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Foot and Ankle Clinics Dec 2015Flatfoot is commonly encountered by pediatric orthopedic surgeons and pediatricians. A paucity of literature exists on how to define a flatfoot. The absence of the... (Review)
Review
Flatfoot is commonly encountered by pediatric orthopedic surgeons and pediatricians. A paucity of literature exists on how to define a flatfoot. The absence of the medial arch with a valgus hindfoot is the hallmark of this pathology. Flatfoot can be flexible or rigid. This review focuses on the diagnosis and treatment of the flexible flatfoot. Most flatfeet are flexible and clinically asymptomatic, and warrant little intervention. If feet are symptomatic, treatment is needed. Most patients who require treatment improve with foot orthotics and exercises. Only feet resistant to conservative modalities are deemed surgical candidates. The presence of a tight heel cord is often found in patients who fail conservative management.
Topics: Exercise Therapy; Flatfoot; Foot Orthoses; Humans; Musculoskeletal Pain; Orthopedic Procedures
PubMed: 26589087
DOI: 10.1016/j.fcl.2015.07.011 -
European Journal of Orthopaedic Surgery... May 2017Adult-acquired flatfoot deformity (AAFD) is a known and recognized cause of pain and disability. Loss of PTT function is the most important contributor to AAFD, and its... (Review)
Review
Adult-acquired flatfoot deformity (AAFD) is a known and recognized cause of pain and disability. Loss of PTT function is the most important contributor to AAFD, and its estimated prevalence is thought to be over 3%. This review aims to summarize the current literature and encompass recent advances regarding AAFD.
Topics: Adult; Bone Screws; Casts, Surgical; Conservative Treatment; Disability Evaluation; Female; Flatfoot; Follow-Up Studies; Foot Deformities, Acquired; Humans; Male; Orthopedic Procedures; Pain Measurement; Radiography; Severity of Illness Index
PubMed: 28324203
DOI: 10.1007/s00590-017-1945-5 -
La Pediatria Medica E Chirurgica :... Oct 2022Congenital vertical talus foot is a complex deformity, characterized by a dislocation of the talus-calcanear navicular joint. It is a rare form of congenital flat foot,...
Congenital vertical talus foot is a complex deformity, characterized by a dislocation of the talus-calcanear navicular joint. It is a rare form of congenital flat foot, where the hindfoot is valgus and equine, the midfoot dorsiflexed and the forefoot abducted. Regardless of the type of classification, the therapeutic approach and prognosis must take into account the functionality and motility of the foot. Initial treatment is manipulative. After 3 months of age, it is possible to think about soft tissue surgery. In this study, we present congenital vertical talus feet treated at the Pediatric Orthopedics Department of SS. Antonio Biagio and Cesare Arrigo Children's Hospital of Alessandria from 1995 to 2022. All 8 patients (12 feet) underwent through the surgical operation technique of open reduction described by Tachdjian and further reviewed and subjected to the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. The mean follow up is 13 years. Global functional result was good and surgery allowed the growth of the foot, which would otherwise be blocked by an ax that is the vertical talus. Questioned remotely, all patients perform sporting activities and wear normal footwear.
Topics: Animals; Horses; Flatfoot; Follow-Up Studies; Treatment Outcome; Retrospective Studies; Talus
PubMed: 37184318
DOI: 10.4081/pmc.2022.292 -
Orthopadie (Heidelberg, Germany) May 2024The diagnosis of flatfoot in children is made clinically. In most cases it is an age-appropriate benign physiological variant, as long as it can be passively and... (Review)
Review
The diagnosis of flatfoot in children is made clinically. In most cases it is an age-appropriate benign physiological variant, as long as it can be passively and actively redressed and the child does not show any neurological abnormalities, especially under the age of 6 years. Treatment is only indicated for symptomatic variants. In the case of rigid flatfeet, further diagnostics are necessary to exclude neurological or structural causes. Subtalar arthroereisis has become established and is an effective but slightly invasive procedure. Further options include the lengthening and medial translational osteotomy of the calcaneus or the Cotton operation; however, the indications must always be critically questioned, especially for surgical but also for conservative treatment, even if it is the wish of the family.
Topics: Humans; Child; Flatfoot; Child, Preschool; Osteotomy; Male; Female; Treatment Outcome; Infant
PubMed: 38578460
DOI: 10.1007/s00132-024-04490-x -
Current Opinion in Pediatrics Feb 2024The purpose of this review is to evaluate the current literature and best practices in the evaluation and treatment of symptomatic flatfoot in cerebral palsy. (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to evaluate the current literature and best practices in the evaluation and treatment of symptomatic flatfoot in cerebral palsy.
RECENT FINDINGS
While techniques to reconstruct the neuromuscular flatfoot and reestablish bony levers have remained similar over time, the concept of surgical dosing has helped guide appropriate interventions based on the magnitude of disease and functional level of the child. Moreover, the utilization of multisegment foot modeling in motion analysis has allowed quantitative description of such deformities and their impact on gait.
SUMMARY
Future research should focus on refining operative indications and interventions with larger, multicenter, prospective cohorts to provide more robust evidence in surgical decision making. Long-term data are needed to confirm and compare efficacy of procedures. Radiographic data alone are not sufficient for describing functional foot position. Gait analysis with foot modeling and pedobarography along with patient-centered subjective outcomes will be needed in such investigations to make conclusive recommendations.
Topics: Child; Humans; Flatfoot; Cerebral Palsy; Prospective Studies; Foot; Gait; Multicenter Studies as Topic
PubMed: 37872808
DOI: 10.1097/MOP.0000000000001300 -
Operative Orthopadie Und Traumatologie Jun 2016Realignment and stabilization of the hindfoot by subtalar joint arthrodesis. (Clinical Trial)
Clinical Trial
OBJECTIVE
Realignment and stabilization of the hindfoot by subtalar joint arthrodesis.
INDICATIONS
Idiopathic/posttraumatic arthritis, inflammatory arthritis of the subtalar joint with/without hindfoot malalignment. Optional flatfoot/cavovarus foot reconstruction.
CONTRAINDICATIONS
Inflammation, vascular disturbances, nicotine abuse.
SURGICAL TECHNIQUE
Approach dependent on assessment. Lateral approach: Supine position. Incision above the sinus tarsi. Exposure of subtalar joint. Removal of cartilage and breakage of the subchondral sclerosis. In valgus malalignment, interposition of corticocancellous bone segment; in varus malalignment resection of bone segment from the calcaneus. Reposition and temporarily stabilization with Kirschner wires. Imaging of hindfoot alignment. Stabilization with cannulated screws. Posterolateral approach: Prone position. Incision parallel to the lateral Achilles tendon border. Removal of cartilage and breakage of subchondral sclerosis. Medial approach: Supine position. Incision just above and parallel to the posterior tibial tendon. Removal of cartilage and breakage of subchondral sclerosis. Stabilization with screws.
POSTOPERATIVE MANAGEMENT
Lower leg walker with partial weightbearing. Active exercises of the ankle. After a 6‑week X‑ray, increase of weightbearing. Full weightbearing not before 8 weeks; with interpositioning bone grafts not before 10-12 weeks. Stable walking shoes. Active mobilization of the ankle.
RESULTS
Of 43 isolated subtalar arthrodesis procedures, 5 wound healing disorders and no infections developed. Significantly improved AOFAS hindfood score. Well-aligned heel observed in 34 patients; 5 varus and 2 valgus malalignments. Sensory disturbances in 8 patients; minor ankle flexion limitations. Full bone healing in 36 subtalar joints, pseudarthrosis in 4 patients.
Topics: Adolescent; Adult; Aged; Arthrodesis; Bone Screws; Bone Wires; Exercise Therapy; Female; Flatfoot; Humans; Male; Middle Aged; Subtalar Joint; Treatment Outcome; Young Adult
PubMed: 26895251
DOI: 10.1007/s00064-016-0438-8 -
The Journal of Maternal-fetal &... Dec 2023This study aimed to analyze the ultrasound characteristics of fetal congenital vertical talus (CVT) to provide a detailed basis for the prenatal diagnosis of CVT.
OBJECTIVE
This study aimed to analyze the ultrasound characteristics of fetal congenital vertical talus (CVT) to provide a detailed basis for the prenatal diagnosis of CVT.
METHODS
We retrospectively analyzed the ultrasonographic findings of fetuses with CVT confirmed by X-ray, surgery, or autopsy from 2010 to 2020. Clinical characteristics and ultrasonographic findings of CVT, including foot morphology, ossification center of the calcaneus and talus, associated deformities, and chromosomal test results, were recorded.
RESULTS
Thirteen patients diagnosed with CVT by prenatal ultrasound were confirmed postpartum. Nine cases were bilateral, and four were unilateral. Under two-dimensional ultrasound, 13/13 cases had abnormal foot morphology, and 10 of 13 cases (76.9%) showed that the ossification center of the talus moved downward, and the calcaneus moved laterally. Under three-dimensional ultrasound, 11 cases (84.6%) presented a "rocking chair" appearance, and two cases did not obtain satisfactory three-dimensional image due to oligohydramnios and fetal position. In this group of cases, two cases (15.4%) were isolated CVT, and the other 11 cases (84.6%) were complicated with other abnormalities. Eleven cases of non-isolated CVT and 1 case of isolated CVT were induced, and another patient with isolated CVT had undergone postnatal surgery, which had been followed up for 8 years and recovered well.
CONCLUSIONS
The combination of fetal foot morphology, ossification center position of the calcaneus and talus, and three-dimensional ultrasound can provide a reliable diagnosis of CVT. Furthermore, we should pay more attention to the evaluation of other systemic and chromosomal abnormalities in CVT cases.
Topics: Female; Humans; Pregnancy; Flatfoot; Retrospective Studies; Prenatal Diagnosis; Talus; Ultrasonography, Prenatal
PubMed: 36948222
DOI: 10.1080/14767058.2023.2192323 -
Foot and Ankle Clinics Sep 2017In 1975, Evans published an article describing the surgical management of the "calcaneo-valgus deformity," pointing out that the deformity was due to relative shortening... (Review)
Review
In 1975, Evans published an article describing the surgical management of the "calcaneo-valgus deformity," pointing out that the deformity was due to relative shortening of the lateral column of the foot. Correction involved "equalizing" both columns by performing an osteotomy in the neck of the calcaneus 1.5 cm from the calcaneocuboid joint, where a trapezoidal wedge of tricortical bone was placed. Although it was considered a success, there were complications, including sural nerve injury, surgical wound dehiscence, undercorrection, and graft subsidence. The osteotomy grew in popularity. Indications extended to other forms of flatfoot with a low incidence of complications.
Topics: Arthrodesis; Calcaneus; Flatfoot; Foot Deformities, Acquired; Humans; Osteotomy; Patient Selection; Postoperative Complications; Tarsal Joints
PubMed: 28779808
DOI: 10.1016/j.fcl.2017.04.006 -
Foot and Ankle Clinics Sep 2017The spring ligament complex is an important static restraint of the medial longitudinal arch of the foot and its failure has been associated with progressive flatfoot... (Review)
Review
The spring ligament complex is an important static restraint of the medial longitudinal arch of the foot and its failure has been associated with progressive flatfoot deformity. Reconstruction of the spring ligament complex is most appropriate in stage II posterior tibial tendon dysfunction, before severe peritalar subluxation and rigid deformity develops. Although an understanding of the spring ligament complex and its contribution to medial arch stability has grown, there is no unanimously accepted surgical technique that has consistently demonstrated satisfactory outcomes. This article reviews the pathoanatomy of the spring ligament complex and the role of spring ligament reconstruction in acquired flatfoot deformity, and highlights current research.
Topics: Ankle Injuries; Collateral Ligaments; Flatfoot; Humans; Posterior Tibial Tendon Dysfunction; Plastic Surgery Procedures
PubMed: 28779804
DOI: 10.1016/j.fcl.2017.04.005 -
Foot and Ankle Clinics Sep 2017Adult acquired flatfoot deformity is a debilitating condition typically affecting middle-aged patients. The multiple components include hindfoot valgus, first ray... (Review)
Review
Adult acquired flatfoot deformity is a debilitating condition typically affecting middle-aged patients. The multiple components include hindfoot valgus, first ray elevation, medial soft tissue compromise, and forefoot abduction. As the foot becomes unbalanced, the deformity progresses with repetitive loading and time. Untreated patients often need significant reconstructions or extensive arthrodesis after arthritis and joint contractures present. Medializing calcaneal osteotomy is the workhorse operation for correction of hindfoot valgus, reliably correcting deformity with a relatively low complication risk. This article reviews indications, techniques, complications, and outcomes for the medializing calcaneal osteotomy.
Topics: Adult; Calcaneus; Flatfoot; Foot Deformities, Acquired; Humans; Middle Aged; Osteotomy; Photography; Postoperative Complications
PubMed: 28779807
DOI: 10.1016/j.fcl.2017.04.011