-
Foot and Ankle Clinics Dec 2022Progressive collapsing foot deformity (PCFD; commonly referred to as flatfoot deformity) is a complex condition classically characterized by hindfoot valgus, midfoot... (Review)
Review
Progressive collapsing foot deformity (PCFD; commonly referred to as flatfoot deformity) is a complex condition classically characterized by hindfoot valgus, midfoot abduction, and forefoot varus. Medial column arthrodesis can be used to reliably correct severe, arthritic, and unstable PCFD involving the medial column. Although both naviculocuneiform arthrodesis and talonavicular arthrodesis have their own indications, patient selection and careful radiographic and clinical assessment are crucial for any medial column arthrodesis. Herein, the authors discuss the indications for medial column arthrodesis procedures, outcomes as reported in the literature, and several case examples using medial column arthrodesis in deformity correction.
Topics: Humans; Flatfoot; Foot Deformities, Acquired; Arthrodesis; Foot Joints; Foot Deformities
PubMed: 36368796
DOI: 10.1016/j.fcl.2022.08.006 -
Foot & Ankle Specialist Aug 2022
Topics: Flatfoot; Foot Deformities; Foot Deformities, Acquired; Humans
PubMed: 35912414
DOI: 10.1177/19386400221115224 -
Clinics in Podiatric Medicine and... Apr 2023The adult-acquired flatfoot is a complex multiplanar deformity that requires the foot and ankle surgeon to balance soft tissue, correct hindfoot valgus, and address... (Review)
Review
The adult-acquired flatfoot is a complex multiplanar deformity that requires the foot and ankle surgeon to balance soft tissue, correct hindfoot valgus, and address instability of the medial column. The naviculocuneiform joint is historically underappreciated in regard to its involvement in medial column instability relative to the talonavicular and tarsometatarsal joints. Proper clinical and radiographic evaluation of the medial column, specifically evaluating for deformity at each medial column joint, will allow the surgeon to ensure correction of deformity and decrease the recurrence of instability or failure of the reconstruction.
Topics: Adult; Humans; Flatfoot; Arthrodesis; Foot Joints; Osteotomy; Ankle
PubMed: 36841580
DOI: 10.1016/j.cpm.2022.11.004 -
Foot and Ankle Clinics Sep 2021Progressive collapsing foot deformity is one of the most controversial topics in foot and ankle surgery. Much research has been done regarding anatomy, biomechanics, and... (Review)
Review
Progressive collapsing foot deformity is one of the most controversial topics in foot and ankle surgery. Much research has been done regarding anatomy, biomechanics, and etiology behind this complex deformity and there is interest in studying metabolic or genetic conditions that could influence the development of this multifactorial disorder. Relevant anatomy includes osseous and soft tissue structures. Several risk factors like obesity, genetics, and flat foot during childhood have been proposed in literature. It occurs 3 times more often in women, the peak incidence happening at age 55, and is more common in white, obese, diabetic, rheumatic, and hypertensive patients.
Topics: Biomechanical Phenomena; Female; Flatfoot; Humans; Middle Aged; Risk Factors
PubMed: 34332726
DOI: 10.1016/j.fcl.2021.05.006 -
Orthopaedics & Traumatology, Surgery &... Feb 2019Idiopathic pes planus is common and usually physiologic. Decompensation, when it occurs, may be obvious or on the contrary difficult to identify, raising challenges in... (Review)
Review
Idiopathic pes planus is common and usually physiologic. Decompensation, when it occurs, may be obvious or on the contrary difficult to identify, raising challenges in patient selection for surgical treatment. The physical examination of a child with pes planus must include an evaluation in the supine position, which helps to adjust the amount of correction during surgery. The many reported surgical procedures include repositioning (talus-reseating, subtalar implants and calcaneo-stop screw), osteotomies and joint fusions. The primary treatment goal is to achieve full architectural correction of the deformity. Selection of the procedure depends on patient age and reducibility of the deformity. The joint lines should be preserved whenever possible. Triceps surae contracture should be sought and corrected if found.
Topics: Arthrodesis; Child; Flatfoot; Humans; Joint Prosthesis; Osteotomy; Patient Selection; Physical Examination; Postoperative Care; Preoperative Care; Radiography; Subtalar Joint; Tarsal Bones
PubMed: 29709656
DOI: 10.1016/j.otsr.2018.03.010 -
Foot and Ankle Clinics Dec 2022A flatfoot deformity is a multiplanar foot deformity characterized by forefoot abduction and supination and hindfoot valgus. With progressive pathology, a rigid... (Review)
Review
A flatfoot deformity is a multiplanar foot deformity characterized by forefoot abduction and supination and hindfoot valgus. With progressive pathology, a rigid deformity may develop. In the setting of a rigid deformity, the appropriate procedure to use is not without controversy. The extent of joints to involve in the arthrodesis depends on the ability to obtain a plantigrade foot. Both double and triple arthrodesis have been suggested. Care must be taken to avoid lateral column shortening and loss of foot reduction when fusing the CC joint. The concerns about lateral skin breakdown led some surgeons to describe a single medial incision for a triple or modified double arthrodesis. The necessity of bone grafting has been controversial. Implant selection is essential to achieve solid stabilization of the arthrodesis sites. To decrease the risk of overcorrection and malunion, the surgeon should be familiar with the hindfoot biomechanics and generate, based on the clinical examination and imaging, a meticulous preoperative plan to address and balance both the soft tissue and bony deformity.
Topics: Humans; Flatfoot; Arthrodesis; Foot Deformities; Tarsal Coalition; Foot; Tarsal Joints
PubMed: 36368798
DOI: 10.1016/j.fcl.2022.08.003 -
Foot and Ankle Clinics Sep 2014Although a painful accessory navicula and a pes planus often coexist, they are not necessarily causally related, and each condition should be assessed and treated... (Review)
Review
Although a painful accessory navicula and a pes planus often coexist, they are not necessarily causally related, and each condition should be assessed and treated individually. A child or adolescent will notice the rubbing of an accessory navicula against footwear as the foot and boney swelling grows. The cause of persistent local pain such as inadequate bony resection, scar pain, irritation of the tibialis posterior tendon, and so forth should be sought and addressed; management will depend on the specific presentation and previous procedure performed. The cause of the ongoing pain should be investigated.
Topics: Flatfoot; Foot; Foot Diseases; Humans; Pain; Radiography; Tarsal Bones
PubMed: 25129360
DOI: 10.1016/j.fcl.2014.06.010 -
Archives of Orthopaedic and Trauma... Nov 2023Overcorrection is a possible complication of clubfoot treatment, whose prevalence varies from 5 to 67%. Overcorrected clubfoot usually presented as a complex flatfoot...
INTRODUCTION
Overcorrection is a possible complication of clubfoot treatment, whose prevalence varies from 5 to 67%. Overcorrected clubfoot usually presented as a complex flatfoot with different degrees of hindfoot valgus, flat top talus, dorsal bunion, and dorsal navicular subluxation. The management of clubfoot overcorrection is challenging, and both conservative and surgical treatments are available. This study aims to present our experience in the surgical management of overcorrected clubfoot and to provide an overview of actual treatment options for each specific sub-deformity.
MATERIALS AND METHODS
A retrospective cohort study of patients surgically treated for an overcorrected clubfoot from 2000 to 2015 at our Institution was conducted. Surgical procedures were tailored to the type and symptomatology of the deformity. A medializing calcaneal osteotomy or subtalar arthrodesis was performed for hindfoot valgus. Subtalar and/or midtarsal arthrodesis were considered in cases of dorsal navicular subluxation. The first metatarsus elevatus was addressed through a proximal plantarflexing osteotomy, sometimes associated with a tibialis anterior tendon transfer. Clinical scores and radiographic parameters were obtained pre-operatively and at the last follow-up.
RESULTS
Fifteen consecutive patients were enrolled. The series included 4 females and 11 males, with a mean age at surgery of 33,1 (18-56) years, and a mean follow-up of 4,46 (2-10) years. Seven medializing calcaneal osteotomies, 5 subtalar arthrodesis, 11 first metatarsal plantarflexing osteotomies, and 7 anterior tibialis tendon transfers were performed. A statistically significant improvement in both clinical and radiographic scores was observed.
CONCLUSIONS
Management of overcorrected clubfoot involves many surgical techniques because of the high interpersonal variability of the deformities. The surgical approach showed positive results, as long as the indication is based on clinical symptoms and functional impairment rather than morphological alterations and radiographic findings.
Topics: Male; Female; Humans; Clubfoot; Retrospective Studies; Foot; Osteotomy; Talus; Flatfoot
PubMed: 37318629
DOI: 10.1007/s00402-023-04946-3 -
Journal of Orthopaedic Science :... Mar 2017This study describes the management of foot deformity in children. Severe congenital clubfeet treated using posteromedial release without talocalcaneal joint release...
This study describes the management of foot deformity in children. Severe congenital clubfeet treated using posteromedial release without talocalcaneal joint release were flexible and functional. Talectomy may be necessary for congenital clubfeet with arthrogryposis multiplex congenita. The diagnosis and severity of vertical talus were defined based on stress radiographs. For the deformity with spina bifida, a combination of talocalcaneal joint fusion and precise correction by soft tissue release and tendon transfer was performed. This combined surgery is effective, particularly in patients with equino-varus feet.
Topics: Arthrogryposis; Child; Child, Preschool; Clubfoot; Flatfoot; Follow-Up Studies; Foot Deformities, Congenital; Humans; Orthopedic Procedures; Radiography; Recovery of Function; Risk Assessment; Treatment Outcome
PubMed: 28081930
DOI: 10.1016/j.jos.2016.12.009 -
Der Orthopade Nov 2020In the case of a rigid flatfoot deformity, joint-preserving techniques like soft-tissue balancing and osteotomies do not achieve acceptable results. This is the... (Review)
Review
In the case of a rigid flatfoot deformity, joint-preserving techniques like soft-tissue balancing and osteotomies do not achieve acceptable results. This is the indication for arthrodesis. The selection of the arthrodesis depends on the amount of deformity, localisation of the rigidity and the general health status of the patient. Isolated arthrodesis can be combined with soft-tissue reconstructions. It is functionally advantageous to preserve as many joints as possible.
Topics: Arthrodesis; Flatfoot; Humans; Osteotomy; Plastic Surgery Procedures; Treatment Outcome
PubMed: 32995906
DOI: 10.1007/s00132-020-03994-6