1
|
Molina-García C, Reinoso-Cobo A, Cortés-Martín J, Lopezosa-Reca E, Marchena-Rodriguez A, Banwell G, Ramos-Petersen L. Efficacy of Personalized Foot Orthoses in Children with Flexible Flat Foot: Protocol for a Randomized Controlled Trial. J Pers Med 2023; 13:1269. [PMID: 37623519 PMCID: PMC10456098 DOI: 10.3390/jpm13081269] [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: 08/04/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or clear treatment approach. There are multiple conservative and surgical treatments, the implantation of foot orthoses (FO) being the most used treatment. The evidence supporting FO is very thin. It is not clearly known what the effect of these is, nor when it is convenient to recommend them. The main objective of this protocol is to design a randomized controlled trial to determine if personalized FO, together with a specific exercise regimen, produce the same or better results regarding the signs and symptoms of PFF, compared to only specific exercises. In order to respond to the stated objectives, we have proposed a randomized controlled clinical trial, in which we intend to evaluate the efficacy of FO together with strengthening exercises, compared to a control group in which placebos will be implanted as FO treatment along with the same exercises as the experimental group. For this, four measurements will be taken throughout 18 months (pre-treatment, two during treatment and finally another post-treatment measurement). The combination of FO plus exercise is expected to improve the signs and symptoms (if present) of PFF compared to exercise alone and the placebo FO group. In addition, it is expected that in both conditions the biomechanics of the foot will improve compared to the initial measurements.
Collapse
Affiliation(s)
- Cristina Molina-García
- Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Campus de los Jerónimos 135, 30107 Murcia, Spain;
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucia, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - Eva Lopezosa-Reca
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
| | - Ana Marchena-Rodriguez
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
| | - George Banwell
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain; (A.R.-C.); (E.L.-R.); (A.M.-R.); (L.R.-P.)
| |
Collapse
|
2
|
Žukauskas S, Barauskas V, Degliūtė-Muller R, Čekanauskas E. Really Asymptomatic? Health-Related Quality of Life and Objective Clinical Foot Characteristics among 5-10-Year-Old Children with a Flexible FlatFoot. J Clin Med 2023; 12:jcm12093331. [PMID: 37176771 PMCID: PMC10179374 DOI: 10.3390/jcm12093331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
The potential effects of asymptomatic flexible flatfoot (FF) on children's health-related quality of life (QoL) and objective clinical foot characteristics have been poorly investigated in the literature. Therefore, this study aimed to analyse these indicators, comparing the children with asymptomatic FF and a control group. METHODS In total, 351 children were enrolled in this cross-sectional study-160 children with asymptomatic FF and 191 controls (children with normal feet). The children and their parents completed the Paediatric Quality of Life Inventory (PedsQLTM 4.0). The objective foot characteristics included clinical foot posture measures, footprints, general hyperlaxity, and X-ray measurements. RESULTS Children with asymptomatic FF had a significantly lower QoL (overall and all four dimensions). The parents' assessment of the QoL of their children with asymptomatic FF in most cases was lower compared to their children's self-reported QoL. Moreover, almost all clinical foot measures also had significantly worse profiles among asymptomatic FF cases compared to the controls. This was observed with the Foot Posture Index-6 (FPI-6), the navicular drop (ND) test, the Chippaux-Smirak Index (CSI), Staheli's Index (SI), the Beighton scale, and radiological angles (except the talo-first metatarsal angle). CONCLUSION The findings suggest that asymptomatic FF not always reflects a normal foot development. This condition is related to decreased health-related quality of life, so the 5-10-year-old children's and their parents' complaints should be considered more closely in identification, treatment, and monitoring plans.
Collapse
Affiliation(s)
- Saidas Žukauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Vidmantas Barauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Ramunė Degliūtė-Muller
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Emilis Čekanauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| |
Collapse
|
3
|
Kim JY, Kim SA, Kim Y, Hwang I, Heo NH. Radiologic changes of long term foot insole use in symptomatic pediatric flatfoot. Medicine (Baltimore) 2023; 102:e33152. [PMID: 36897708 PMCID: PMC9997835 DOI: 10.1097/md.0000000000033152] [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: 07/17/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
Clinically, flatfoot, known as pes planus, is quite prevalent. It is classified into 2 types: flexible and rigid, both of which may or may not have symptoms. If a flexible flatfoot is symptomatic, it must be treated to prevent subsequent complications. In principle, most physicians initially use conservative methods, such as foot insoles. This study aimed to demonstrate the effect of long term use of a foot insole using plain radiography as an objective measurement in children with symptomatic flexible flatfoot (SFFF) in large samples. This study analyzed the medical records of 292 children aged < 18 years who were diagnosed with SFFF. Of these, 200 children (62 boys and 138 girls, mean age: 6.49 ± 2.96 years) were selected and conservatively treated with foot insoles. They were periodically followed up within 3 to 4 months to modify the foot insole and perform radiologic evaluations, such as foot radiography. The calcaneal pitch angle (CPA) and talo first metatarsal angle were measured and compared individually using foot lateral radiographs, which were pictured in a bilateral barefoot state. The treatment was terminated by repeating the same procedure until the symptoms disappeared. A significant improvement (P < .001) was observed in the radiological indicators, both CPA and talo first metatarsal angle, regardless of age, after the application of soft foot insoles. However, the right foot CPA in the group with valgus deformity was an exception (P = .078). This study showed that in children diagnosed with SFFF under 18 years of age, wearing a periodically revised foot insole as conservative treatment could not only decrease the symptoms, but also improve the radiologic indices.
Collapse
Affiliation(s)
- Joon Yeop Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Soo A Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Yuntae Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Insu Hwang
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| |
Collapse
|
4
|
Ryu SM, Shin K, Shin SW, Lee SH, Seo SM, Cheon SU, Ryu SA, Kim MJ, Kim H, Doh CH, Choi YR, Kim N. Automated diagnosis of flatfoot using cascaded convolutional neural network for angle measurements in weight-bearing lateral radiographs. Eur Radiol 2023:10.1007/s00330-023-09442-1. [PMID: 36856842 DOI: 10.1007/s00330-023-09442-1] [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: 10/21/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES Diagnosis of flatfoot using a radiograph is subject to intra- and inter-observer variabilities. Here, we developed a cascade convolutional neural network (CNN)-based deep learning model (DLM) for an automated angle measurement for flatfoot diagnosis using landmark detection. METHODS We used 1200 weight-bearing lateral foot radiographs from young adult Korean males for the model development. An experienced orthopedic surgeon identified 22 radiographic landmarks and measured three angles for flatfoot diagnosis that served as the ground truth (GT). Another orthopedic surgeon (OS) and a general physician (GP) independently identified the landmarks of the test dataset and measured the angles using the same method. External validation was performed using 100 and 17 radiographs acquired from a tertiary referral center and a public database, respectively. RESULTS The DLM showed smaller absolute average errors from the GT for the three angle measurements for flatfoot diagnosis compared with both human observers. Under the guidance of the DLM, the average errors of observers OS and GP decreased from 2.35° ± 3.01° to 1.55° ± 2.09° and from 1.99° ± 2.76° to 1.56° ± 2.19°, respectively (both p < 0.001). The total measurement time decreased from 195 to 135 min in observer OS and from 205 to 155 min in observer GP. The absolute average errors of the DLM in the external validation sets were similar or superior to those of human observers in the original test dataset. CONCLUSIONS Our CNN model had significantly better accuracy and reliability than human observers in diagnosing flatfoot, and notably improved the accuracy and reliability of human observers. KEY POINTS • Development of deep learning model (DLM) that allows automated angle measurements for landmark detection based on 1200 weight-bearing lateral radiographs for diagnosing flatfoot. • Our DLM showed smaller absolute average errors for flatfoot diagnosis compared with two human observers. • Under the guidance of the model, the average errors of two human observers decreased and total measurement time also decreased from 195 to 135 min and from 205 to 155 min.
Collapse
Affiliation(s)
- Seung Min Ryu
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 26, Olympic-ro 43-gil, Songpa-gu, Seoul, 05506, Republic of Korea.,Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Keewon Shin
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 26, Olympic-ro 43-gil, Songpa-gu, Seoul, 05506, Republic of Korea
| | - Soo Wung Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05506, Republic of Korea.,Department of Computer Science and Engineering, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Sun Ho Lee
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Su Min Seo
- Department of Anesthesiology and Pain Medicine, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, 02053, Republic of Korea
| | - Seung-Uk Cheon
- Department of Anesthesiology and Pain Medicine, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, 02053, Republic of Korea
| | - Seung-Ah Ryu
- Department of Anesthesiology and Pain Medicine, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, 02053, Republic of Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hyunjung Kim
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 26, Olympic-ro 43-gil, Songpa-gu, Seoul, 05506, Republic of Korea
| | - Chang Hyun Doh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young Rak Choi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Namkug Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05506, Republic of Korea. .,Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 26, Olympic-ro 43-gil, Songpa-gu, Seoul, 05506, Republic of Korea.
| |
Collapse
|
5
|
Molina-García C, Banwell G, Rodríguez-Blanque R, Sánchez-García JC, Reinoso-Cobo A, Cortés-Martín J, Ramos-Petersen L. Efficacy of Plantar Orthoses in Paediatric Flexible Flatfoot: A Five-Year Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020371. [PMID: 36832500 PMCID: PMC9955448 DOI: 10.3390/children10020371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Paediatric flexible flatfoot (PFF) is a very common condition and a common concern among parents and various healthcare professionals. There is a multitude of conservative and surgical treatments, with foot orthoses (FO) being the first line of treatment due to their lack of contraindications and because the active participation of the child is not required, although the evidence supporting them is weak. It is not clear what the effect of FO is, nor when it is advisable to recommend them. PFF, if left untreated or uncorrected, could eventually cause problems in the foot itself or adjacent structures. It was necessary to update the existing information on the efficacy of FO as a conservative treatment for the reduction in signs and symptoms in patients with PFF, to know the best type of FO and the minimum time of use and to identify the diagnostic techniques most commonly used for PFF and the definition of PFF. A systematic review was carried out in the databases PubMed, EBSCO, Web of Science, Cochrane, SCOPUS and PEDro using the following strategy: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) on child patients with PFF, compared to those treated with FO or not being treated, assessing the improvement of signs and symptoms of PFF. Studies in which subjects had neurological or systemic disease or had undergone surgery were excluded. Two of the authors independently assessed study quality. PRISMA guidelines were followed, and the systematic review was registered in PROSPERO: CRD42021240163. Of the 237 initial studies considered, 7 RCTs and CCTs published between 2017 and 2022 met the inclusion criteria, representing 679 participants with PFF aged 3-14 years. The interventions of the included studies differed in diagnostic criteria, types of FO and duration of treatment, among others. All articles conclude that FO are beneficial, although the results must be taken with caution due to the risk of bias of the included articles. There is evidence for the efficacy of FO as a treatment for PFF signs and symptoms. There is no treatment algorithm. There is no clear definition for PFF. There is no ideal type of FO, although all have in common the incorporation of a large internal longitudinal arch.
Collapse
Affiliation(s)
- Cristina Molina-García
- Health Sciences Ph.D. Program, Universidad Católica de Murcia UCAM, Campus de Los Jerónimos n°135, Guadalupe, 30107 Murcia, Spain
| | - George Banwell
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- San Cecilio Clinical University Hospital, 18016 Granada, Spain
- Correspondence:
| | - Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| |
Collapse
|
6
|
Herdea A, Neculai AG, Ulici A. The Role of Arthroereisis in Improving Sports Performance, Foot Aesthetics and Quality of Life in Children and Adolescents with Flexible Flatfoot. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070973. [PMID: 35883957 PMCID: PMC9323989 DOI: 10.3390/children9070973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
Abstract
Flexible flatfoot represents one of the most common deformities of the lower limb, affecting children and adolescents. Aesthetic aspect, abnormal gait, pain and fatigue are by far the most important symptoms which determine parents to bring their children to the orthopedist. We set out to conduct a prospective study, case-controlled, including patients with symptomatic flexible flatfeet operated on by arthroereisis surgery and comparing them to a normal feet group of children age- and sex-matched (control group). Minimum follow-up time was 2 years. In total, 33 patients with bilateral arthroereisis were included and 36 patients formed the control group (12.12 +/− 1.85 years vs. 11.81 ± 2.40 years, p = 0.54). Quality of life improved postoperatively (p = 0.18) and was not different from the control group. Median running time improved postoperatively by 2.25 s (p < 0.0001) and got closer to the median running time from the control group (22.30 s compared to 20.94 s, p = 0.01). All radiological angles improved (p < 0.0001), but quality of life improvement was correlated with talonavicular coverage angle and Meary angle measurements. Flatfoot in children and adolescents may be a condition in which the quality of life and sports performance are decreased, compared to healthy children. Arthroereisis is a minimally invasive surgical procedure with a short recovery time and a short period before resumption of sport activities, which can be useful in certain types of flexible flatfoot due to its effectiveness on symptom reduction.
Collapse
Affiliation(s)
- Alexandru Herdea
- 11th Department of Pediatric Orthopedics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Pediatric Orthopedics Department, Grigore Alexandrescu Children’s Emergency Hospital, 011743 Bucharest, Romania;
| | - Adrian-Gabriel Neculai
- Pediatric Orthopedics Department, Grigore Alexandrescu Children’s Emergency Hospital, 011743 Bucharest, Romania;
| | - Alexandru Ulici
- 11th Department of Pediatric Orthopedics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Pediatric Orthopedics Department, Grigore Alexandrescu Children’s Emergency Hospital, 011743 Bucharest, Romania;
- Correspondence: ; Tel.: +40-0723188988
| |
Collapse
|
7
|
Cho DJ, Ahn SY, Bok SK. Effect of Foot Orthoses in Children With Symptomatic Flexible Flatfoot Based on Ultrasonography of the Ankle Invertor and Evertor Muscles. Ann Rehabil Med 2022; 45:459-470. [PMID: 35000371 PMCID: PMC8743848 DOI: 10.5535/arm.21137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the changes in the cross-sectional area (CSA) ratio of the ankle invertors and evertors following rigid foot orthosis (RFO) application in children with symptomatic flexible flatfoot and to determine the correlation between the degree of change in CSA ratio and pain-severity after RFO application. Methods We included 24 children with symptomatic flexible flatfoot without comorbidities and measured the CSAs of tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) using ultrasonography, resting calcaneal stance position (RCSP) angle, calcaneal pitch (CP), Meary’s angle, talonavicular coverage angle, and talocalcaneal angle using radiography, and foot function index (FFI) at baseline and 12 months after RFO application. We analyzed 48 data by measuring both feet of 24 children. The CSA ratios, the ratio of CSA of each muscle to the sum of CSA of TA, TP, and PL, were also compared. Correlations between the degree of change in FFI, each muscle’s CSA ratio, RCSP angle, and radiographic measurements were investigated. Results Following RFO application, significant increase in the PL ratio and CP and significant decrease in the RCSP angle, FFI total, pain, and disability scores were observed. The degree of change in the total score, pain, and disability score of FFI were significantly correlated with the degree of change in the PL ratio and RCSP angle. Conclusion RFOs applied to children with symptomatic flexible flatfoot might reduce the compensatory activities of the ankle invertors, thereby increasing the PL ratio, and pain decreases as the PL ratio increases.
Collapse
Affiliation(s)
- Dong Joon Cho
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - So Young Ahn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
8
|
Žukauskas S, Barauskas V, Čekanauskas E. Comparison of multiple flatfoot indicators in 5-8-year-old children. Open Med (Wars) 2021; 16:246-256. [PMID: 33623820 PMCID: PMC7885299 DOI: 10.1515/med-2021-0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/15/2020] [Accepted: 01/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background The foot posture is age dependent. The purpose of this study was to investigate the relationship between the 6-item version of the foot posture index (FPI) and other clinical, foot anthropometric, radiological measurements for the foot position in 5–8-year-old children. Methods A total of 301 participants with a mean age of 6.4 ± 1.14 years were enrolled in the study. Children were examined physically, clinically, and radiologically to measure the FPI and navicular drop (ND) test, resting calcaneal stance position (RCSP) angle, Chippaux–Smirak index (CSI), Staheli index (SI), calcaneal pitch (CP) angle, talocalcaneal angle (TCA), and the first lateral metatarsal angle. Tibial torsions, internal rotation of the hip as an indirect method of femoral anteversion, and Beighton scale were analyzed for factors associated with flatfoot prevalence. Results The study included children with normal and flexible flatfeet. Statistical analysis showed a significant FPI score correlation with other parameters (SI, CSI, RCSP, ND, CP, TMA, and TCA showed strong and moderate correlations, p < 0.001). Overall, the strongest associates are CSI (β = 0.34) and ND (β = 0.28). Other indicators have relatively small relationships with the FPI. Conclusion A positive correlation was observed between FPI-6 and ND test, CSI in 5–8-year-old children. All three prominent foot posture indicators (FPI-6, ND, and CSI) might be used as a primary or preferred tool in clinical practice.
Collapse
Affiliation(s)
- Saidas Žukauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, Pramonės pr. 47-24, Kaunas, Kauno m., LT-50461, Lithuania
| | - Vidmantas Barauskas
- Department of Paediatric Surgery, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307, Kaunas, Lithuania
| | - Emilis Čekanauskas
- Department of Paediatric Surgery Pediatric Orthopedics - Traumatology Unit, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307, Kaunas, Lithuania
| |
Collapse
|
9
|
Choi JY, Lee DJ, Kim SJ, Suh JS. Does the long-term use of medial arch support insole induce the radiographic structural changes for pediatric flexible flat foot? - A prospective comparative study. Foot Ankle Surg 2020; 26:449-456. [PMID: 31201010 DOI: 10.1016/j.fas.2019.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several conservative treatment methods, from intrinsic muscle exercises to orthoses, including insoles or specially designed shoes, have been introduced for pediatric flexible flat foot (PFFF). However, the structural effects of a long-term use of medial arch support insole remain unclear because the normal physiological maturation of the medial longitudinal arch cannot be ruled out. METHODS From January 2005 to June 2015, 18 patients (34 feet) in group 1 (continuously insole applied group) and 13 patients (26 feet) in group 2 (untreated group) were enrolled. Medial arch support insole was applied from the age 10-11years to radiographic physeal closure. RESULTS In group 1, talonavicular coverage angle, lateral talo-1st metatarsal angle, calcaneal pitch angle and medial cuneiform height were significantly changed at final follow-up, although all values were still within the abnormal range. Further, no significant differences were found in any of the increments of the radiographic parameters between group 1 and 2. CONCLUSIONS Radiographic improvements were found in both of medial arch support insole treated or untreated group despite all radiographic values were still within the abnormal range. It was meaningful that the PFFF could be improved somewhat until the physes were closed. And the hindfoot alignment remained unchanged regardless of medial arch support insole application.
Collapse
Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Dong Joo Lee
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Seung Joo Kim
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea.
| |
Collapse
|
10
|
Ng JW, Chong LJY, Pan JW, Lam WK, Ho M, Kong PW. Effects of foot orthosis on ground reaction forces and perception during short sprints in flat-footed athletes. Res Sports Med 2020; 29:43-55. [PMID: 32326755 DOI: 10.1080/15438627.2020.1755673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prefabricated foot orthosis (FO) is commonly worn for flat foot management. This study aimed to investigate the kinetic and perceptual effects of wearing prefabricated FO among flat-footed athletes during bouts of sprints. Twenty male sprint-based sports athletes who had flat foot bilaterally ran at three test speeds (5, 6, 7 m/s) under two conditions: prefabricated FO and sham FO. Ground reaction force (GRF) variables and subjective perceptions were recorded. Kinetic variability of GRF variables were computed to indicate step-to-step variance. Biomechanically, wearing prefabricated FOs increased vertical impact force (p =.005), loading rate (p =.001), and kinetic variability of peak propulsive force (p =.038) and loading rate (p =.019) during sprinting speeds across 5 to 7 m/s. Subjectively, prefabricated FO provided better arch support (p =.001) but resulted in reduced forefoot cushioning (p =.001), heel cushioning (p =.002), and overall comfort (p =.008).
Collapse
Affiliation(s)
- Jun W Ng
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University , Singapore
| | - Lowell J Y Chong
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University , Singapore
| | - Jing W Pan
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University , Singapore
| | - Wing-Kai Lam
- Department of Kinesiology, Shenyang Sport University , Shenyang, China.,Li Ning Sports Science Research Center , Beijing, China
| | - Malia Ho
- Department of Podiatry, School of Health, Medical and Applied Sciences, CQUniversity , Rockhampton, Queensland, Australia
| | - Pui W Kong
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University , Singapore
| |
Collapse
|
11
|
The long-term structural effect of orthoses for pediatric flexible flat foot: A systematic review. Foot Ankle Surg 2020; 26:181-188. [PMID: 30765257 DOI: 10.1016/j.fas.2019.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/20/2018] [Accepted: 01/23/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to evaluate the structural effects of the long-term use of orthoses for pediatric flexible flat foot (PFFF) using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies. METHODS A comprehensive literature search using five databases, namely MEDLINE, the Cochrane Library, Scopus, the Web of Science, and EMBASE, was performed for pertinent articles published before March 30, 2018. Studies with quantitative data on the effects of the long-term use of orthoses for PFFF were included. The search strategy was adapted as appropriate for all other databases searched considering the differences in indexing terms and search syntax for each database. RESULTS Randomized controlled trials and prospective cohort studies could not prove the estimated effects of orthoses on the medial longitudinal arch. They revealed that flexible flat feet in young children slowly improved with growth, regardless of the type of footwear used. However, three of four case series studies revealed that positive long-term effects could be achieved using orthoses. CONCLUSION There is no strong evidence that the long-term use of orthoses improved the structural problem of PFFF.
Collapse
|
12
|
Ohuchi H, Chavez JS, Alvarez CAD. Changes in calcaneal pitch and heel fat pad thickness in static weight bearing radiographs while wearing shoes with arch support and heel cup orthotics. Asia Pac J Sports Med Arthrosc Rehabil Technol 2019; 17:21-24. [PMID: 31453111 PMCID: PMC6700667 DOI: 10.1016/j.asmart.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/12/2019] [Accepted: 07/16/2019] [Indexed: 11/28/2022] Open
Abstract
Background Foot orthoses have been shown to reduce the collapse of the longitudinal arch and to constrain soft tissue displacement under the heel. However, there has not been a study that has shown the effectiveness of both the arch and heel features in the same orthosis. This study quantitatively analyzed if the calcaneal pitch and the heel pad thickness will be affected by the use of an arch support and heel cup insole in a static weightbearing stance while wearing sports shoes. Methods Twenty-four (24) feet from 12 elite-level female soccer players with a mean age of 25 ± 3.99 years (20–33 years old) were studied. Lateral weightbearing radiographs with and without orthotics were obtained in order to measure the calcaneal pitch angle and heel fat pad thickness for each foot. A subjective outcome measure was used and the scores were classified as bad (0–2), fair (3–5), good (6–8), or excellent (9-10). Results The calcaneal pitch angle increased in all but three cases by an average of 1.05° (range, −1.14 to 3.19) after wearing orthotics (p < 0.01). The heel fat pad thickness increased in all cases with an average of 1.25 mm (range, 1.05 to 1.47; p < 0.01)). 9 of 12 subjects (75%) reported excellent (n = 2) or good (n = 7) overall subjective scores with insole wear. Conclusion Under static weightbearing conditions, the arch support and heel cup features of a foot orthosis help improve the height of the calcaneal pitch and the thickness of the heel fat pad, respectively.
Collapse
Affiliation(s)
- Hiroshi Ohuchi
- Department of Sports Medicine, Kameda Medical Center, Japan
| | | | | |
Collapse
|
13
|
Ho M, Kong PW, Chong LJY, Lam WK. Foot orthoses alter lower limb biomechanics but not jump performance in basketball players with and without flat feet. J Foot Ankle Res 2019; 12:24. [PMID: 31044012 PMCID: PMC6480506 DOI: 10.1186/s13047-019-0334-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
Background Flat-footed individuals are believed to have poorer jump performance compared to normal-arched individuals. Foot orthoses are commonly used to support the deformed foot arch, and improve normal foot function. However, it is unclear if foot orthoses use affects jump performance in athletes. Our study aims to investigate if foot type and/or foot orthosis influence countermovement jump (CMJ) and standing broad jump (SBJ) performance and lower limb biomechanics. Methods Twenty-six male basketball players were classified into normal-arched (n = 15) or flat-footed (n = 11) groups using the Chippaux-Smirak index, navicular drop test, and the resting calcaneal angle measurement. They performed jumps with and without prefabricated foot orthoses. We measured jump height and distance for CMJ and SBJ, respectively. Hip, knee and ankle joint angles, angular velocities, moments and powers during take-off were also measured. Results For CMJ, the flat-footed group exhibited less ankle plantarflexion (F1,24 = 8.407, p = 0.008, ηp2 = 0.259 large effect) and less hip joint power (F1,24 = 7.416, p = 0.012, ηp2 = 0.244 large effect) than the normal-arched group. Foot orthoses reduced ankle eversion in both groups (F1,24 = 6.702, p = 0.016, ηp2 = 0.218 large effect). For SBJ, the flat-footed group produced lower peak hip angular velocity (F1,24 = 7.115, p = 0.013, ηp2 = 0.229 large effect) and generated lower horizontal GRF (F1,24 = 5.594, p = 0.026, ηp2 = 0.189 large effect) than the normal-arched group. Wearing foot orthoses reduced ankle eversion (F1,24 = 5.453, p = 0.028, ηp2 = 0.185 large effect), peak horizontal GRF (F1,24 = 13.672, p = 0.001, ηp2 = 0.363 large effect) and frontal plane ankle moment (F1,24 = 4.932, p = 0.036, ηp2 = 0.170 large effect). Conclusion Foot type and the use of foot orthoses influence take-off biomechanics, but not actual CMJ and SBJ performances in basketball players. Compared to the normal-arched individuals, flat-footed athletes generated smaller propulsion GRF and lower hip flexion velocity and power, which suggests possible compensatory movement strategies to maximise jump performance. Future studies may investigate whether these altered biomechanics, taking into consideration their respective magnitude and effect sizes, may have implications on lower limb injuries. The use of foot orthoses resulted in biomechanical changes in both the normal-arched and flat-footed groups but does not enhance jumping performance.
Collapse
Affiliation(s)
- Malia Ho
- 1Department of Podiatry, School of Health, Medical and Applied Science, Central Queensland University, Rockhampton, Queensland Australia
| | - Pui Wah Kong
- 2Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Lowell Jia-Yee Chong
- 2Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore.,Li Ning Sports Science Research Center, Beijing, China
| | - Wing-Kai Lam
- 3Department of Kinesiology, Shenyang Sport University, Shenyang, China.,Li Ning Sports Science Research Center, Beijing, China
| |
Collapse
|