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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 -
The Journal of Maternal-fetal &... Dec 2024
Topics: Humans; Flatfoot; Talus; Abnormalities, Multiple
PubMed: 38238108
DOI: 10.1080/14767058.2024.2304280 -
PloS One 2024Individuals with flatfoot have impaired proprioception owing to ligament laxity and impaired tendons, which can result in poor balance. Foot orthoses (FOs) have been... (Meta-Analysis)
Meta-Analysis
Individuals with flatfoot have impaired proprioception owing to ligament laxity and impaired tendons, which can result in poor balance. Foot orthoses (FOs) have been reported to stimulate plantar mechanical receptors and are used to manage foot overpronation in individuals with flatfoot. However, the results of the use of FOs to improve balance are inconsistent. In this systematic review and meta-analysis, we aimed to identify and investigate the effects of FOs on balance in individuals with flatfoot. Electronic databases were searched for articles published before March 2023. Peer-reviewed journal studies that included adult participants with flexible flatfoot and reported the effects of FOs on balance were included and classified based on the study design: randomized control trials (RCT) and non-RCTs. Four RCT studies were retained, and their methodological quality was assessed (mean, 63.2%; range 47.3%-73.1%: high), as were three non-RCT studies (mean, 54.1%; range, 42.1%-68.4%: high). Meta-analysis was performed by calculating the effect size using the standardized mean differences between the control and FO conditions. Transverse-arch insoles immediately improved static balance after use. However, no immediate significant effect was found for medial archsupport FOs, cuboid-posting FOs, or University of California Berkeley Laboratory FOs during the study period (2-5 weeks) when compared with the controls. The transverse-arch insole is the most effective FO feature for improving static balance. However, the high heterogeneity between study protocols contributes to the lack of evidence for the effects of FO on balance in people with flatfoot.
Topics: Humans; Flatfoot; Foot; Foot Orthoses; Lower Extremity; Tarsal Bones; Postural Balance
PubMed: 38457399
DOI: 10.1371/journal.pone.0299446 -
Infectious Diseases and Therapy May 2024Heel puncture (HP) in neonates can result in osteomyelitis if done non-aseptically or with incorrect technique. This study summarizes clinical experience with heel... (Review)
Review
INTRODUCTION
Heel puncture (HP) in neonates can result in osteomyelitis if done non-aseptically or with incorrect technique. This study summarizes clinical experience with heel puncture-related osteomyelitis of the calcaneus (HP-CO) in newborns.
METHODS
We systematically reviewed studies that examined HP-CO in newborn patients using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search included the PubMed, Embase, and Cochrane Library databases until December 31, 2023. We used the National Institutes of Health (NIH) assessment scale to evaluate the quality of our analyzed studies.
RESULTS
This study analyzed 15 neonatal calcaneal osteomyelitis (CO) cases due to HP conducted in six countries from 1976 to 2016. The average age of the cases was 8.87 ± 6.13 days, with an average birth weight of 2367.27 ± 947.59 g. The infants had undergone an average of 9.00 ± 8.90 HP, with 93.33% exhibiting swelling. Staphylococcus aureus was present in 80% of cases. Beta-lactam antibiotics were used, with satisfactory outcomes in 53.33% of cases. However, in seven cases, three patients had flatfoot due to calcaneal deformity, and other complications were observed in some patients after 7-8 years.
CONCLUSIONS
This study offers valuable insights into a rare condition, including its epidemiology, clinical and laboratory characteristics, and treatment options for infants with HP-CO. To prevent the risk of osteomyelitis in this vulnerable group of patients, increasing awareness and maintaining strict aseptic techniques is necessary. We recommend that infants presenting with tenderness, redness, purulent discharge, erythema, or fever and with a history of repeated HP and swollen ankles should be evaluated for suspicion of osteomyelitis. A graphical abstract is avilable for this article.
PubMed: 38589762
DOI: 10.1007/s40121-024-00957-8 -
Frontiers in Pediatrics 2023To investigate the clinical efficacy of modified kidner procedure combined with subtalar arthroereisis in the treatment of adolescent type II painful accessory navicular...
PURPOSE
To investigate the clinical efficacy of modified kidner procedure combined with subtalar arthroereisis in the treatment of adolescent type II painful accessory navicular with flexible flatfoot.
METHODS
From January 2018 to January 2022, 25 adolescent patients (40 feet) with painful type II accessory navicular and flexible flatfoot admitted to our hospital were enrolled in the study, including 13 males (23 feet) and 12 females (17 feet). All patients underwent modified kidner procedure combined with subtalar joint arthrodesis. The Meary's Angle, the first metatarsal Angle of talus (APTMT), the second metatarsal Angle of talus, Pitch Angle, talus tilt Angle, talonavicular coverage Angle (TCA), talus calcaneal Angle (LTCA), and calcaneal Angle were measured on weight-bearing anteroposterior and lateral x-ray films before operation and at last follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) were used to evaluate the improvement of foot function and pain.
RESULTS
All patients were followed up for average 17.4 ± 2.6 months (12-24). The incisions of 25 patients healed by first intention. The weight-bearing anteroposterior and lateral x-ray films of the foot showed that the suture anchors did not pull out or break, and the foot arch did not collapse further. There was no screw withdrawal or secondary operation to remove the screw in all patients. At the last follow-up, the postoperative visual analogue scale (VAS) score of the affected foot was significantly lower than that before operation ( < 0.01), and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function score was significantly higher than that before operation ( < 0.01). At the last follow-up, the weight-bearing anteroposterior and lateral foot x-ray films showed that: The Meary's Angle, the first metatarsal Angle of the talus (APTMT), the second metatarsal Angle of the talus, Pitch Angle, talar tilt Angle, talonavicular overbite Angle (TCA), talocalcaneal Angle (LTCA), and calcaneal Angle significantly improved when compared with those before operation ( < 0.01).
CONCLUSIONS
The modified kidner procedure combined with subtalar arthroereisis has a good clinical effect in the treatment of adolescent type II painful accessory navicular with flexible flatfoot, which can effectively improve the pain symptoms, improve the foot function and imaging manifestations, and correct the flatfoot deformity.
PubMed: 37675392
DOI: 10.3389/fped.2023.1258032 -
Children (Basel, Switzerland) May 2024Flatfeet in children are common, causing concern for parents due to potential symptoms. Technological advances, like 3D foot kinematic analysis, have revolutionized... (Review)
Review
BACKGROUND
Flatfeet in children are common, causing concern for parents due to potential symptoms. Technological advances, like 3D foot kinematic analysis, have revolutionized assessment. This review examined 3D assessments in paediatric idiopathic flexible flat feet (FFF).
METHODS
Searches focused on paediatric idiopathic FFF in PubMed, Web of Science, and SCOPUS. Inclusion criteria required 3D kinematic and/or kinetic analysis during posture or locomotion, excluding non-idiopathic cases, adult feet, and studies solely on pedobarography or radiographs.
RESULTS
Twenty-four studies met the criteria. Kinematic and kinetic differences between FFF and typical feet during gait were outlined, with frontal plane deviations like hindfoot eversion and forefoot supination, alongside decreased second peak vertical GRF. Dynamic foot classification surpassed static assessments, revealing varied movement patterns within FFF. Associations between gait characteristics and clinical measures like pain symptoms and quality of life were explored. Interventions varied, with orthoses reducing ankle eversion and knee and hip abductor moments during gait, while arthroereisis normalized calcaneal alignment and hindfoot eversion.
CONCLUSIONS
This review synthesises research on 3D kinematics and kinetics in paediatric idiopathic FFF, offering insights for intervention strategies and further research.
PubMed: 38790599
DOI: 10.3390/children11050604 -
Acta Ortopedica Brasileira 2023To describe the technique, analyze possible radiographic correction and evaluate the clinical result of medial and plantar calcaneal displacement osteotomy associated...
OBJECTIVE
To describe the technique, analyze possible radiographic correction and evaluate the clinical result of medial and plantar calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy for flexible flatfoot correction.
METHODS
23 patients (30 feet) diagnosed with flexible flat foot treated with plantar and medial calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy were evaluated retrospectively. In the lateral radiographs calcaneal pitch and Meary's angle were the radiographic parameters evaluated; while the talonavicular coverage angle was evaluated in the anteroposterior radiographs. To assess the clinical outcome of the surgical procedure, the American Orthopedic Foot and Ankle Society Score (AOFAS) for the ankle and hindfoot was adopted.
RESULTS
The mean values of the evaluated angles and AOFAS score for ankle and hindfoot significantly improved when comparing pre- and postoperative values.
CONCLUSION
Plantar and medial calcaneal displacement osteotomy associated with an opening wedge cuboid osteotomy is able to improve radiological and clinical parameters of child patients with flexible flatfoot.
PubMed: 37547233
DOI: 10.1590/1413-785220233104e265045 -
Journal of Orthopaedic Surgery and... Mar 2024Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis,...
BACKGROUND
Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens.
METHODS AND RESULTS
We performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18-64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle.
RESULTS
Ankle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months.
CONCLUSION
Ultrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist's office, with a very basic instrument set and local anesthesia, thus reducing expenses.
Topics: Adult; Male; Female; Child; Humans; Achilles Tendon; Prospective Studies; Fasciitis, Plantar; Tendinopathy; Muscle, Skeletal; Contracture; Ultrasonography, Interventional; Metatarsalgia
PubMed: 38532430
DOI: 10.1186/s13018-024-04685-0