-
The Journal of Foot and Ankle Surgery :... Apr 2024The present study was to determine the characteristics of the ankle skeletal structure in patients with talus Hepple V type. We conducted a retrospective study on the...
The present study was to determine the characteristics of the ankle skeletal structure in patients with talus Hepple V type. We conducted a retrospective study on the skeletal structure of the talus in 110 patients with Hepple V osteochondral lesions of the talus and in control participants. The radiographic measurements taken include the following: in the coronal plane - depth of talus frontal curvature, length of the lateral and medial malleolus; in the sagittal plane - radius and height of talus, angle of tibial lateral surface, tibiotalar sector, and vertical neck angle. The osteochondral lesion of the talus showed a significantly larger mean radius (mean ± SD, 21.4 ± 2.5 mm; p < .001) and height (mean ± SD, 26.0 ± 2.7 mm; p < .005). It also demonstrated a longer mean medial malleolus length (mean ± SD, 15.7 ± 2.4 mm; p < .005), a larger mean vertical neck angle (mean ± SD, 86.2 ± 5.4°; p < .050), and a greater mean tibial lateral surface angle (mean ± SD, 80.0 ± 4.5°; p < .001). And there was a greater mean frontal curvature depth (mean ± SD, 3.9 ± 0.6 mm; p < .005). Overall, this study found that patients with Hepple V osteochondral lesions of the talus had a larger vertical neck angle and tibial lateral surface angle, a longer talus radius and medial malleolus length, a higher talus height, and a deeper frontal curvature depth. STUDY DESIGNS: Retrospective Case-Control Study.
PubMed: 38679411
DOI: 10.1053/j.jfas.2024.04.004 -
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 -
Foot & Ankle International Nov 2023Peritalar subluxation (PTS) is part of progressive collapsing foot deformity (PCFD). This study aimed to evaluate initial deformity correction and PTS optimization in...
BACKGROUND
Peritalar subluxation (PTS) is part of progressive collapsing foot deformity (PCFD). This study aimed to evaluate initial deformity correction and PTS optimization in PCFD patients with flexible hindfoot deformity undergoing hindfoot joint-sparing surgical procedures and its relationship with improvements in patient-reported outcome measures (PROMs) at latest follow-up. We hypothesized that significant deformity/PTS correction would be observed postoperatively, positively correlating with improved PROMs.
METHODS
A prospective comparative study was performed with 26 flexible PCFD patients undergoing hindfoot joint-sparing reconstructive procedures, mean age 47.1 years (range, 18-77). We assessed weightbearing computed tomography (WBCT) overall deformity (foot and ankle offset [FAO]) and PTS markers (distance and coverage maps) at 3 months, as well as PROMs at final follow-up. A multivariate regression model assessed the influence of initial deformity correction and PTS optimization in patient-reported outcomes.
RESULTS
Mean follow-up was 19.9 months (6-39), and the average number of procedures performed was 4.8 (2-8). FAO improved from 9.4% (8.4-10.9) to 1.9% (1.1-3.6) postoperatively ( < .0001). Mean coverage improved by 69.6% ( = .012), 12.1% ( = .0343) and 5.2% ( = .0074) in, respectively, the anterior, middle, and posterior facets, whereas the sinus tarsi coverage decreased by an average 57.1% ( < .0001) postoperatively. Improvements in patient-reported outcomes were noted for all scores assessed ( < .03). The multivariate regression analysis demonstrated that improvement in both FAO and PTS measurements significantly influenced the assessed PROMs.
CONCLUSION
This study demonstrated significant improvements in the overall 3D deformity, PTS markers, and PROMs following hindfoot joint-sparing surgical treatment in patients with flexible PCFD. More importantly, initial 3D deformity correction and improvement in subtalar joint coverage and extraarticular impingement have been shown to influence PROMs significantly and positively. Addressing these variables should be considered as goals when treating PCFD.
LEVEL OF EVIDENCE
Level II, prospective cohort study.
Topics: Humans; Middle Aged; Prospective Studies; Flatfoot; Foot Deformities; Lower Extremity; Joint Dislocations; Patient Reported Outcome Measures
PubMed: 37698292
DOI: 10.1177/10711007231192479 -
Foot (Edinburgh, Scotland) Sep 2023AAFD comprises ligamentous failure and tendon overload, mainly focused on the symptomatic posterior tibial tendon and the spring ligament. Increased lateral column (LC)... (Review)
Review
AAFD comprises ligamentous failure and tendon overload, mainly focused on the symptomatic posterior tibial tendon and the spring ligament. Increased lateral column (LC) instability arising in AAFD is not defined or quantified. This study aims to quantify the increased LC motion in unilateral symptomatic planus feet, using the contralateral unaffected asymptomatic foot as an internal control. In this case matched analysis, 15 patients with unilateral stage 2 AAFD foot and an unaffected contralateral foot were included. Lateral foot translation was measured as a guide to spring ligament competency. Medial and LC dorsal sagittal instability were assessed by direct measurement of dorsal 1st and 4th/5th metatarsal head motion and further video analysis. The mean increase in dorsal LC sagittal motion (between affected vs unaffected foot) was 5.6 mm (95% CI [4.63-6.55], p < 0.001). The mean increase in the lateral translation score was 42.8 mm (95% CI [37.48-48.03], p < 0.001). The mean increase in medial column dorsal sagittal motion was 6.8 mm (95% CI [5.7-7.8], p < 0.001). Video analysis also showed a statistically significant increase in LC dorsal sagittal motion between affected and unaffected sides (p < 0.001). This is the first study that quantifies a statistically significant increased LC dorsal motion in feet with AAFD. Understanding its pathogenesis and its link to talonavicular/spring ligament laxity improves foot assessment and may allow the development of future preventative treatment strategies.
Topics: Humans; Adult; Flatfoot; Foot; Ligaments, Articular; Tendons; Tarsal Joints
PubMed: 37271102
DOI: 10.1016/j.foot.2023.102036 -
The Journal of Foot and Ankle Surgery :... 2023Pain in the flexible flatfoot is a common complaint, if present it is important to find its exact location and causes Therefore, the study aimed to find differences...
Pain in the flexible flatfoot is a common complaint, if present it is important to find its exact location and causes Therefore, the study aimed to find differences between children with and without medial arch pain and relate them to the reduction of pain following surgical treatment. Children with idiopathic flexible flatfeet were retrospectively included in the study. All children underwent a clinical, radiographic, and gait examination. The feet were subdivided into 2 groups: asymptomatic and those with medial arch pain. Factors associated with medial arch pain were identified via t test. Significant radiological and gait parameters were correlated to the change in medial arch pain score following surgery. Included were 322 feet belonging to 177 children, with the mean age of 11.8 (SD = 2.2) years. The pain was perceived in 52% of the feet, of these, 74% in the medial arch. In the group with pain, 31 feet received a gait analysis following surgery. The radiological parameters, talus-1 and -2 metatarsal angles and the gait parameter, calcaneal lateral shift during walking showed a significant difference (p ≤ .004) between the no pain and pain groups and were associated (R ≥0.14, p ≤ .04) with the reduction in pain following surgery. The increased talus-1 and -2 metatarsal angles and the calcaneal lateral shift may cause increased tension on the soft-tissues along the medial side of the foot and may produce pain. Therapies aiming at improving the medial arch pain should be directed to normalize the talus-1 or -2 metatarsal angles and the calcaneal lateral shift.
Topics: Humans; Child; Flatfoot; Retrospective Studies; Foot; Calcaneus; Gait; Pain
PubMed: 36822970
DOI: 10.1053/j.jfas.2023.01.008 -
Iranian Journal of Public Health Feb 2024Deviation of the foot from the normal posture affects the function of the foot and lower limb and causes lower limb injuries in normal people and athletes. Flat feet or... (Review)
Review
BACKGROUND
Deviation of the foot from the normal posture affects the function of the foot and lower limb and causes lower limb injuries in normal people and athletes. Flat feet or flatfoot deformity are usually associated with pain in the foot area and a decrease in the normal function of the foot, which can negatively affect the sports ability of athletes. Therefore, we aimed to investigate the abnormality of flat feet from training, exercise to therapeutic interventions.
METHODS
Articles were identified by searching five databases: PubMed, Scopus, Google Scholar, Science Direct, and Gate & Pasteur from 2000 to 2022. The keywords were selected specifically and correctly and all the researches and articles related to the title of the article were searched and found. This research was also searched in Persian databases that this database, included: Irandoc, Mag Iran and Noormagz.
RESULTS
Finally, 30 studies met the criteria for entering this study, selected and used to conduct this study.
CONCLUSION
By using the results obtained in the research, which include corrective exercises and therapeutic interventions, especially the use of orthoses and various medical insoles, it is possible to help in the treatment and improvement of this anomaly.
PubMed: 38894830
DOI: 10.18502/ijph.v53i2.14915 -
Foot & Ankle International Oct 2023Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is...
BACKGROUND
Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets and endangers specific os calcis subtalar joint (OCST) subtypes without distinct facets. H-LCL is oriented between the posterior and middle facets and should be suitable for all OCSTs. Both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between 2 articular surfaces represented by color patterns. This study aims to measure the safe zones for LCL using 3-dimensional (3D) models and DM; we hypothesize that it could be measured with high reproducibility.
METHODS
Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. Four angles were measured independently. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies; similarly, the proximal and distal extents of the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. Consequently, the surface available for safe osteotomies were calculated. An interclass correlation was used to assess the agreement between the 2 raters. Additionally, analysis of variance and Mann-Whitney test were used to compare the safe zones between OCSTs.
RESULTS
The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees from a line parallel to the lateral border of the calcaneus, respectively, and the proximal and distal extent of the ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. There were no statistically significant differences between the OCSTs. Two raters measured the angles with good to excellent interrater and intrarater agreement. In 18 cases, we were unable to plan for H-LCL or E-LCL osteotomies.
CONCLUSION
Distance mapping could be used to measure the safe zone, tailor a preoperative plan, and potentially reduce the risk for iatrogenic damage in LCL. 3D models and DM can increase the reliability of preoperative plans in bones with complex 3D structures.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
Topics: Humans; Reproducibility of Results; Retrospective Studies; Flatfoot; Calcaneus; Iatrogenic Disease
PubMed: 37542418
DOI: 10.1177/10711007231185328 -
Sensors (Basel, Switzerland) Oct 2023Flat foot is a postural deformity in which the plantar part of the foot is either completely or partially contacted with the ground. In recent clinical practices, X-ray...
Flat foot is a postural deformity in which the plantar part of the foot is either completely or partially contacted with the ground. In recent clinical practices, X-ray radiographs have been introduced to detect flat feet because they are more affordable to many clinics than using specialized devices. This research aims to develop an automated model that detects flat foot cases and their severity levels from lateral foot X-ray images by measuring three different foot angles: the Arch Angle, Meary's Angle, and the Calcaneal Inclination Angle. Since these angles are formed by connecting a set of points on the image, Template Matching is used to allocate a set of potential points for each angle, and then a classifier is used to select the points with the highest predicted likelihood to be the correct point. Inspired by literature, this research constructed and compared two models: a Convolutional Neural Network-based model and a Random Forest-based model. These models were trained on 8000 images and tested on 240 unseen cases. As a result, the highest overall accuracy rate was 93.13% achieved by the Random Forest model, with mean values for all foot types (normal foot, mild flat foot, and moderate flat foot) being: 93.38 precision, 92.56 recall, 96.46 specificity, 95.42 accuracy, and 92.90 F-Score. The main conclusions that were deduced from this research are: (1) Using transfer learning (VGG-16) as a feature-extractor-only, in addition to image augmentation, has greatly increased the overall accuracy rate. (2) Relying on three different foot angles shows more accurate estimations than measuring a single foot angle.
Topics: Humans; Flatfoot; Foot; Calcaneus; Radiography
PubMed: 37837049
DOI: 10.3390/s23198219 -
Clinics in Podiatric Medicine and... Oct 2023Naviculocuneiform arthrodesis, while often used to support the medial column during management of primary/post-traumatic arthritis, deformity correction, or in the... (Review)
Review
Naviculocuneiform arthrodesis, while often used to support the medial column during management of primary/post-traumatic arthritis, deformity correction, or in the surgical treatment of progressive collapsing foot deformity, can develop nonunion. Addressing this condition hinges on the assessment of various parameters such as patient/host factors and recognition of the etiology of the nonunion. In this article, methods of optimizing this surgical intervention through anatomic and physiologic considerations are highlighted. Further, information is provided to assist foot and ankle surgeons in performing a comprehensive work-up to allow for successful reconstruction and optimal patient outcomes.
Topics: Humans; Ankle Joint; Arthrodesis; Lower Extremity
PubMed: 37716740
DOI: 10.1016/j.cpm.2023.05.006 -
Musculoskeletal Care Dec 2023Foot involvement is present in approximately 60%-90% of children with Juvenile idiopathic arthritis (JIA). It is a major cause of disability, which can lead to...
AIM
Foot involvement is present in approximately 60%-90% of children with Juvenile idiopathic arthritis (JIA). It is a major cause of disability, which can lead to deterioration in daily activities and quality of life. However, it is often overlooked and can compromise patient management.
PURPOSE
Our objective was to describe the ankle and foot involvement in JIA and to appraise the functional impact of this damage on the child's performance and quality of life by using validated scores.
METHODS
The cross-sectional study included patients with JIA. Functional impairment was assessed through the Juvenile Arthritis Functionality Scale (JAFS) and the Oxford Ankle and Foot Questionnaire for children.
RESULTS
Twenty-three patients aged 12.75 ± 3.9 and with 41 months of disease duration. After completing the Oxford score, the physical domain appeared to be the most altered. A long delay in diagnosis was associated with an alteration in the emotional domain of the Oxford score. Higher disease activity was significantly associated with impairment in both the physical activity and the footwear domains of the Oxford score. As regards clinical examination data, the presence of foot pain as well as the presence of tendinopathy were associated with an alteration of all Oxford score domains. The presence of flat feet significantly affected all domains of the Oxford score. The JAFS was reported to affect the child's performance ability and was associated with impairment in physical activity, school and play, and emotional domains.
CONCLUSION
Ankle and foot involvement was common in our study. Functional ability was most impaired in the lower limbs. High disease activity, foot and ankle pain, tenosynovitis, and flat feet were associated with poorer quality of life and higher functional impact.
Topics: Child; Humans; Arthritis, Juvenile; Quality of Life; Flatfoot; Cross-Sectional Studies; Pain; Lower Extremity
PubMed: 37408090
DOI: 10.1002/msc.1794