-
Foot and Ankle Clinics Jun 2021Undiagnosed medial ankle instability can be a prerequisite for pathogenic progression in the foot, particularly for adult acquired flatfoot deformity. With the complex... (Review)
Review
Undiagnosed medial ankle instability can be a prerequisite for pathogenic progression in the foot, particularly for adult acquired flatfoot deformity. With the complex anatomy in this region, and the limitations of each individual investigational method, accurately identifying peritalar instability remains a serious challenge to clinicians. Performing a thorough clinical examination aided by evaluation with advanced imaging can improve the threshold of detection for this condition and allow early proper treatment to prevent further manifestations of the instability.
Topics: Adult; Flatfoot; Foot; Humans; Joint Instability
PubMed: 33990252
DOI: 10.1016/j.fcl.2021.03.003 -
Foot and Ankle Clinics Mar 2019Müller-Weiss disease (MWD) is a dysplasia of the tarsal navicular. The shifting of the talar head laterally over the calcaneus drives the subtalar joint into varus.... (Review)
Review
Müller-Weiss disease (MWD) is a dysplasia of the tarsal navicular. The shifting of the talar head laterally over the calcaneus drives the subtalar joint into varus. Failure to identify patients with paradoxic flatfoot varus may lead to the incorrect diagnosis and management. Conservative treatment with the use of rigid insoles with medial arch support and a lateral heel wedge is effective in most patients. Dwyer calcaneal osteotomy combined with lateral displacement seems to be a satisfactory treatment for patients who had failed to respond to conservative measures and a good alternative to the different types of perinavicular fusions.
Topics: Flatfoot; Foot Diseases; Humans; Orthopedic Procedures; Osteonecrosis; Tarsal Bones
PubMed: 30685016
DOI: 10.1016/j.fcl.2018.09.006 -
Journal of Pediatric Orthopedics Dec 2016Children with flatfeet are frequently referred to pediatric orthopaedic clinics. Most of these patients are asymptomatic and require no treatment. Care must be taken to... (Review)
Review
BACKGROUND
Children with flatfeet are frequently referred to pediatric orthopaedic clinics. Most of these patients are asymptomatic and require no treatment. Care must be taken to differentiate patients with flexible flatfeet from those with rigid deformity that may have underlying pathology and have need of treatment. Rigid flatfeet in infants may be attributable to a congenital vertical talus (CVT); whereas those in older children and adolescents may be due to an underlying tarsal coalition. We performed a review of the recent literature regarding evaluation and management of pediatric flatfeet to discuss new findings and suggest areas where further research is needed.
METHODS
We searched the PubMed database for all papers related to the treatment of pediatric flatfoot, tarsal coalition, and CVT published from January 1, 2011 to December 31, 2014, yielding 85 English language papers.
RESULTS
A total of 18 papers contributed new or interesting findings.
CONCLUSIONS
The pediatric flexible flatfoot (FFF) remains poorly defined, making the understanding, study, and treatment of the condition extremely difficult.Pediatric FFF is often unnecessarily treated. There is very little evidence for the efficacy of nonsurgical intervention to affect the shape of the foot or to influence potential long-term disability for children with FFF. The treatment of tarsal coalition remains challenging, but short-term and intermediate-term outcome studies are satisfactory, whereas long-term outcome studies are lacking. Management of the associated flatfoot deformity may be as important as management of the coalition itself. The management of CVT is still evolving; however, early results of less invasive treatment methods seem promising.
LEVEL OF EVIDENCE
Level 4-literature review.
Topics: Adolescent; Child; Flatfoot; Humans; Orthopedic Procedures
PubMed: 26296215
DOI: 10.1097/BPO.0000000000000582 -
International Orthopaedics Apr 2023To analyze the results of a conservative method for treating congenital vertical talus in children with early start and to know in which cases surgical treatment was...
PURPOSE
To analyze the results of a conservative method for treating congenital vertical talus in children with early start and to know in which cases surgical treatment was needed.
METHODS
A retrospective analysis of all children diagnosed with idiopathic vertical talus was carried out during the years 2008-2021. Thirty-two children (46 feet) were finally included. Children were treated with serial manipulations, muscle stimulation, and corrective bandages. Age at the time of initiation of treatment, duration of treatment, and correction or not of the deformity without surgical intervention were recorded as variables of interest. The talocalcaneal angle, TAMBA, and ankle range of motion were measured before treatment, after treatment, and at the end of the follow-up period. Statistics decision tree was used to determine which variable best discriminated whether the patient needed surgery. To complement the tree diagram, a two-step cluster analysis was carried out.
RESULTS
After treatment, TAMBA and talocalcaneal angle changed from "vertical" to "oblique" category in 45 and 37 feet, respectively. The pathological dorsal flexion of the ankle changed to normal in 37 feet and ankle plantar flexion was normal in 46 feet. These variables showed significant changes between the three measurement moments. The results of the statistics decision tree and cluster analysis indicate that "No surgery" was associated with an age equal to or lower than one week when treatment was started, and with an ankle plantar flexion range of motion lower than 36°.
CONCLUSIONS
The beginning of this conservative treatment in the first week of life and having a plantar flexion of the ankle lower than 36° were related to the success of the treatment without surgery.
Topics: Child; Humans; Infant, Newborn; Follow-Up Studies; Flatfoot; Retrospective Studies; Talus; Orthopedic Procedures; Treatment Outcome
PubMed: 36629851
DOI: 10.1007/s00264-022-05685-7 -
Foot and Ankle Clinics Sep 2017In symptomatic patients, undercorrection of a flatfoot deformity can lead to the need for revision surgery to restore functional mechanics and prevent progression of... (Review)
Review
In symptomatic patients, undercorrection of a flatfoot deformity can lead to the need for revision surgery to restore functional mechanics and prevent progression of deformity. The underlying cause of undercorrection is failure to fully recognize or understand the extent of the deformity. This article discusses the typical deformities in adult flatfoot and indications for surgical intervention. Also presented are the surgical procedures for the correction of the typical deformity patterns with available outcome statistics and a stepwise algorithm for patient evaluation to assist in treatment and mitigate the risk of undercorrection of deformity.
Topics: Adult; Algorithms; Arthrodesis; Calcaneus; Disease Progression; Flatfoot; Foot Deformities, Acquired; Humans; Ligaments, Articular; Osteotomy; Postoperative Complications; Reoperation
PubMed: 28779811
DOI: 10.1016/j.fcl.2017.04.003 -
Foot and Ankle Clinics Mar 2022This article introduces novel types of ankle arthritis related to a flatfoot deformity. There has been a long-held belief that severe unmanaged flatfoot deformity leads... (Review)
Review
This article introduces novel types of ankle arthritis related to a flatfoot deformity. There has been a long-held belief that severe unmanaged flatfoot deformity leads to valgus ankle arthritis, due to deltoid ligament insufficiency. However, flatfoot deformity can also give rise to varus ankle arthritis as the talus and calcaneus subluxate into opposite directions. Plantarflexion and posterior translation of the talus in the sagittal plane contributes to the eccentric narrowing of the posterior aspect of the tibiotalar joint, which the authors termed posterior ankle arthritis. Subtalar arthrodesis was performed to address the opposing dynamics of the talus and calcaneus, and was combined with a medial longitudinal arch reconstruction in most cases of posterior ankle arthritis and in selected cases of varus ankle arthritis, and satisfactory clinical and radiological results were achieved.
Topics: Ankle; Ankle Joint; Arthritis; Arthrodesis; Flatfoot; Humans
PubMed: 35219360
DOI: 10.1016/j.fcl.2021.11.010 -
Clinics in Podiatric Medicine and... Jul 2022The fibrocartilage within the superomedial calcaneonavicular (spring) ligament is part of an interwoven complex of ligaments that span the ankle, subtalar, and... (Review)
Review
The fibrocartilage within the superomedial calcaneonavicular (spring) ligament is part of an interwoven complex of ligaments that span the ankle, subtalar, and talonavicular joints. Acute isolated rupture of the spring ligament has been reported in association with an eversion ankle sprain. Attenuation and failure of the spring ligament causes complex 3D changes called the progressive collapsing foot deformity (PCFD). This deformity is characterized by hindfoot eversion, forefoot supination, collapse of the medial longitudinal arch, and forefoot abduction. Nonoperative treatment of an isolated spring ligament rupture and PCFD using various designs of orthoses have shown promising results.
Topics: Ankle; Flatfoot; Foot; Foot Deformities, Acquired; Humans; Ligaments, Articular
PubMed: 35717063
DOI: 10.1016/j.cpm.2022.02.007 -
Clinics in Podiatric Medicine and... Apr 2022The correction of the flexible pes planovalgus foot and ankle is a complicated and somewhat controversial topic. After conservative methods fail, there is a wide range... (Review)
Review
The correction of the flexible pes planovalgus foot and ankle is a complicated and somewhat controversial topic. After conservative methods fail, there is a wide range of possible soft tissue and bony procedures. The appropriate work up and understanding of the pathomechanics are vital to the correct choice of procedures to correct these deformities. Once the work up and procedure selection are done, the operation must also be technically performed well and with efficiency, as most often the condition is corrected with a variety of procedures. This article discusses some of the most common procedures necessary to fully correct the pes planovalgus foot and discusses the authors' technique and pearls.
Topics: Ankle Joint; Flatfoot; Humans; Osteotomy
PubMed: 35365324
DOI: 10.1016/j.cpm.2021.11.010 -
Journal of Orthopaedic Surgery and... Apr 2023Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is dorsiflexed and forefoot is abducted due to a fixed dorsal...
Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is dorsiflexed and forefoot is abducted due to a fixed dorsal dislocation of the navicular on the head of the talus and the cuboid on the anterior part of the calcaneus. The epidemiology and etiology of vertical talus is unknown. Dobbs et al. (J Bone Joint Surg Am 88(6):1192-200, 2006) described a minimally invasive alternative which allowed to avoid the need for extensive soft tissue release procedures in treatment of congenital vertical talus. Eleven congenital vertical talus feet (group 5 according to Hamanishi) in eight children (four boys and four girls) constituted the study material. Upon the diagnosis, the patients' age ranged from 5 to 26 months old (the mean - 14.6). The treatment involved serial manipulation and casting according to the reverse Ponseti method (from 4 to 7 casts) followed by a minimally invasive approach consisting in temporary stabilization of the talonavicular joint with the use of K-wire and Achilles tenotomy according to the Dobbs technique. Then patients continued the shoe and bar program for 2 years. The X-ray measurements on lateral radiographic included the talocalcaneal angle, tibiotalar angle and talar axis-first metatarsal base angle whereas AP radiographic images-the talocalcaneal angle and talar axis-first metatarsal angle. The Wilcoxon test was used to compare dependent variables. The final clinical assessment made during the last follow-up (the mean: 35.8 months, the range: 25-52) revealed that neutral position of the foot and normal range of motion were observed in ten cases and recurrence of foot deformity in one case. The last X-ray examination showed normalization all of radiological parameters, except for one case, and examined parameters were statistically significant. The minimally invasive technique described by Dobbs should be the first option in treatment of congenital vertical talus. It allows to reduce the talonavicular joint, brings good results and preserves foot mobility. The attention should be put on early diagnosis.
Topics: Male; Child; Female; Humans; Infant; Child, Preschool; Flatfoot; Follow-Up Studies; Foot Deformities, Congenital; Talus; Foot Deformities
PubMed: 37069684
DOI: 10.1186/s13018-023-03708-6 -
Journal of Pediatric OrthopedicsThis paper aims to report on the last 5 years of relevant research on pediatric foot and ankle pathology with specific focus on clubfoot, congenital vertical talus, toe... (Review)
Review
BACKGROUND
This paper aims to report on the last 5 years of relevant research on pediatric foot and ankle pathology with specific focus on clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans.
METHODS
The Browzine platform was used to review the table of contents for all papers published in the following target journals related to the treatment of pediatric foot and ankle conditions. Search results were further refined to include clinical trials and randomized controlled trials published from March 1, 2015 to November 15, 2021.
RESULTS
A total of 73 papers were selected for review based on new findings and significant contributions in treatment of clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Also included were several papers that did not fit into any of these categories but provided new insight into specific foot and ankle pathologies.
CONCLUSIONS
Treatment strategies for children with foot and ankle pathology are continually evolving. We review many of the most recent publications with the goal of improving understanding of these pathologies and highlighting current best practices.
LEVEL OF EVIDENCE
Level III.
Topics: Ankle; Child; Clubfoot; Flatfoot; Foot Diseases; Humans; Osteochondritis Dissecans; Tarsal Bones; Tarsal Coalition
PubMed: 35405728
DOI: 10.1097/BPO.0000000000002134