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Cureus Jan 2022Arthroereisis is a surgical procedure primarily used to treat flexible pes planus (flatfoot) in pediatric and young adult patients. The principal goal of subtalar... (Review)
Review
Arthroereisis is a surgical procedure primarily used to treat flexible pes planus (flatfoot) in pediatric and young adult patients. The principal goal of subtalar arthroereisis is to relieve pain and restore function. This is primarily done by restoring the medial foot arch without fusing the subtalar joint and without requiring a long recovery period needed after osteotomies. Although the procedure can be performed in isolation to treat flexible flatfoot, it can also be performed as an ancillary in the treatment of tarsal coalition, posterior tibial tendon dysfunction, and accessory navicular syndrome. Various implants and multiple surgical techniques exist for arthroereisis, such as the sinus tarsi implant and calcaneo-stop. The type of device and the surgical approach to proceed with are based on the surgeon's discretion rather than an evidence-based protocol. Multiple complications can arise from subtalar arthroereisis, most commonly sinus tarsi pain. Currently, there is a dearth of quality clinical data and evidence on the long-term outcomes and complications of arthroereisis. This lack of literature for a commonly performed procedure validates the need for future studies to better guide a standard protocol, reach consensus on well-defined indications and contraindications, provide expected complications, and improve the practice of evidence-based medicine.
PubMed: 35154977
DOI: 10.7759/cureus.21003 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Calcaneal osteotomy is an extra-articular procedure used for conservative surgical treatment of hindfoot deformity. It has static, architectural and dynamic effects,... (Review)
Review
Calcaneal osteotomy is an extra-articular procedure used for conservative surgical treatment of hindfoot deformity. It has static, architectural and dynamic effects, reorienting the tuberosity action point of the digastric muscle formation of the sural triceps and plantar aponeurosis. Calcaneal osteotomies vary in location, form and displacement, but can be categorized as tuberosity osteotomy, acting on talar position, and cervical osteotomy, acting on Chopart joint-line orientation. We here describe the 3 main calcaneal osteotomies we use for hindfoot deformity: talar varus/valgus, valgus flatfoot, and midfoot abductus/adductus. In each case, we describe our technique, resulting from our responses to the difficulties we have had to deal with: medializing osteotomy: performed percutaneously to limit skin complications, and easily associated to cervical calcaneal osteotomy to manage valgus flatfoot; Hintermann cervical adduction osteotomy: providing excellent angular correction, while conserving a medial cortical hinge; lateralizingosteotomy: performed on a medial approach, to enhance translation capacity and prevent the acute tarsal tunnel syndrome with which we have been otherwise confronted. Correcting foot deformities involves complex, multi-dimensional, multi-tissue surgery that is risky as it concerns a segment with terminal vascularization. The present three techniques need to be mastered, as they are usually associated to other tendon and/or ligament reconstruction procedures, and tourniquet time is limited. LEVEL OF EVIDENCE: V; expert opinion.
Topics: Calcaneus; Flatfoot; Foot; Humans; Osteotomy; Plastic Surgery Procedures; Tendons
PubMed: 34687951
DOI: 10.1016/j.otsr.2021.103121 -
Musculoskeletal Surgery Dec 2022Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other... (Review)
Review
BACKGROUND
Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other involvement of the foot. Dislocation can occur medially (85%), laterally (15%), posteriorly (2.5%) and anteriorly (1%). Reduction can be performed by closed or open technique; lateral dislocations often require open reduction because of inclusion of soft tissues or bone fragments. Lateral dislocations are frequently complicated by bone exposure, risk of infection and associated soft tissues injuries.
AIM OF THE STUDY
The aim of this study is to explain main characteristics and to clarify the most important pitfalls of subtalar dislocations.
MATERIALS AND METHODS
We examined 47 articles published in the last thirty years (389 cases). For each dislocation we reviewed its main characteristics: direction, bone exposure, need for open reduction and for surgical stabilisation, associated injuries and method used for diagnosis.
RESULTS
Medial dislocations (68.1%) has greater incidence compared to lateral ones (27.7%). Bone exposure (44.5%), associated lesions (44.5%) and need for surgical reduction (48.2%) are much more represented in lateral dislocation than in the others.
CONCLUSIONS
Subtalar dislocations, especially the lateral one, represent a challenge for surgeons. Lateral subtalar dislocation occurs following high-energy trauma often involving associated injuries. Closed reduction could be unsuccessful and patients must undergo surgical reduction. After reduction CT scan is recommended. Our narrative review confirms these findings.
Topics: Humans; Subtalar Joint; Joint Dislocations; Fractures, Bone; Tomography, X-Ray Computed
PubMed: 35435636
DOI: 10.1007/s12306-022-00746-x -
European Journal of Physical and... Feb 2019Foot orthoses are widely used in conservative treatment of painful flexible flatfoot (PFFF) however research is limited to choose the best option in orthotic treatment. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Foot orthoses are widely used in conservative treatment of painful flexible flatfoot (PFFF) however research is limited to choose the best option in orthotic treatment.
AIM
We aimed to compare the effects of computer-aided design/computer-aided manufacturing (CAD-CAM) and conventional insole types in comparison with sham insole, on pain and health related quality of life in patients with PFFF.
DESIGN
Randomized controlled trial.
SETTING
Outpatient rehabilitation clinic.
POPULATION
Sixty-seven people with PFFF, aged between 18 and 45 years, were assigned to CAD-CAM (N.=22), conventional (N.=22) or sham (N.=23) groups.
METHODS
In addition to insoles, a home-based exercise program was followed by all participants for eight weeks. Foot pain intensity and quality of life were assessed at the initial evaluation and at the end of two-month follow-up.
RESULTS
Pain intensity (Mean±SD, mm on VAS) was significantly lower in CAD-CAM (27.84±18.41) and conventional (27.05±16.82) insole groups than sham group (46.39±20.18) after two months (P<0.05), but there was no difference between conventional and CAD-CAM (P>0.05). All groups had significantly higher physical health scores at the second assessment (P<0.05), but there was no intergroup difference (P>0.05).
CONCLUSIONS
CAD-CAM and conventionally designed insoles are both more effective than having sham insole in alleviating pain in PFFF.
CLINICAL REHABILITATION IMPACT
CAD-CAM and conventionally designed semicustom insoles in conjunction with a home-based exercise program are both effective in controlling pain compared with sham insole and exercise in PFFF. Clinicians can prescribe both types of semicustom insoles as a part of conservative treatment instead of each other.
Topics: Adolescent; Adult; Computer-Aided Design; Equipment Design; Exercise Therapy; Female; Flatfoot; Foot Orthoses; Humans; Male; Middle Aged; Pain; Quality of Life; Young Adult
PubMed: 29553223
DOI: 10.23736/S1973-9087.18.05108-0 -
Foot & Ankle Orthopaedics Jul 2019Originally described as a means to address fixed deformities or uncontrolled movement of the hindfoot observed in paralytic foot deformities, triple arthrodesis has... (Review)
Review
UNLABELLED
Originally described as a means to address fixed deformities or uncontrolled movement of the hindfoot observed in paralytic foot deformities, triple arthrodesis has evolved into a powerful procedure for the correction of a variety of foot deformities. Over the past decade, multiple advances have been made with respect to diagnostic imaging, fixation options, bone graft substitutes, and postoperative regimens. While this operation requires experience and skill to execute, when properly performed, it allows for correction of deformity and a plantigrade and ideally pain-free foot for ambulation. The purpose of this review is to highlight advances in the procedure and its application to the rigid planovalgus foot.
LEVEL OF EVIDENCE
Level V, review.
PubMed: 35097328
DOI: 10.1177/2473011419849609 -
Diagnostic and Interventional Radiology... May 2021Lateral hindfoot impingement (LHI) is a subtype of ankle impingement syndrome with classic MRI findings. Biomechanically, LHI is the sequela of lateral transfer of...
Lateral hindfoot impingement (LHI) is a subtype of ankle impingement syndrome with classic MRI findings. Biomechanically, LHI is the sequela of lateral transfer of weight bearing from the central talar dome to the lateral talus and fibula. The transfer occurs due to collapse of the medial arch of the foot, most commonly from posterior tibial tendon (PTT) and spring ligament (SL) insufficiency. Clinical features include lateral hindfoot pain, deformity, and overpronation on gait analysis. MRI changes continuously reflect the altered biomechanics as the syndrome progresses over time, including typical and often sequential changes of PTT and SL failure, increasing heel valgus, talocalcaneal and subfibular impingement, and finally lateral soft tissue entrapment. In addition to diagnosis, MRI is a useful adjunct to plan surgical treatment.
Topics: Biomechanical Phenomena; Flatfoot; Humans; Ligaments, Articular; Magnetic Resonance Imaging
PubMed: 34003130
DOI: 10.5152/dir.2021.20268 -
World Journal of Orthopedics Jun 2023Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly. Subtalar dislocations are high-mechanism... (Review)
Review
Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly. Subtalar dislocations are high-mechanism injuries, which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints, without major fracture of the talus. They are usually classified as medial (most common), lateral, anterior and posterior dislocations, based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury. They are usually diagnosed by X rays, but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively. Majority being closed injuries, can be managed in ED by closed reduction and cast immobilisation, but if they are open, have poor outcomes. Complications that ensue open dislocations are post-traumatic arthritis, instability and avascular necrosis.
PubMed: 37377991
DOI: 10.5312/wjo.v14.i6.379 -
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 -
World Journal of Clinical Cases Dec 2023Accessory navicular (AN) is a developmental variation of the secondary ossification center of the navicular tuberosity. Ten percent of patients with AN will have pain... (Review)
Review
Accessory navicular (AN) is a developmental variation of the secondary ossification center of the navicular tuberosity. Ten percent of patients with AN will have pain symptoms that affect walking and life. As the AN changes the position of the posterior tibial tendon insertion, children with AN often have posterior tibial tendon function insufficiency and flexible flat foot. Surgical treatment is often required after failure of conservative treatment. This article reviewed the etiology, clinical manifestations, complications, and treatment methods of AN.
PubMed: 38130606
DOI: 10.12998/wjcc.v11.i35.8256 -
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