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Clinics in Podiatric Medicine and... Apr 2023A stable medial column is important to the normal function of the foot and ankle. Medial column instability and forefoot varus can result in compensatory hindfoot motion... (Review)
Review
A stable medial column is important to the normal function of the foot and ankle. Medial column instability and forefoot varus can result in compensatory hindfoot motion leading to stress along the medial soft-tissue structures. Medial column stabilization should therefore be considered when (1) forefoot varus deformity is identified following hindfoot realignment; (2) pronounced medial column instability is present, even in the absence of forefoot varus; and (3) when degenerative changes are present within the medial column articulations. Common surgical procedures include arthrodesis of the talonavicular joint, naviculocuneiform joint, and first tarsometatarsal joint, as well as osteotomy of the medial cuneiform (Cotton osteotomy).
Topics: Humans; Flatfoot; Tarsal Bones; Foot Joints; Osteotomy; Arthrodesis
PubMed: 36841579
DOI: 10.1016/j.cpm.2022.11.003 -
Clinics in Podiatric Medicine and... Apr 2023Reconstructive surgery of the symptomatic pes planus deformity is a very common procedure with relatively good outcomes. Many factors such as patient selection, patient... (Review)
Review
Reconstructive surgery of the symptomatic pes planus deformity is a very common procedure with relatively good outcomes. Many factors such as patient selection, patient expectations, and surgical execution can influence the results. In addition to achieving osseous union, the overall postoperative alignment is critical in determining functional outcome. Specifically, under- and over-correction respectively present their own unique problems and symptomatology. The purpose of this review is to discuss the adverse outcomes after mal-reduction of flatfoot reconstruction and emphasize the strategies to correct the subsequent deformity.
Topics: Humans; Flatfoot; Foot Deformities, Acquired; Plastic Surgery Procedures
PubMed: 36841585
DOI: 10.1016/j.cpm.2022.11.005 -
The Journal of the American Academy of... Jan 2022Adult acquired flatfoot deformity (AAFD) is a condition commonly seen by orthopaedic surgeons. Posterior tibial tendon dysfunction is thought to be the initial...
Adult acquired flatfoot deformity (AAFD) is a condition commonly seen by orthopaedic surgeons. Posterior tibial tendon dysfunction is thought to be the initial pathoanatomic etiology that leads to this deformity. Successful resolution of the pain associated with AAFD can be achievable with nonsurgical methods. Patients who continue to have pain or functional limitations despite nonsurgical treatment can find improvement with appropriately selected surgical interventions. This article addresses new advances in treatment based on the stage of AAFD and will identify areas of continued development with a focus on surgical management. The literature continues to evolve as demonstrated by a recent update regarding the nomenclature and treatment of this condition to progressive collapsing flatfoot deformity. Future goals of research include understanding the natural history of the disease, from asymptomatic to symptomatic, and studying a wide array of newer treatments and implants that have not been prospectively evaluated.
Topics: Flatfoot; Humans; Pain; Prostheses and Implants
PubMed: 34932505
DOI: 10.5435/JAAOS-D-21-00008 -
Instructional Course Lectures 2015Flatfoot in a child may be normal before development of the arch, but the prevalence decreases with age. Treatment is indicated only in the presence of pain and should... (Review)
Review
Flatfoot in a child may be normal before development of the arch, but the prevalence decreases with age. Treatment is indicated only in the presence of pain and should begin with nonsurgical management options such as stretching of the Achilles tendon and the use of soft shoe orthotics. If pain persists, a modified Evans procedure, together with additional procedures to address forefoot supination, can be successful in correcting deformity and addressing pain. A thorough understanding of the pathology and correction desired will help minimize complications and recurrence. If neuromuscular pathology is present, treatment principles are altered and greatly depend on the severity of the deformity, the association of tibialis posterior spasticity, and ambulatory status. In mild to moderate pathology in walking patients with cerebral palsy, osteotomies can be successful. Various forms of arthrodesis can decrease recurrence when the deformity is severe in a nonambulatory patient with cerebral palsy and a symptomatic valgus foot deformity. In cases of collagen disorders, where soft-tissue laxity complicates management, deformity correction may be of higher importance. Overall alignment always should be evaluated and corrected when necessary to optimize the outcome in patients with valgus foot deformities. The successful treatment of flexible or rigid flatfoot deformity must take into account underlying pathology to optimize outcomes.
Topics: Diagnostic Imaging; Disease Management; Flatfoot; Humans; Orthopedic Procedures
PubMed: 25745926
DOI: No ID Found -
International Orthopaedics Sep 2023Although flatfoot is a widespread human condition, historical medical texts and ancient illustrations on this deformity are extremely rare. Nowadays, doubts regarding... (Review)
Review
PURPOSE
Although flatfoot is a widespread human condition, historical medical texts and ancient illustrations on this deformity are extremely rare. Nowadays, doubts regarding its management remain unsolved. This historical review aims to identify the presence of pes planus since the prehistoric era and examine the treatments proposed over the centuries up to the present.
METHOD
For this propose, we performed an extensive electronic search of the relevant literature, complemented by a manual search of additional sources from archaeological to artistic, literary, historical, and scientific accounts, describing flatfoot and its treatment in different eras.
RESULTS
Flatfoot accompanied the evolutionary timeline of human species: from Lucy Australopithecus to Homo Sapiens. It was described among various diseases suffered by Tutankhamun (1343-1324 B.C.), while the first anatomical description dates to Emperor Trajan (53-117 A.D.) and the medical studies of Galen (129-201 A.D.). It was also represented in the anatomical drawings of Leonardo da Vinci (1452-1519) and Girolamo Fabrici d'Acquapendente (1533-1619). Historically, the conservative treatment by insoles was the only one proposed until the nineteenth century. Since then, the most popular surgical procedures performed for correction have been osteotomies, arthrodesis, arthrorisis, and tendon lengthening and transfer.
CONCLUSION
During the centuries, conservative therapeutic strategies have not radically changed in their substance, while operative ones have become the protagonists during the twentieth century up to the present. Nevertheless, after more than 2000 years of history, there is no consensus regarding the best indication for the flatfoot and if it really needs to be treated.
Topics: Humans; Arthrodesis; Flatfoot; Osteotomy; Tendon Transfer
PubMed: 37222816
DOI: 10.1007/s00264-023-05837-3 -
Foot and Ankle Clinics Sep 2017Stage II posterior tibial tendon dysfunction encompasses a wide range of patients with varying degrees of deformity and function. The spectrum of patients can be... (Review)
Review
Stage II posterior tibial tendon dysfunction encompasses a wide range of patients with varying degrees of deformity and function. The spectrum of patients can be difficult to treat with a single surgical approach, as evidenced by the wide range of techniques present in the literature. Severity of the deformity, patient functional level, age, and comorbidities must be considered to determine the best course of treatment. This article examines when fusion versus reconstruction is the appropriate treatment of patients with severe stage II posterior tibial tendon dysfunction and its subclassifications.
Topics: Adult; Age Factors; Arthrodesis; Female; Flatfoot; Foot Deformities, Acquired; Humans; Male; Posterior Tibial Tendon Dysfunction
PubMed: 28779813
DOI: 10.1016/j.fcl.2017.04.002 -
Foot and Ankle Clinics Sep 2017Deltoid ligament reconstruction allows for joint preservation of the ankle in the setting of patients a triple arthrodesis due to a flat foot deformity. Although the... (Review)
Review
Deltoid ligament reconstruction allows for joint preservation of the ankle in the setting of patients a triple arthrodesis due to a flat foot deformity. Although the increased forces that may occur in the ankle joint after a triple arthrodesis cannot be eliminated, reconstruction of the ligament will delay and may prevent the onset arthritis, allowing the patient to maintain mobility of the ankle joint. The anatomy, surgery, and risks and benefits are discussed.
Topics: Ankle Joint; Arthrodesis; Collateral Ligaments; Flatfoot; Humans; Plastic Surgery Procedures
PubMed: 28779803
DOI: 10.1016/j.fcl.2017.04.001 -
Foot and Ankle Clinics Sep 2017Understanding of the complexities of the adult acquired pathologic flatfoot has undergone serious evolution in the past 30 years to an understanding of the subtleties of... (Review)
Review
Understanding of the complexities of the adult acquired pathologic flatfoot has undergone serious evolution in the past 30 years to an understanding of the subtleties of what causes the different presentations and drives successful treatment. As the treatment of ankle arthritis evolves from fusion to ankle replacement, the need for answers for the difficult patient with valgus degenerative ankle disease begs a look at what causes this form of flatfoot. This article poses the question, is there a subset of patients with "flatfoot" that has little to do with the foot and is all about the ankle?
Topics: Adult; Ankle Injuries; Ankle Joint; Collateral Ligaments; Disease Progression; Flatfoot; Foot Deformities, Acquired; Humans; Sprains and Strains
PubMed: 28779809
DOI: 10.1016/j.fcl.2017.04.012 -
Clinics in Podiatric Medicine and... Jan 2020Understanding of medial column biomechanics is paramount to a successful outcome in both conservative and surgical treatment. Dysfunctions of the dynamic stabilizers as... (Review)
Review
Understanding of medial column biomechanics is paramount to a successful outcome in both conservative and surgical treatment. Dysfunctions of the dynamic stabilizers as well as the static stabilizers of the medial column play a role in pathomechanics. Conservative options for addressing the medial column include custom foot orthotics and bracing. Options for addressing the medial column surgically with the goal to restore a stable tripod configuration, include first tarsometatarsal joint arthrodesis, opening plantarflexory medial cuneiform osteotomy, and naviculocuneiform arthrodesis.
Topics: Arthrodesis; Flatfoot; Foot Joints; Foot Orthoses; Humans; Osteotomy; Tarsal Bones
PubMed: 31735268
DOI: 10.1016/j.cpm.2019.08.004 -
Archives of Orthopaedic and Trauma... Nov 2022Progressive collapsing foot deformity (PCFD) is a complex 3-dimensional (3-D) deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot varus.... (Review)
Review
BACKGROUND
Progressive collapsing foot deformity (PCFD) is a complex 3-dimensional (3-D) deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot varus. The first aim of this study was to perform a 3-D analysis of the talus morphology between symptomatic PCFD patients that underwent operative flatfoot correction and controls. The second aim was to investigate if there is an impact of individual talus morphology on the success of operative flatfoot correction.
METHODS
We reviewed all patients that underwent lateral calcaneal lengthening for correction of PCFD between 2008 and 2018 at our clinic. Radiographic flatfoot parameters on preoperative and postoperative radiographs were assessed. Additionally, 3-D surface models of the tali were generated using computed tomography (CT) data. The talus morphology of 44 flatfeet was compared to 3-D models of 50 controls without foot or ankle pain of any kind.
RESULTS
Groups were comparable regarding demographics. Talus morphology differed significantly between PCFD and controls in multiple aspects. There was a 2.6° increased plantar flexion (22.3° versus 26°; p = 0.02) and medial deviation (31.7° and 33.5°; p = 0.04) of the talar head in relation to the body in PCFD patients compared to controls. Moreover, PCFD were characterized by an increased valgus (difference of 4.6°; p = 0.01) alignment of the subtalar joint. Satisfactory correction was achieved in all cases, with an improvement of the talometatarsal-angle and the talonavicular uncoverage angle of 5.6° ± 9.7 (p = 0.02) and 9.9° ± 16.3 (p = 0.001), respectively. No statistically significant correlation was found between talus morphology and the correction achieved or loss of correction one year postoperatively.
CONCLUSION
The different morphological features mentioned above might be contributing or risk factors for progression to PCFD. However, despite the variety of talar morphology, which is different compared to controls, the surgical outcome of calcaneal lengthening osteotomy was not affected.
LEVEL OF EVIDENCE
III.
Topics: Calcaneus; Flatfoot; Foot; Humans; Osteotomy; Talus
PubMed: 33970321
DOI: 10.1007/s00402-021-03925-w