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The American Journal of Case Reports Dec 2023BACKGROUND Tarsometatarsal joint (TMJ) arthrodesis is common method used for correcting hallux abductus valgus (HAV). Its popularity has grown due to studies revealing...
A 28-Year-Old Woman with Down Syndrome, Congenital Heart Disease, and a History of Knee Surgery and Plantar Fasciitis, with Hallux Abducto Valgus (Bunion) and Lapiplasty Three-Dimensional Correction Surgery.
BACKGROUND Tarsometatarsal joint (TMJ) arthrodesis is common method used for correcting hallux abductus valgus (HAV). Its popularity has grown due to studies revealing HAV's triplanar deformity with frontal plane rotation. This case report presents a 28-year-old woman with Down syndrome, congenital heart disease, and a history of knee surgery and plantar fasciitis, with severe HAV deformity and flexible valgus flatfoot associated with ligamentous hyperlaxity. CASE REPORT Examination revealed severe foot deformities, and radiographic studies confirmed the condition. A surgical intervention was planned, and the patient's cardiologist confirmed she was fit for the procedure. The modified Lapidus technique with frontal plane rotational correction included realigning the metatarsal joint, resecting spurs, osteosynthesis material, and arthrosis in the sinus tarsi. After surgery, the patient underwent a recovery period without support for 8 weeks and received appropriate medical care. Radiographs showed successful alignment, and the patient gradually resumed her daily activities. The patient had an uneventful recovery, and postoperative radiographs showed good alignment in all planes. CONCLUSIONS The hyperlaxity associated with Down syndrome makes the incidence of HAV more frequent, and TMJ fusion is preferable to correction by osteotomy. The modified Lapidus technique with frontal plane rotational correction could be a good technique to achieve satisfactory correction in patients with severe HAV deformity and flexible valgus flatfoot associated with ligamentous hyperlaxity. TMJ fusion is indicated when severe or recurrent rotational component is observed in X-rays.
Topics: Female; Humans; Adult; Hallux; Down Syndrome; Flatfoot; Fasciitis, Plantar; Bunion; Hallux Valgus; Joint Instability; Heart Defects, Congenital; Metatarsal Bones
PubMed: 38091276
DOI: 10.12659/AJCR.940879 -
Prosthetics and Orthotics International Dec 2023Pediatric flexible flat foot (PFFF) is often associated with pain along the medial longitudinal arch and potential disability. There are several conservative treatment...
BACKGROUND
Pediatric flexible flat foot (PFFF) is often associated with pain along the medial longitudinal arch and potential disability. There are several conservative treatment options for PFFF, ranging from intrinsic muscle exercises to orthosis, including University of California Biomechanics Laboratory (UCBL) and custom-made semi-rigid insoles.
OBJECTIVES
To investigate and compare the effect of UCBL and custom-made semi-rigid insoles on pedobarographic and radiologic parameters in PFFF.
STUDY DESIGN
This study prepared a retrospective chart review of 143 children diagnosed with PFFF between the age of 4 and 12 years.
METHODS
Data of twenty-seven children with PFFF who were prescribed foot orthoses between the age of 4 and 12 years were retrospectively reviewed. Medical charts were retrospectively reviewed, and pedobarographic and radiological parameters assessed before and 1 year after application of orthoses were reviewed.
RESULTS
The difference in the calcaneal pitch angle and the center of pressure excursion index (CPEI) were significantly improved in the custom-made semi-rigid insole group compared to that in the UCBL group. The contact area ratio of the midfoot and toe and CPEI at 1 year after wearing the insole was significantly improved in the custom-made semi-rigid insole group compared to that in the UCBL group. Moreover, the calcaneal pitch angle and CPEI were significantly improved 1 year after application of the insole in the custom-made semi-rigid insole group.
CONCLUSIONS
This result showed that the custom-made semi-rigid insole is more effective in improving the deviation of the center pressure curve and calcaneal pitch angle than the UCBL. The custom-made semi-rigid insole may help relieve foot instability during gait and improve the medial longitudinal arch in children with PFFF.
Topics: Humans; Child; Child, Preschool; Flatfoot; Retrospective Studies; Biomechanical Phenomena; Equipment Design; Foot Orthoses
PubMed: 37227812
DOI: 10.1097/PXR.0000000000000238 -
Medical Engineering & Physics Nov 2023The abnormal plantar pressure of flatfoot patients is a common condition. The main objective of the present study was to investigate the effect of custom-molded insole...
The abnormal plantar pressure of flatfoot patients is a common condition. The main objective of the present study was to investigate the effect of custom-molded insole on the plantar pain of flatfoot METHODS: 105 patients (representing 174 feet) participated in evaluating a custom-made orthotic insole from June 2018 to March 2019. The height of the navicular tubercle (HNT) and the deflection angle of calcaneus (DAC) in flatfoot patients after using orthotic insoles for 6 months were recorded by X-ray imaging and scanning measurements. Plantar pressure on metatarsals 1-5 was measured by using an RSscan system RESULTS: Without the use of an orthotic insole, mean HNT was 0.99±0.34 cm and mean DAC was 20.0 ± 3.78 ° during the bearing weight. After using the insole, mean HNT and DAC values reduced to 0.87±0.30 cm and 14.3 ± 3.45 °, respectively (P < 0.05). Hindfoot plantar pressure did not change significantly (P > 0.05). Furthermore, pressure at metatarsals 1-3 decreased by 48.5 %, 45.6 %, and 14.3 %, respectively; that at metatarsals 4-5 increased by 33.3 % and 137.5 %, separately, when using the custom-made insole CONCLUSIONS: Visual analog scale score for plantar pain was significantly reduced. These findings indicate that metatarsal pain of flatfoot patients might be the cause of load imbalance in plantar foot.
Topics: Humans; Child; Flatfoot; Walking; Pressure; Foot; Foot Orthoses; Pain; Shoes
PubMed: 37985027
DOI: 10.1016/j.medengphy.2023.104070 -
Medicina (Kaunas, Lithuania) Nov 2023: although musculoskeletal alterations are common in patients with Down syndrome (DS), studies investigating this association are scarce, and proposals for diagnostic...
: although musculoskeletal alterations are common in patients with Down syndrome (DS), studies investigating this association are scarce, and proposals for diagnostic standardization are limited. We aimed to evaluate the prevalence of musculoskeletal disorders in the lower limbs in a sample of children and adolescents with DS and to investigate the diagnostic capacity of orthopedic clinical examinations performed by orthopedists and pediatricians to diagnose these alterations. : Twenty-two patients aged between three and ten years with DS were included. Patients and guardians answered a simple questionnaire regarding orthopedic complaints and underwent a systematic orthopedic physical examination, performed twice: once by an orthopedist and again by a pediatrician. Patients underwent a series of radiographs to diagnose anisomelia, hip dysplasia, epiphysiolysis, flatfoot valgus, mechanical axis varus, and mechanical axis valgus. The radiological diagnosis was considered the gold standard, and the diagnostic capacity of the physical examination performed by each physician was determined. : The median age was 6.50 years. Only four patients (18.2%) presented with orthopedic complaints. All patients were diagnosed with at least one musculoskeletal disorder. The only musculoskeletal disorder with a good diagnostic capacity was flatfoot valgus. Limited sensitivity values were found for hip dysplasia, mechanical axis varus, and mechanical axis valgus. The agreement between the orthopedic physical examinations performed by the two examiners was weak, poor, or indeterminate for most of the analyzed items. : There was a high prevalence of orthopedic alterations in children with DS who did not present with musculoskeletal complaints. The diagnostic capacity of the physical examination was limited. Therefore, all children with DS should undergo a radiological evaluation of the musculoskeletal system and subsequent specialized orthopedic evaluation. Level of Evidence: Level II (Diagnostic Studies).
Topics: Adolescent; Humans; Child; Child, Preschool; Flatfoot; Down Syndrome; Hip Dislocation; Lower Extremity; Musculoskeletal Diseases; Hip Dislocation, Congenital; Physical Examination
PubMed: 38004035
DOI: 10.3390/medicina59111986 -
Foot (Edinburgh, Scotland) Sep 2023Flexible flatfoot (FFF) cause biomechanical and sensorimotor disorders of the foot and ankle complex and reduce of postural stability. Postural stability is an important... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Flexible flatfoot (FFF) cause biomechanical and sensorimotor disorders of the foot and ankle complex and reduce of postural stability. Postural stability is an important movement skill that affects the performance of taekwondo (TKD) athletes and can lead to fall injuries. The purpose of this study is the effect 12-week application of foot orthosis (FOs) on dynamic balance in TKD athletes with FFF.
METHOD
In this trial, 30 girls of the TKD athletes with FFF were recruited. They were randomly assigned to experimental and control groups (15 subjects in each group). The experimental group used FOs with medial longitudinal arch support for 12 weeks, and the control group did not have any intervention. The outcome measures include navicular drop and balance in three directions: anterior-posterior, medial-lateral and overall stability. Covariance analysis was used to compare the results between two groups.
RESULTS
The covariance results showed that the experimental group compared to the control group with a high effect size had a significant difference in reducing of navicular drop (P = 0.000, ηp2 =0.512), anterior-posterior sway (P = 0.000, (ηp2 =0.397) medial-lateral sway (P = 0.019, ηp2 = 0.186) and overall stability sway (P = 0.008, ηp2 = 0.232).
CONCLUSIONS
The FOs with medial longitudinal arch support leads to FFF correction and provides mechanical stability of the foot and ankle complex. Also, the impulses sent from plantar receptors are increased and a better understanding of postural sway is transmitted to the central nervous system and balance strategies are improved.
Topics: Female; Humans; Foot Orthoses; Flatfoot; Ankle; Ankle Joint; Athletes; Postural Balance
PubMed: 37354702
DOI: 10.1016/j.foot.2023.102042 -
Journal of Surgical Orthopaedic Advances 2023Pes planovalgus affects knee biomechanics but there are no studies describing its impact on total knee arthroplasty (TKA). We aim to characterize the demographics,...
Pes planovalgus affects knee biomechanics but there are no studies describing its impact on total knee arthroplasty (TKA). We aim to characterize the demographics, medical, and surgical complications of patients with pes planovalgus undergoing TKA. A Medicare database was queried using ICD-9 codes to identify 5,750 patients with and 23,000 patients without pes planovalgus who underwent TKA from 2005 to 2014. Standard descriptive statistics were used to compare medical and surgical complications at 90 days and 2 years, with alpha < 0.003 after a Bonferroni Correction. Patients with pes planovalgus had an elevated incidence of hypertension (80%, p < 0.001), pulmonary disease (31%, p < 0.001), hypothyroidism (28%, p < 0.001), diabetes (30%, p < 0.001), vascular disease (20%, p < 0.001), obesity (26%, p < 0.001), and depression (23%, p < 0.001). They also had increased odds of deep vein thrombosis (DVT) (odds ratio [OR] 1.3, p < 0.001), stiffness (OR 1.3, p < 0.003) and revision (OR 1.59, p < 0.003) at 90 days. At 2 years, odds of stiffness had increased (OR 1.34, p < 0.001) with similar rates of revision and medical complications. Pes planovaglus is associated with increased medical comorbidities and this patient population may be at an increased risk for postoperative stiffness, early revisions, and DVT after TKA. Arthroplasty surgeons should be conscious of these risks when considering TKA in a patient with pes planovalgus and counsel them appropriately. (Journal of Surgical Orthopaedic Advances 32(3):202-206, 2023).
Topics: United States; Humans; Aged; Arthroplasty, Replacement, Knee; Medicare; Flatfoot; Comorbidity; Knee Joint
PubMed: 38252610
DOI: No ID Found -
Journal of Bodywork and Movement... Jul 2024Distal extremity misalignment may give rise to pelvic floor dysfunctions (PFDs). This study aimed to compare pelvic floor muscle strength (PFMS) and dysfunctions in...
BACKGROUND/AIM
Distal extremity misalignment may give rise to pelvic floor dysfunctions (PFDs). This study aimed to compare pelvic floor muscle strength (PFMS) and dysfunctions in women with and without pes planus.
MATERIALS AND METHODS
Women with (pes planus group, n = 30) and without pes planus (control group, n = 30) were included. The presence of PFDs questioned. Pes planus with the Feiss Line Test, PFMS with the Modified Oxford Scale, and the severity of PFDs with the Pelvic Floor Distress Inventory-20 (PFDI-20), including three subscales (Pelvic Organ Distress Inventory-6 (POPDI-6) for pelvic organ prolapse, Colorectal-Anal Distress Inventory-8 (CRADI-8) for colorecto-anal symptoms, and Urinary Distress Inventory-6 (UDI-6) for urinary symptoms, were assessed.
RESULTS
It was seen that no difference was found between groups in terms of PFMS (p > 0.05). However, urinary incontinence and anal incontinence were higher in women with pes planus than in women without pes planus (p < 0.05). Only the PFDI-20, CRADI-8, and UDI-6 scores were higher in women with pes planus compared to controls (p < 0.05). There was no difference was found between groups in terms of POPDI-6 scores (p > 0.05).
CONCLUSION
The PFMS did not change according to the presence of pes planus. However, the prevalence of PFDs and their severity were higher in women with pes planus in comparison to controls. Posture assessments of individuals with PFDs, especially examination of foot posture, and pelvic floor assessments of individuals with posture disorders should be considered.
Topics: Humans; Female; Muscle Strength; Case-Control Studies; Pelvic Floor; Adult; Middle Aged; Urinary Incontinence; Flatfoot; Fecal Incontinence; Pelvic Floor Disorders
PubMed: 38876655
DOI: 10.1016/j.jbmt.2024.02.024 -
Foot and Ankle Surgery : Official... Apr 2024This study evaluates the efficacy of the calcaneo-stop (C-Stop) procedure's effectiveness in treating symptomatic flexible flatfoot (FFF) in children. (Review)
Review
BACKGROUND
This study evaluates the efficacy of the calcaneo-stop (C-Stop) procedure's effectiveness in treating symptomatic flexible flatfoot (FFF) in children.
METHODS
A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane databases to identify studies until 2023 on the outcomes of the C-Stop procedure in children with FFF. The risk of bias was assessed using MINORS criteria.
RESULTS
Of 85 studies screened, 20 involving 2394 feet from 1415 patients (mean age 11.2 ± 1.3 years) were included. Post-procedure, significant improvements were noted in pain reduction (93.5%), heel alignment (95.21%), and radiological measures, including reductions in Kite (7.32º), Meary (11.65º), Costa-Bartani angles (17.11º), talar declination (12.63º) and increase in Calcaneal Pitch Angle (5.92º). AOFAS scores increased by 22.32 points on average, with 94.83% reporting high satisfaction. Complication rate was low (7.8%).
CONCLUSIONS
The C-Stop procedure is effective for treating FFF in children, offering significant clinical, radiological, and functional improvements with high patient satisfaction and a low complication rate.
LEVEL OF EVIDENCE
Level IV, Systematic review of Level-IV studies.
PubMed: 38714453
DOI: 10.1016/j.fas.2024.04.011 -
Gait & Posture Jun 2024Exercises strengthening foot muscles and customized arch support insoles are recommended for improving foot posture in flexible flatfoot. However, it is not known what...
Effects of foot exercises and customized arch support insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot: A randomized controlled trial.
BACKGROUND
Exercises strengthening foot muscles and customized arch support insoles are recommended for improving foot posture in flexible flatfoot. However, it is not known what the effects of exercises and insoles on plantar force distribution obtained during walking at different speeds. Also, randomized controlled trials comparing the effects of exercises and insoles are limited.
RESEARCH QUESTION
What are the effects of foot exercises, customized arch support insoles, and exercises plus insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot? Do exercises, insoles, and exercises plus insoles affect outcome measures differently?
METHODS
Forty-five people with flexible flatfoot were randomly divided into three groups and 40 of those completed the study. The exercise group performed tibialis posterior strengthening and short foot exercises three days a week for six weeks. The insole group used their customized arch support insoles for six weeks. The exercise plus insole group received both interventions for six weeks. The assessments were performed three times: before the interventions and at the 6th and 12th weeks. Outcome measures were (1) foot posture, (2) plantar force distribution in the following conditions: static standing, barefoot walking at different speeds, and walking immediately after the heel-rise test, and (3) balance.
RESULTS
Foot posture improved in all groups, but insole was less effective than exercise and exercise plus insole (p<0.05). Plantar force variables obtained during standing and walking changed in all groups (p<0.05). The superiority of the interventions differed according to the plantar regions and walking speed conditions (p<0.05). Static balance improved in all groups, but limits of stability improved in the exercise plus insole and exercise groups (p<0.05).
SIGNIFICANCE
The superiority of the interventions differed according to the assessed parameter. The management of flexible flatfoot should be tailored based on the assessment results of each individual.
PubMed: 38865799
DOI: 10.1016/j.gaitpost.2024.05.030 -
European Journal of Pediatrics Apr 2024The aim of the study was to determine the relationship between flatfoot morphology and body mass and height in children aged 6-12 years. A total of 6471 Chinese children...
UNLABELLED
The aim of the study was to determine the relationship between flatfoot morphology and body mass and height in children aged 6-12 years. A total of 6471 Chinese children (mean age 9.0 ± 1.9 years, 41% female) were assessed for foot morphometry, body height, and body mass index. Foot morphology, including foot length, width, girth, arch height, hallux valgus angle, and rearfoot valgus angle, was measured using a 3D laser scanner. Flatfoot evaluations were conducted using the Sztriter-Godunov index (KY) from footprints. All measurements were analyzed by age and sex using the mean values of the left and right sides. Comparisons were performed between flatfoot groups, between body mass index (BMI) groups, and between body height groups. The study revealed a significant decrease in the incidence of bipedal flatfoot with age (p < 0.001), whereas the prevalence of obesity remained consistent (p > 0.05). Bipedal flatfoot was associated with distinct morphological changes, including lower arches, reduced instep height, diminished ankle heights and a greater rearfoot valgus angle (p < 0.05). When comparing the BMI groups, overweight children had larger and thicker feet (p < 0.05), but no differences were found in arch height and ankle height (p > 0.05). When comparing the body height groups, short-statured children had a shorter feet girth, shorter arches, and shorter ankle height (p < 0.05), but no differences were found in the rearfoot valgus angle (p > 0.05).
CONCLUSION
The main characteristics of flat feet include lower arches and instep heights and ankle heights but higher rearfoot valgus angles. In general, overweight children's feet do not have the common features of flat feet. In contrast, short children had similar features of flatfoot except for rearfoot valgus. Assessment of posture, such as rearfoot valgus, can be critical in identifying children with flat feet.
WHAT IS KNOWN
• The morphology of children's feet is associated with body growth, but the relationship between flatfeet and body mass and height remains controversial.
WHAT IS NEW
• Three-dimensional foot measurement shows that body mass is generally not associated with flatfeet, while short children have lower arches but no rearfoot valgus.
Topics: Child; Humans; Female; Male; Flatfoot; Overweight; Body Height; Foot; Obesity
PubMed: 38337095
DOI: 10.1007/s00431-024-05471-0