high-quality prospective studies, a paucity of long-term data and the heterogeneity of utilized outcome measures between studies. Cite this article: EFORT Open Rev 2021;6:118-129. DOI: 10.1302/2058-5241.6.200076.
Collapse
Affiliation(s)
| | - Razi Zaidi
- Guys and St Thomas NHS Foundation Trust, London, UK
| | | | - Anna Bridgens
- Evelina Children’s Hospital, Westminster Bridge Road, London, UK
| | - Caesar Wek
- Guys and St Thomas NHS Foundation Trust, London, UK
| | | |
Collapse
|
36
|
Long-term results of subtalar arthroereisis for the treatment of symptomatic flexible flatfoot in children: an average fifteen year follow-up study. INTERNATIONAL ORTHOPAEDICS 2021; 45:657-664. [PMID: 33443598 DOI: 10.1007/s00264-020-04911-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/11/2020] [Indexed: 01/12/2023]
Abstract
AIM OF THE STUDY The aim of this study is to report the long-term outcomes of a homogenous series of patients who underwent subtalar arthroereisis (STA) for the treatment of symptomatic flexible flatfoot (FFF). METHODS Thirty-four pediatric patients who underwent STA with a bioabsorbable implant were enrolled and radiographic measurements, clinical outcomes, and patients' satisfaction were evaluated. RESULTS At a mean 180 months follow-up, radiographic measurements showed significant improvement. A physiological footprint and a proper hindfoot alignment were shown in more than 70% of patients. Mean AOFAS score was 90.4 ± 9.2 (72-100), mean SF-12 was 44.7 with 30 out of 34 patients (88.2%) satisfied with the procedure. CONCLUSION STA with a bioabsorbable implant showed satisfactory long-term results. Based on the data subgroup analysis, nine to 11.5 years for female and nine to 13.5 years for male appeared to be the most appropriate age for surgery.
Collapse
|
37
|
Li B, He W, Yu G, Zhou H, Xia J, Zhao Y, Zhu H, Yu T, Yang Y. Treatment for Flexible Flatfoot in Children With Subtalar Arthroereisis and Soft Tissue Procedures. Front Pediatr 2021; 9:656178. [PMID: 34095026 PMCID: PMC8175848 DOI: 10.3389/fped.2021.656178] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Children with flexible flatfoot is common in clinics and there is no unified conclusion on surgical treatment. And for some patients with severe deformities, the correction of the subtalar joint arthroereisis combine the release of the Achilles tendon or gastrocnemius muscle release is still not satisfactory. The main aim of the present study was to investigate the therapeutic outcomes of subtalar arthroereisis combined with Achilles tendon or gastrocnemius recession and medial soft tissue (spring ligament, talonavicular joint capsule, tibionavicular ligaments and tibiospring ligaments) tightening for treating flexible flatfoot with severe deformities. Methods: Thirty patients (32 feet) with pediatric flexible flatfoot who underwent subtalar arthroereisis and soft tissue procedures during January 2016 to January 2018. There were 18 males (20 feet) and 12 females (12 feet) with an average age of 9.5 years (range, 8-12 years). We used the AOFAS scores and VAS scores combined with angles measure to evaluate the pre-operative and post-operative status. Results: Thirty patients (32 feet) were followed up for 25.3 months on average (range, 18-36 months). There was no infection. Post-operative foot pain, arch collapse, and other symptoms improved. At last follow-up, the Meary angle was decreased from 17.5° ± 4.4° to 4.1° ± 1.2° (P < 0.05), the talar-first metatarsal (AP) was decreased from 15.3° ± 3.1° to 4.8° ± 1.3°(P < 0.05), The mean AOFAS score was rose from 66.6 ± 5.8 to 88.6 ± 7.9 (P < 0.05), the mean VAS score was decreased from 6.6 ± 0.6 to 1.7 ± 0.3 (P < 0.05). Conclusion: The subtalar arthroereisis combined with soft tissue procedures can effectively correct flexible flatfoot in children and it is a significant method for severe forefoot abduction reconstruction. Level of Evidence: IV.
Collapse
Affiliation(s)
- Bing Li
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenbao He
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guangrong Yu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haichao Zhou
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiang Xia
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Youguang Zhao
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Zhu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Yu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunfeng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
38
|
The diagnosis and management of common childhood orthopedic disorders: An update. Curr Probl Pediatr Adolesc Health Care 2020; 50:100884. [PMID: 33069588 DOI: 10.1016/j.cppeds.2020.100884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Musculoskeletal illness represents a significant portion of office visits to primary and urgent care clinicians. Despite this, little emphasis is placed on learning pediatric orthopaedics during medical school or residency. The focus of this paper is to provide a systematic approach to this general musculoskeletal physical exam and to assist in the recognition of what conditions are normal development and what conditions require observation, workup and referral to an experienced pediatric orthopaedist.
Collapse
|
39
|
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.
Collapse
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
| | | |
Collapse
|
40
|
Braito M, Radlwimmer M, Dammerer D, Hofer-Picout P, Wansch J, Biedermann R. Tarsometatarsal bone remodelling after subtalar arthroereisis. J Child Orthop 2020; 14:221-229. [PMID: 32582390 PMCID: PMC7302416 DOI: 10.1302/1863-2548.14.190190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Subtalar arthroereisis has been described for the treatment of flexible juvenile flatfoot. However, the mechanism responsible for deformity correction has not yet been investigated adequately. The aim of this study was to document the effect of subtalar arthroereisis on the tarsometatarsal bone morphology. METHODS We retrospectively reviewed the clinical and radiological data of 26 patients (45 feet) with juvenile flexible flatfoot deformity treated by subtalar arthroereisis at our department between 2000 and 2018. Radiological evaluation included angular measurements of tarsometatarsal bone morphology as well as hindfoot and midfoot alignment. Mean radiographic follow-up was 19.4 months (sd 8.8; 12 to 41). RESULTS A significant change of angular measurements of tarsometatarsal bone morphology was found after subtalar arthroereisis (p < 0.001). While there was an increase of the distal medial cuneiform angle (DMCA) and the medial cuneo-first metatarsal angle on the anteroposterior view, a decrease of the naviculo-medial cuneiform angle and the medial cuneo-first metatarsal angle was seen on the lateral view. Furthermore, we found significant improvements of all hindfoot and midfoot alignment parameters except the lateral tibio-calcaneal angle and the calcaneal pitch angle (p < 0.001). CONCLUSION Our data support the theory of tarsometatarsal bone remodelling, which may contribute to the effect of subtalar arthroereisis for the treatment of flexible juvenile flatfoot. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Matthias Braito
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria
| | - Maria Radlwimmer
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria
| | | | - Jürgen Wansch
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria
| | - Rainer Biedermann
- Department of Orthopedic Surgery, Medical University of Innsbruck, Austria,Correspondence should be sent to Rainer Biedermann, Department of Orthopedics, Medical University of Innsbruck, Austria, Anichstraße 35, A-6020 Innsbruck, Austria. E-Mail:
| |
Collapse
|
41
|
Foot and Ankle Musculoskeletal Imaging of Pediatric Patients With Cerebral Palsy. AJR Am J Roentgenol 2020; 214:1389-1397. [PMID: 32228327 DOI: 10.2214/ajr.19.22354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Any combination of abnormal positioning of the ankle, hindfoot, midfoot, and forefoot is possible in the context of cerebral palsy, but some patterns are more common than others. The purpose of this article is to discuss the radiographic manifestations and surgical management of the following common conditions: equinus, equinoplanovalgus, equinocavovarus, vertical talus, oblique talus, hallux valgus, and ankle valgus. CONCLUSION. CP is defined by abnormalities of the developing fetal or infant brain that result in permanent central motor dysfunction. Foot and ankle deformities are very common in the patients with CP, occurring in up to 93% of such patients as a result of underlying abnormal muscle tone, impaired motor control, and dynamic muscle imbalance. Radiologists must develop knowledge of the most common changes in alignment and basic techniques for correction to better recognize abnormalities and improve communication with orthopedic colleagues.
Collapse
|
42
|
Rabenhorst BM, Blasier RD. An Assessment of International Classification of Diseases, 10th Revision, Clinical Modification, Codes Used to Describe Common Pediatric Orthopedic Conditions. Orthopedics 2020; 43:e87-e90. [PMID: 31930410 DOI: 10.3928/01477447-20200107-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/11/2019] [Indexed: 02/03/2023]
Abstract
The diagnosis coding system for health care providers that is used in the United States recently converted from the International Classification of Diseases, 9th Revision (ICD-9), to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). The authors are unaware of any studies specifically evaluating the utility and specificity of ICD-10-CM codes in the pediatric orthopedic literature. The authors chose 20 diagnoses that are commonly seen in general pediatric orthopedic practice. The study had two goals: (1) to evaluate the adequacy of these codes to describe the diagnoses and (2) to offer advice on the most appropriate code to use when the ideal code does not exist. A list of 20 diagnoses that are commonly seen in general pediatric orthopedic practice were chosen by 2 fellowship-trained pediatric orthopedic surgeons. Each author independently evaluated the appropriate ICD-10-CM code for each diagnosis. The authors came to a consensus regarding whether the codes were adequate and agreed on an appropriate alternate code when the ideal one did not exist. One common condition had no code (accessory navicular), necessitating the recommendation of a nonspecific code. Other seemingly dissimilar conditions were described by the same code (acetabular dysplasia/femoral anteversion, Osgood-Schlatter disease/Blount's disease). Numerous codes lacked specificity, and the option of laterality was not uniform. Compared with the ICD-9, the ICD-10-CM allows more diagnostic options for these 20 common pediatric orthopedic conditions. The authors identified several areas for improvement. Involvement of subspecialty societies could guide future endeavors to improve this new coding system. [Orthopedics. 2020;43(2):e87-e90.].
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
Zollino M, Zweier C, Van Balkom ID, Sweetser DA, Alaimo J, Bijlsma EK, Cody J, Elsea SH, Giurgea I, Macchiaiolo M, Smigiel R, Thibert RL, Benoist I, Clayton-Smith J, De Winter CF, Deckers S, Gandhi A, Huisman S, Kempink D, Kruisinga F, Lamacchia V, Marangi G, Menke L, Mulder P, Nordgren A, Renieri A, Routledge S, Saunders CJ, Stembalska A, Van Balkom H, Whalen S, Hennekam RC. Diagnosis and management in Pitt-Hopkins syndrome: First international consensus statement. Clin Genet 2019; 95:462-478. [PMID: 30677142 DOI: 10.1111/cge.13506] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023]
Abstract
Pitt-Hopkins syndrome (PTHS) is a neurodevelopmental disorder characterized by intellectual disability, specific facial features, and marked autonomic nervous system dysfunction, especially with disturbances of regulating respiration and intestinal mobility. It is caused by variants in the transcription factor TCF4. Heterogeneity in the clinical and molecular diagnostic criteria and care practices has prompted a group of international experts to establish guidelines for diagnostics and care. For issues, for which there was limited information available in international literature, we collaborated with national support groups and the participants of a syndrome specific international conference to obtain further information. Here, we discuss the resultant consensus, including the clinical definition of PTHS and a molecular diagnostic pathway. Recommendations for managing particular health problems such as dysregulated respiration are provided. We emphasize the need for integration of care for physical and behavioral issues. The recommendations as presented here will need to be evaluated for improvements to allow for continued optimization of diagnostics and care.
Collapse
Affiliation(s)
- Marcella Zollino
- Fondazione Policlinico Universitario A.Gemelli, IRCCS, UOC Genetica.,Università Cattolica Sacro Cuore, Istituto di Medicina Genomica, Roma, Italy
| | - Christiane Zweier
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ingrid D Van Balkom
- Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, The Netherlands.,Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - David A Sweetser
- Division of Medical Genetics and Metabolism, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Joseph Alaimo
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Emilia K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jannine Cody
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Irina Giurgea
- Sorbonne Université, INSERM, UMR_S 933, Assistance Publique Hôpitaux de Paris, Département de Génétique Médicale, Hôpital Trousseau, Paris, France
| | - Marina Macchiaiolo
- Rare and Genetic Diseases Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Robert Smigiel
- Department of Pediatrics, Division of Pediatrics and Rare Disorders, Wroclaw Medical University, Wroclaw, Poland
| | - Ronald L Thibert
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ingrid Benoist
- Dutch Pitt-Hopkins Syndrome Foundation, Vlaggeschip, Oosterhout, The Netherlands
| | - Jill Clayton-Smith
- Manchester Centre for Genomic Medicine, St Mary's Hospital, and Division of Evolution and Genomic Sciences School of Biological Sciences, University of Manchester, Manchester, UK
| | - Channa F De Winter
- Organisation for Individuals with Intellectual Disabilities, Trajectum, Zwolle, The Netherlands
| | - Stijn Deckers
- Department of Pedagogical Sciences, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Anusha Gandhi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Sylvia Huisman
- Department of Pediatrics, Academic Medical Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Dagmar Kempink
- Department of Orthopedic Surgery, Sophia Children's Hospital, UMCR, Rotterdam, The Netherlands
| | - Frea Kruisinga
- Department of Pediatrics, Academic Medical Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Giuseppe Marangi
- Fondazione Policlinico Universitario A.Gemelli, IRCCS, UOC Genetica.,Università Cattolica Sacro Cuore, Istituto di Medicina Genomica, Roma, Italy
| | - Leonie Menke
- Department of Pediatrics, Academic Medical Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul Mulder
- Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, The Netherlands.,Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Ann Nordgren
- Karolinska Center for Rare Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Carol J Saunders
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Hans Van Balkom
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Sandra Whalen
- Sorbonne Université, INSERM, UMR_S 933, Assistance Publique Hôpitaux de Paris, Département de Génétique Médicale, Hôpital Trousseau, Paris, France
| | - Raoul C Hennekam
- Department of Pediatrics, Academic Medical Centre, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
45
|
Suh DH, Park JH, Lee SH, Kim HJ, Park YH, Jang WY, Baek JH, Sung HJ, Choi GW. Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review. INTERNATIONAL ORTHOPAEDICS 2019; 43:1179-1192. [PMID: 30701302 DOI: 10.1007/s00264-019-04303-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and arthroereisis (AR) for treating symptomatic flatfoot in children. METHODS We conducted a comprehensive search on MEDLINE, EMBASE, and Cochrane Library databases. Literature search, data extraction, and quality assessment were conducted by two independent reviewers. The outcomes analyzed included radiographic parameters, clinical scores, satisfaction, complications, and re-operations. RESULTS Twenty-one and 13 studies were included in the LCL and AR groups, respectively. The change in anteroposterior talo-first metatarsal angle was greater in the LCL (9.5° to 21.7°) than in the AR group (10.6° to 12.8°). The change in calcaneal pitch was greater in the LCL (2.1° to 26.53°) than in the AR group (- 1.3° to 3.23°). Improvements in the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were greater in the LCL (27.7 to 39.1) than in the AR group (17 to 22). The percentage of satisfaction was similar between the LCL (68% to 89%) and AR (78.5% to 96.4%) groups. The complication rate was higher in the LCL (0% to 86.9%) than in the AR group (3.5% to 45%). The most common complications were calcaneocuboid subluxation and persistent pain in the LCL and AR groups, respectively. The re-operation rate was similar between the LCL (0% to 27.3%) and AR (0% to 36.4%) groups. CONCLUSIONS The LCL group has achieved more radiographic corrections and more improvements in the AOFAS score than the AR group. Complications were more common in the LCL group than in the AR group, and the re-operation rates were similar between the two groups.
Collapse
Affiliation(s)
- Dong Hun Suh
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Jung Ho Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Soon Hyuck Lee
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Woo Young Jang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung Heum Baek
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Hyun Jae Sung
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea.
| |
Collapse
|
46
|
Abstract
Pediatric flatfeet are common, are usually asymptomatic, and typically improve over time as young children age. It is critical to differentiate flexible from rigid flatfeet and to assess for associated Achilles contracture with a careful history, physical examination, and initial radiographs. Although there are limited data, nonsurgical management of symptomatic flatfeet, both flexible and rigid, should be exhausted before considering surgical intervention. If patients fail conservative treatment, surgical management with joint-preserving, deformity-corrective techniques is typically used for pediatric flexible flatfeet in conjunction with deformity-specific soft tissue procedures.
Collapse
|
47
|
Faldini C, Mazzotti A, Panciera A, Perna F, Stefanini N, Giannini S. Bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot. Musculoskelet Surg 2017; 102:11-19. [PMID: 28717988 DOI: 10.1007/s12306-017-0491-y] [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: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022]
Abstract
Flatfoot is a common condition in growing-age patients. Despite its common presentation, nowadays surgical indications and treatments are still debated. Arthroereisis is a widely used technique, and several implants designs have been proposed over time. Despite the good results shown in the literature, the main drawback of these techniques has always been the need for a second surgery for implant removal. Bioabsorbable devices have been introduced to overcome this necessity.Correct approach to the patient, indications and contraindications and available studies on bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot were analyzed in this narrative review. Even if only a few studies have been published in the literature, bioabsorbable implants showed good clinical results comparable to non-absorbable implants and with a rare necessity for implant removal or revision. When correct indications and proper surgical technique are followed, arthroereisis with bioabsorbable implants appears to be an effective solution for the treatment of pediatric flexible flatfoot.
Collapse
Affiliation(s)
- C Faldini
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - A Panciera
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - F Perna
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - N Stefanini
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Giannini
- Professor Emeritus, Orthopeadics and Traumatology, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| |
Collapse
|
48
|
Meyr AJ, Sansosti LE, Ali S. A pictorial review of reconstructive foot and ankle surgery: evaluation and intervention of the flatfoot deformity. J Radiol Case Rep 2017; 11:26-36. [PMID: 29299095 DOI: 10.3941/jrcr.v11i6.2757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This pictorial review focuses on basic procedures performed within the field of podiatric surgery, specifically for elective reconstruction of the midfoot and rearfoot with focus on the flatfoot deformity. Our goal is to demonstrate objective radiographic parameters that surgeons utilize to initially define the deformity, lead to procedure selection, and judge post-operative outcomes. We hope that radiologists will employ this information to improve their assessment of post-operative radiographs following reconstructive foot surgeries. First, relevant radiographic measurements are defined and their role in procedure selection explained. Second, the specific surgical procedures of the Evans calcaneal osteotomy, medial calcaneal slide osteotomy, Cotton osteotomy, subtalar joint arthroeresis, and arthrodeses of the rearfoot are described. Finally, specific plain film radiographic findings that judge post-operative outcomes for each procedure are detailed.
Collapse
Affiliation(s)
- Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania, USA
| | - Laura E Sansosti
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
49
|
Bahramian F, Abootorabi A, Zarezadeh F, Rezaeian T. Effect of Custom-Molded Insole With New Technique on Pain and Function in Females With Flexible Flat Foot: A Pilot Study. JOURNAL OF REHABILITATION 2016. [DOI: 10.21859/jrehab-1704318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
50
|
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.
Collapse
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
| |
Collapse
|