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The Journal of Bone and Joint Surgery.... Aug 2015The most common historical treatment method for congenital vertical talus is extensive soft-tissue release surgery. A minimally invasive treatment approach that relies... (Comparative Study)
Comparative Study
BACKGROUND
The most common historical treatment method for congenital vertical talus is extensive soft-tissue release surgery. A minimally invasive treatment approach that relies primarily on serial cast correction was introduced almost ten years ago, with promising early results. The purpose of this study was to assess the long-term outcome of patients with congenital vertical talus managed with the minimally invasive technique and compare them with a cohort treated with extensive soft-tissue release surgery.
METHODS
The records of twenty-seven consecutive patients with vertical talus (forty-two feet) were retrospectively reviewed at a mean of seven years (range, five to 11.3 years) after initial correction was achieved. The minimally invasive method was used to treat sixteen patients (twenty-four feet), and extensive soft-tissue release surgery was used to treat eleven patients (eighteen feet). Patient demographics, ankle range of motion, the PODCI (Pediatric Outcomes Data Collection Instrument) questionnaire, and radiographic measurements were analyzed.
RESULTS
At the latest follow-up, the mean range of motion of patients treated with the minimally invasive method was 42.4° compared with 12.7° for patients treated with extensive surgery (p < 0.0001). The PODCI normative pain and global function scores were superior in the minimally invasive treatment group compared with the extensive soft-tissue release group. Greater correction of hindfoot valgus (anteroposterior talar axis-first metatarsal base angle) was achieved in the minimally invasive treatment group compared with the extensive surgery group (40.1° versus 27.9°, p = 0.03), although all other radiographic values were similar between the two groups (p > 0.1 for all). Subgroup analysis of patients with isolated vertical talus also showed superior range of motion and PODCI normative global function scores in the minimally invasive group.
CONCLUSIONS
The minimally invasive treatment method for vertical talus resulted in better long-term ankle range of motion and pain scores compared with extensive soft-tissue release surgery. Longer-term studies are necessary to determine whether the improved outcomes are maintained into adulthood and whether the superior outcome is related to reduced scarring.
Topics: Analysis of Variance; Casts, Surgical; Female; Flatfoot; Follow-Up Studies; Foot Deformities, Congenital; Humans; Infant; Joint Capsule Release; Male; Minimally Invasive Surgical Procedures; Orthopedic Procedures; Pain Measurement; Radiography; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Risk Assessment; Therapy, Soft Tissue; Time Factors; Treatment Outcome
PubMed: 26290087
DOI: 10.2106/JBJS.N.01002 -
Der Orthopade Nov 2020On average, one in six adults is affected by an acquired flatfoot. This foot deformity is characterized by its progression of stages and in 10% of cases causes... (Review)
Review
BACKGROUND
On average, one in six adults is affected by an acquired flatfoot. This foot deformity is characterized by its progression of stages and in 10% of cases causes complaints that require treatment. Untreated, the loss of walking ability may result in the final stage. Correct staging is crucial to being able to offer a specific course of therapy including a wide spectrum of conservative and operative treatments.
MATERIAL AND METHODS
This review is based on pertinent publications retrieved from a selective search in PubMed and Medline and on the authors' clinical experience.
DIAGNOSTICS
The loss of function of static (spring ligament complex) and dynamic (tibialis posterior tendon) stabilizers causes the characteristic deformity with loss of the medial arch, hind foot valgus and forefoot abduction. In the late stage, severe secondary osteoarthritis in upper and lower ankle joints occurs and impedes walking ability. The essential physical examination is supplemented by weight-bearing dorsoplantar and lateral radiographs, which provide further information about axial malalignment (Meary's angle, Kite's angle). The long axis hind foot view allows analysis of the hindfoot valgus. MRI provides further information about the integrity of the tibialis posterior tendon, spring ligament complex and cartilage damage.
THERAPY
The therapy aims to reduce pain, regain function and avoid development of secondary osteoarthritis and degenerative tendon disorders. Progress of the deformity should be stopped. Therefore, the main aspects of the deformity-loss of medial arch, hindfoot valgus and forefoot abduction should be addressed and corrected. In the acute phase, tendovaginitis of the tibialis posterior tendon can be treated sufficiently by anti-inflammatory measures, relieving mechanical loads on the tendon and muscle and physiotherapy.
Topics: Adult; Conservative Treatment; Flatfoot; Foot Deformities, Acquired; Humans; Ligaments, Articular; Tendons
PubMed: 33034668
DOI: 10.1007/s00132-020-03995-5 -
Journal of Pediatric Orthopedics. Part B Sep 2021The aim of the study was to compare the clinical, radiological and functional outcomes between idiopathic and non-idiopathic congenital vertical talus (CVT) treated with...
The aim of the study was to compare the clinical, radiological and functional outcomes between idiopathic and non-idiopathic congenital vertical talus (CVT) treated with soft tissue release. All the consecutive cases with CVT treated with soft tissue release were prospectively followed up. Indication for soft tissue release was either late presented or failed serial manipulation and cast application. Nineteen children (33 feet) with a minimum follow-up of 2 years following the soft tissue release (the mean 5.5 years follow-up) were included. The children without any other joint involvement with the normal spine without syndromic association were categorized as idiopathic (15 feet) and the rest were categorized as non-idiopathic (18 feet). Clinical and radiological scoring was done using Adelaar and Kodros scores. The morphological, functional and radiological outcomes were assessed using the International Clubfoot Study Group evaluation scale. The clinical, radiological and functional outcomes of the idiopathic and non-idiopathic groups were compared. The range of motion was significantly higher in the idiopathic group. The functional outcome was satisfactory in both groups. All the radiological parameters improved significantly in both groups. The functional outcome was considerably better in the idiopathic group. There was no significant difference in clinical and radiological outcomes among the two groups. Soft tissue release is an effective surgery for deformity correction in children with CVT. A good clinical outcome is observed in both groups. The range of motion was significantly higher in the idiopathic group. The overall outcome was similar in both groups.
Topics: Casts, Surgical; Child; Clubfoot; Flatfoot; Follow-Up Studies; Humans; Retrospective Studies; Talus; Treatment Outcome
PubMed: 33136793
DOI: 10.1097/BPB.0000000000000815 -
JBJS Reviews Aug 2017
Review
Topics: Adult; Ankle; Conservative Treatment; Disease Management; Flatfoot; Foot; Foot Deformities, Acquired; Humans; Orthopedic Procedures
PubMed: 28806265
DOI: 10.2106/JBJS.RVW.16.00116 -
Foot and Ankle Clinics Jun 2022Managing complications of clubfoot deformities can be very challenging. Some patients present with recurrent clubfoot and residual symptoms, and some present with... (Review)
Review
Managing complications of clubfoot deformities can be very challenging. Some patients present with recurrent clubfoot and residual symptoms, and some present with overcorrection leading to a severe complex flatfoot deformity. Both can lead to long-term degenerative changes of the foot and ankle joints owing to deformity caused by unbalanced loading. This article only focuses on severe complications caused by recurrence and overcorrection in both children and adult patients.
Topics: Adult; Ankle Joint; Child; Clubfoot; Flatfoot; Humans; Treatment Outcome
PubMed: 35680301
DOI: 10.1016/j.fcl.2021.11.029 -
Foot and Ankle Clinics Jun 2022Our understanding of the cause and principles of treatment of progressive collapsing foot deformity (PCFD) has significantly evolved in recent decades. The goals of... (Review)
Review
Our understanding of the cause and principles of treatment of progressive collapsing foot deformity (PCFD) has significantly evolved in recent decades. The goals of treatment remain improvement in symptoms, correction of deformity, maintenance of joint motion, and return of function. Although notable advancements in understanding the deformity have been made, complications still occur and typically result from (1) poor decision making, (2) technical errors, and (3) patient-related conditions. In this article, we discuss common surgical modalities used in the treatment of PCFD and further highlight the common complications that occur and the techniques that can be used to prevent them.
Topics: Ankle; Arthrodesis; Flatfoot; Foot Deformities; Humans; Osteotomy
PubMed: 35680290
DOI: 10.1016/j.fcl.2021.11.018 -
Journal of Pediatric Orthopedics. Part B Jan 2023There is sparse literature evaluating the outcomes in toddlers with congenital vertical talus (CVT) deformity who undergo treatment with the recently introduced...
There is sparse literature evaluating the outcomes in toddlers with congenital vertical talus (CVT) deformity who undergo treatment with the recently introduced minimally invasive Dobbs Method. We present the first study of this patient cohort to determine the efficacy of this method in patients 18 months of age and older. A list of all patients over 18 months of age who underwent CVT correction at our institution was created. Retrospective chart review was performed, and all follow-up notes were reviewed for clinical outcomes and complications. Eligible patients completed Patient-Reported Outcome Measurement Information System (PROMIS) questionnaires. Statistical analysis was performed using an alpha of 0.05. Sixteen children (24 feet) met all inclusion criteria and were included in the final analysis. Initial radiographic correction of all measured angles was seen, but by the latest follow-up, the average lateral TAMBA had increased from 12.04 degrees immediately postoperatively to 28.8 degrees at the latest follow-up ( P = 0.0012). Radiographic recurrence of deformity was seen in 9 (37.5%) feet and additional unplanned surgery was required in 3 (12.5%) feet. Residual radiographic pes planus was seen in 5 (20.8%) feet. PROMIS pain interference and peer relationship scores were near the population mean. Although the recurrence rate in this patient population seems to be higher than that of younger patients, the majority of toddlers who undergo treatment with this method do experience successful outcomes. We recommend attempting this treatment method in toddlers before performing extensive soft tissue releases or salvage procedures.
Topics: Humans; Flatfoot; Retrospective Studies; Walking
PubMed: 36125903
DOI: 10.1097/BPB.0000000000001014 -
Foot & Ankle International Jun 2022A consensus group recently proposed the term (PCFD) and a new classification with 2 stages plus 5 classes to describe the complex array of flatfoot deformities. This...
BACKGROUND
A consensus group recently proposed the term (PCFD) and a new classification with 2 stages plus 5 classes to describe the complex array of flatfoot deformities. This study aimed to validate different diagnostic accuracy rates of the PCFD classification.
METHODS
This was a survey-based study distributed among 13 foot and ankle fellowship programs for 3 groups of participants with varied experience in practice (group 1: fellows in training, group 2: surgeons in practice for 1-4 years, and group 3: surgeons in practice for ≥5 years). Each participant was asked to assign 20 different cases of flatfoot deformity to the appropriate classes and stages using the PCFD classification. The overall diagnostic accuracy, class, and stage diagnostic accuracy rates for the 20 cases were calculated first for the entire cohort and then compared among the 3 groups. The misdiagnosis rate for each class of deformity (the sum of overdiagnosis and underdiagnosis rates) of the entire cohort was calculated and compared with the other classes. Mean and standard evidence were used to describe numerical data. One-way analysis of variance was used to compare values among the 3 groups and the 5 classes. <.05 was considered statistically significant.
RESULTS
For the whole cohort, the overall diagnostic accuracy, class diagnostic accuracy, and stage diagnostic accuracy rates were 71.0%, 78.3%, and 81.7%, respectively There was a statistically significant difference between group 1 and 2, and group 1 and 3, in overall diagnostic accuracy and class diagnostic accuracy, with no significant difference among the 3 groups regarding stage diagnostic accuracy. Class B had a significantly higher overdiagnosis rate than the rest of the classes, whereas class D was significantly underdiagnosed than others. The misdiagnosis rates for classes A to E were 3.3%, 17.5%, 11.1%, 26.0%, and 3.7%, respectively.
CONCLUSION
The PCFD classification showed overall fair diagnostic accuracy rates. The highest diagnostic accuracy was for "hindfoot valgus deformity" and "ankle instability." Further content validation of the PCFD classification is needed to examine the terminology and interpretation of those classes with low diagnostic accuracy including "midfoot/forefoot abduction deformity," "forefoot varus deformity/medial column instability," and "peritalar subluxation/dislocation." Level II, prospective comparative study.
Topics: Ankle Joint; Flatfoot; Foot Deformities; Humans; Joint Dislocations; Prospective Studies; Weight-Bearing
PubMed: 35301895
DOI: 10.1177/10711007221078000 -
Orthopaedics & Traumatology, Surgery &... Oct 2021The aim of the present systematic literature review was to determine results and complications in subtalar arthroereisis for stage-2 adult-acquired flatfoot. (Review)
Review
INTRODUCTION
The aim of the present systematic literature review was to determine results and complications in subtalar arthroereisis for stage-2 adult-acquired flatfoot.
METHOD
A search of the PubMed, Medline, CINAHL, Cochrane and Embase databases used MeSH terms "arthroereisis" AND "flatfoot" OR "adult-acquired flatfoot" OR "pes planovalgus" OR "pes planus". Two of the authors analyzed 125 articles. After reading titles and Abstracts, 105 articles were read in full text and their references were analyzed. Finally, 12 articles were selected and divided into 2 groups: isolated and associated arthroereisis.
RESULTS
Improvement in functional scores was greater in associated arthroereisis. Whether isolated or associated, arthroereisis achieved radiologic correction. However, the rate of complications was high, mainly concerning tarsal sinus pain.
CONCLUSION
Subtalar arthroereisis for stage-2 adult-acquired flatfoot is rarely performed in isolation. When it is associated to other procedures, good radiologic and clinical results can be expected.
LEVEL OF EVIDENCE
IV.
Topics: Adult; Databases, Factual; Flatfoot; Humans; Orthopedic Procedures; Pain; Radiology; Subtalar Joint
PubMed: 34216843
DOI: 10.1016/j.otsr.2021.103002 -
Journal of Pediatric OrthopedicsIn 2006, a new minimally invasive method was introduced for the definitive correction of congenital vertical talus (CVT) deformity. There are no studies to date that...
BACKGROUND
In 2006, a new minimally invasive method was introduced for the definitive correction of congenital vertical talus (CVT) deformity. There are no studies to date that have utilized the Patient-Reported Outcome Measurement Information System (PROMIS) to evaluate long-term quality of life outcomes in these patients.
METHODS
We identified all children with CVT who underwent treatment with the minimally invasive method and were seen at our institution after 2015. A retrospective chart review was then performed on these patients, and PROMIS scores were recorded for the following domains: Pain Interference, Mobility, and Peer Relations. Subgroup analysis was performed on patients who experienced recurrence and those who required a second corrective surgery. An alpha level of 0.05 was used for all analyses.
RESULTS
There were 24 children who were treated for CVT at our institution after 2015 and had completed PROMIS surveys. Seven (29.2%) of these patients developed recurrence during the follow-up period. Among the entire cohort, the mean PROMIS pain interference score was 48±9, the mean PROMIS mobility score was 42±13, and the mean PROMIS peer relations score was 54±9. There were no statistically significant differences in the PROMIS scores between the entire cohort and those who experienced radiographic recurrence in any of the 3 domains ( P >0.05). Children who initiated treatment after the age of 12 months had lower PROMIS mobility scores than those who initiated treatment before 12 months of age (32.48 vs. 47.31, P =0.02).
CONCLUSION
On average, children who undergo treatment with this technique end up within 1 SD of the reference population in all 3 domains that were measured (pain interference, mobility, and peer relations) regardless of sex, age, and status of recurrence. However, there was a trend towards lower mobility scores in this population compared with the reference population (42±13 vs. 50±10). Treatment should be initiated at less than 12 months of age whenever possible to maximize patient-reported outcomes.
LEVEL OF EVIDENCE
Level III.
Topics: Child; Flatfoot; Humans; Infant; Pain; Patient Reported Outcome Measures; Quality of Life; Retrospective Studies
PubMed: 36053022
DOI: 10.1097/BPO.0000000000002259