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Revue Medicale Suisse Dec 2023Flatfoot is a progressive deformity with a collapse of the foot. Its therapeutic approach has undergone a conceptual shift. Initially focused on posterior tibial tendon...
Flatfoot is a progressive deformity with a collapse of the foot. Its therapeutic approach has undergone a conceptual shift. Initially focused on posterior tibial tendon insufficiency, it is now defined by a sum of anatomical alterations resulting in a three-dimensional deformity. If the deformity is symptomatic, we look for hindfoot valgus, forefoot abduction and varus, as well as valgus ankle instability. The clinical rigidity of the deformities and the weight-bearing radiological examinations help guide treatment. Although plantar supports and rigid orthoses are sufficient for mild cases, surgical treatment using bone, ligament, tendon or even prosthetics procedures are the final stage of management for severe cases.
Topics: Humans; Flatfoot; Foot; Posterior Tibial Tendon Dysfunction; Joint Instability; Radiography
PubMed: 38088408
DOI: 10.53738/REVMED.2023.19.854.2363 -
Foot (Edinburgh, Scotland) Sep 2023Subtalar arthroereisis is a minimally-invasive technique for the treatment of flexible flatfoot. Some issues regarding the procedure are still debated, such as... (Review)
Review
PURPOSE
Subtalar arthroereisis is a minimally-invasive technique for the treatment of flexible flatfoot. Some issues regarding the procedure are still debated, such as post-operative management. The aim of this study is to offer a review of the pertaining literature to identify current post-operative protocols and describe possible differences among them.
METHODS
We searched the PubMed database for all papers related to subtalar arthroereisis in children specifying the post-operative protocols. After reviewing all studies according to excluding criteria, 50 articles were selected for analysis.
RESULTS
Based on the literature review, different post-operative protocols emerged in the treatment of patients undergoing subtalar arthroereisis, in particular regarding length of hospital stay, type and duration of immobilization, weight-bearing management, adopted rehabilitation scheme, sport resumption and implant removal.
CONCLUSIONS
The most important finding was the existence of a wide variety in post-operative management after subtalar arthroereisis in children, thus confirming that no clear consensus still exists in this field.
PubMed: 37167704
DOI: 10.1016/j.foot.2023.102037 -
Foot & Ankle International Jun 2024Congenital Vertical Talus (CVT) is a rare form of rigid flatfoot commonly seen in patients with underlying neurologic syndromes. This study aims to evaluate the...
BACKGROUND
Congenital Vertical Talus (CVT) is a rare form of rigid flatfoot commonly seen in patients with underlying neurologic syndromes. This study aims to evaluate the long-term effectiveness of the minimally invasive method for correcting CVT deformity in a large cohort of syndromic patients.
METHODS
A single author recorded preoperative, 2-week postoperative, 1-year postoperative, and most recent radiographic measurements and complications for 25 patients treated with the minimally invasive method from 2006 to 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires were administered for 12 patients after January 1, 2015, when the institution began collecting PROMIS in all orthopaedic patients. Average follow-up was 55 months (13-111); 18 patients had minimum 24-month follow-up.
RESULTS
Forty feet in 25 patients were analyzed. The average preoperative lateral talar axis-first metatarsal base angle (TAMBA) was 68.7 ± 21.3 vs 12.1 ± 8.9 after initial surgical intervention ( < .0001). There was a statistically significant increase in the lateral TAMBA between the initial postoperative and final follow-up visits (13.0 vs 21.6, = .02). Radiographic recurrence of talonavicular deformity was noted in 12 feet (30.9%); 7 (15.55%) required corrective surgery. Larger preoperative lateral TAMBA was predictive of recurrence. Notably, patients with arthrogryposis experienced higher radiographic recurrence than other syndromic patients (45.0% vs 14.3%, = .0384). PROMIS scores were within population norms.
CONCLUSION
The study suggests that less than one-third of syndromic CVT patients experienced a radiographic recurrence of talonavicular deformity, with 15% requiring further surgical intervention at an average of 55 months following the initial procedure. A higher incidence of radiographic recurrence occurred in patients with distal arthrogryposis. These findings, along with the satisfactory patient-reported outcomes, suggest that the minimally invasive technique is an effective treatment method for syndromic CVT, underscoring the necessity for clinicians to provide detailed prognoses and consider more intensive follow-up for those at higher risk.
LEVEL OF EVIDENCE
Level IV, case series.
PubMed: 38840534
DOI: 10.1177/10711007241255116 -
Frontiers in Bioengineering and... 2023This study provided a comprehensive updated review of the biological aspects of children foot morphology across different ages, sex, and weight, aiming to reveal the...
This study provided a comprehensive updated review of the biological aspects of children foot morphology across different ages, sex, and weight, aiming to reveal the patterns of normal and pathological changes in children feet during growth and development. This review article comprised 25 papers in total that satisfied the screening standards. The aim was to investigate how weight changes, age and sex affect foot type, and gain a deeper understanding of the prevalent foot deformities that occur during children growth. Three different foot morphological conditions were discussed, specifically including the effect of sex and age differences, the effect of weight changes, and abnormal foot morphologies commonly documented during growth. This review found that sex, age, and weight changes would affect foot size, bony structure, foot posture, and plantar pressures during child growth. As a result of this biological nature, the children's feet generally exhibit neutral and internally rotated foot postures, which frequently lead to abnormal foot morphologies (e.g., flat foot, pronated foot, etc.). In the future, attention shall be paid to the causal factors leading to specific foot morphologies during the growth and development of children. However, sufficient evidence could not be provided due to a relatively short period of investigation and non-uniformed research methodology in the current literature. A more comprehensive and in-depth exploration is recommended to provide scientific evidence for the discovery of children foot development and personalized growth pattern.
PubMed: 37539437
DOI: 10.3389/fbioe.2023.1192524 -
The Iowa Orthopaedic Journal Dec 2023The current classification system of progressive collapsing foot deformity (PCFD) is comprised of 5 possible classes. PCFD is understood to be a complex,...
BACKGROUND
The current classification system of progressive collapsing foot deformity (PCFD) is comprised of 5 possible classes. PCFD is understood to be a complex, three-dimensional deformity occurring in many regions along the foot and ankle. The question remains whether a deformity in one area impacts other areas. The objective of this study is to assess how each one of the classes is influenced by other classes by evaluating each associated angular measurement. We hypothesized that positive and linear correlations would occur for each class with at least one other class and that this influence would be high.
METHODS
We retrospectively assessed weight bearing CT (WBCT) measurements of 32 feet with PCFD diagnosis. The classes and their associated radiographic measurements were defined as follows: class A (hindfoot valgus) measured by the hindfoot moment arm (HMA), class B (midfoot abduction) measured by the talonavicular coverage angle (TNCA), class C (medial column instability) measured by Meary's angle, class D (peritalar sub-luxation) measured by the medial facet uncoverage (MFU), and class E (ankle valgus) measured using the talar tilt angle (TTA). Multivariate analyses were completed comparing each class measurement to the other classes. A p-value <0.05 was considered significant.
RESULTS
Class A showed substantial positive correlation with class C (ρ=0.71; R=0.576; p=0.001). Class B was substantially correlated with class D (ρ=0.74; R=0.613; p=0.001). Class C showed a substantial positive correlation with class A (ρ=0.71; R=0.576; p=0.001) and class D (ρ=0.75; R=0.559; p=0.001). Class D showed substantial positive correlation with class B and class C (ρ=0.74; R=0.613; p=0.001), (ρ=0.75; R=0.559; p=0.001) respectively. Class E did not show correlation with class B, C or D (ρ=0.24; R=0.074; p=0.059), (ρ=0.17; R=0.071; p=0.179), and (ρ=0.22; R=0.022; p=0.082) respectively.
CONCLUSION
This study was able to find relations between components of PCFD deformity with exception of ankle valgus (Class E). Measurements associated with each class were influenced by others, and in some instances with pronounced strength. The presented data may support the notion that PCFD is a three-dimensional complex deformity and suggests a possible relation among its ostensibly independent features. .
Topics: Humans; Retrospective Studies; Flatfoot; Radiography; Lower Extremity; Joint Dislocations; Weight-Bearing; Foot Deformities
PubMed: 38213846
DOI: No ID Found -
Neuropsychobiology Apr 202418q deletion syndrome is a rare genetic disorder characterized by various neurodevelopmental anomalies and medical issues. Although the occurrence of psychosis has been...
INTRODUCTION
18q deletion syndrome is a rare genetic disorder characterized by various neurodevelopmental anomalies and medical issues. Although the occurrence of psychosis has been reported in a small number of cases, details regarding the nature of such symptoms and their response to treatment have not been described.
CASE PRESENTATION
We describe a 31-year-old male with a history of speech delays, autistic features, a tethered spinal cord, bilateral vertical talus, subaortic stenosis and aortic regurgitation, recurrent otitis media, mild hearing loss, and hypospadias, who experienced a first episode of psychosis in his late 20s. His psychotic symptoms included auditory hallucinations, various delusions, and disorganization of thought. Although his presentation is atypical in certain ways (e.g., exhibiting highly fluctuant symptoms), he nonetheless meets criteria for schizophrenia. Given his overall clinical picture, chromosomal microarray analysis was completed, which revealed a 19.78 Mb deletion at 18q21.32 from nucleotide 58,226,713 to 78,015,180 (GRCh37). Despite exhibiting a somewhat idiosyncratic response to numerous antipsychotic medications, he eventually achieved partial remission of symptoms with improved insight on relatively low dose oral aripiprazole therapy.
CONCLUSION
This is the first in-depth description of 18q deletion syndrome-associated schizophrenia. While our patient's atypical presentation and idiosyncratic response to treatment may be mediated by his comorbid diagnosis of autism, his unusual psychiatric phenotype may alternatively be directly related to his underlying genetic disorder. The description of additional cases in the future will hopefully help clarify matters further.
PubMed: 38684151
DOI: 10.1159/000538693 -
Medical Science Monitor : International... Sep 2023BACKGROUND In the treatment of pes planus, if the implant does not match the anatomical structures of the sinus tarsi, synovitis can develop, causing pain symptoms. In...
BACKGROUND In the treatment of pes planus, if the implant does not match the anatomical structures of the sinus tarsi, synovitis can develop, causing pain symptoms. In the interest of making clinical recommendations for extra-osseous talotarsal stabilization, the goal of the present study was to characterize the anatomical characteristics of the sinus tarsi in patients with pes planus using magnetic resonance imaging (MRI) scans. MATERIAL AND METHODS This was a retrospective study involving 56 pes planus patients and 56 healthy volunteers from January 2014 to May 2022. The sinus tarsi was measured for length and width, for angle with the coronal and sagittal axes, and for length of the subtalar implant. RESULTS All examined metrics showed a difference between pes planus patients and healthy participants, with the exception of the subtalar implant's length. The average sinus tarsi length and width among pes planus patients were 19.23 mm and 2.91 mm, respectively. The angle between the sinus tarsi and the coronal and sagittal axes was 21.418° and 25.077°, while the length of approach was 33.06 mm and 0.76°. The only gender differences that were statistically significant were in the length and width of the sinus tarsi. There were no notable variations between the left and right sides. CONCLUSIONS Sinus tarsi morphology may be impacted by pes planus. When treating patients with pes planus, clinicians should take these anatomical factors into consideration since they might more completely characterize the anatomical features of the sinus tarsi.
Topics: Humans; Flatfoot; Heel; Retrospective Studies; Benchmarking; Bone and Bones
PubMed: 37731240
DOI: 10.12659/MSM.940687 -
Acta Bio-medica : Atenei Parmensis Jul 2023Talar body fractures are uncommon fractures of the foot and its management results to be very hard due to retrograde vascularization and wide articular cartilage... (Review)
Review
Talar body fractures are uncommon fractures of the foot and its management results to be very hard due to retrograde vascularization and wide articular cartilage coverage of talar surface, which could easily lead to poor functional outcomes, avascular osteonecrosis and early post traumatic arthritis. We describe a case of displaced, vertical, talar body fracture in a 41-year-old patient treated with reduction and fixation by talar anteromedial approach coupled to medial malleolar osteotomy to better expose the fracture. Our literature review has found few studies, in addition with a low level of statistical evidence. We advocate for more studies with a bigger sample and with a design of randomized control trials.
Topics: Humans; Adult; Fracture Fixation, Internal; Fractures, Bone; Talus; Foot; Ankle Joint
PubMed: 37486598
DOI: 10.23750/abm.v94iS1.14198 -
World Journal of Orthopedics Oct 2023Flexible flatfoot (FFF) is a very common condition in children, but no evidence-based guidelines or assessment tools exist. Yet, surgical indication is left to the...
BACKGROUND
Flexible flatfoot (FFF) is a very common condition in children, but no evidence-based guidelines or assessment tools exist. Yet, surgical indication is left to the surgeon's experience and preferences.
AIM
To develop a functional clinical score for FFF [Catania flatfoot (CTF) score] and a measure of internal consistency; to evaluate inter-observer and intra-observer reliability of the CTF Score; to provide a strong tool for proper FFF surgical indication.
METHODS
CTF is a medically compiled score of four main domains for a total of twelve items: Patient features, Pain, Clinical Parameters, and Functionality. Each item refers to a specific rate. Five experienced observers answered 10 case reports according to the CTF. To assess inter- and intra-observer reliability of the CTF score, the intra-class correlation coefficients' (ICCs) statistics test was performed, as well as to gauge the correlation between the CTF score and the surgical or conservative treatment indication. Values of 75% were chosen as the score cut-off for surgical indication. Sensitivity, specificity, positive likelihood ratio (PLHR), negative likelihood ratio (NLHR), positive predictive value (PPV), and negative predictive value (NPV).
RESULTS
Overall interobserver reliability ICC was 0.87 [95% confidence interval (CI): 0.846-0.892; < 0.001]. Overall intra-observer reliability ICC was 0.883 (95%CI: 0.854-0.909; < 0.001). A direct correlation between the CTF score and surgical treatment indication [Pearson correlation coefficient = 0.94 ( < 0.001)] was found. According to the 75% cut-off, the sensitivity was 100% (95%CI: 83.43%-100%), specificity was 85.71% (95%CI: 75.29%-92.93%), PLHR was 7 (95%CI: 3.94-12.43), NLHR was 0 (95%CI: 0-0), PPV was 75% (95%CI: 62.83%-84.19%) and NPV was 100% (95%CI: 100%-100%).
CONCLUSION
CTF represents a useful tool for orthopedic surgeons in the FFF evaluation. The CTF score is a quality questionnaire to reproduce suitable clinical research, survey studies, and clinical practice. Moreover, the 75% cut-off is an important threshold for surgical indication and helps in the decision-making process.
PubMed: 37970624
DOI: 10.5312/wjo.v14.i10.755 -
Foot and Ankle Clinics Sep 2023This article is meant to serve as a reference for radiologists, orthopedic surgeons, and other physicians to enhance their understanding of progressive collapsing foot... (Review)
Review
This article is meant to serve as a reference for radiologists, orthopedic surgeons, and other physicians to enhance their understanding of progressive collapsing foot deformity, also known as adult acquired flat foot deformity. Pathophysiology, imaging findings, especially on MRI and 3-dimensional MRI are discussed with relevant illustrations so that the readers can apply these principles in their practice for better patient managements.
Topics: Adult; Humans; Flatfoot; Magnetic Resonance Imaging
PubMed: 37536818
DOI: 10.1016/j.fcl.2023.04.009