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Journal of Foot and Ankle Research Jun 2024Posterior Tibial Tendon Dysfunction (PTTD) is commonly seen within musculoskeletal care. The condition's prevalence and management is poorly understood. This study aims...
BACKGROUND
Posterior Tibial Tendon Dysfunction (PTTD) is commonly seen within musculoskeletal care. The condition's prevalence and management is poorly understood. This study aims to demonstrate current practice by multi-professional clinicians across the United Kingdom within the National Health Service.
METHODS
A national (UK) cross-sectional online survey was conducted among multi-professionals who treat PTTD within their NHS practice. The survey covered assessment, management and evaluation. This was shared via social media and professional groups.
RESULTS
Two hundred thirteen surveys were completed, with 153 matching the eligibility criteria. The main respondents were Physiotherapists (48%) and Podiatrists (38%). Ultrasound scanning was used most frequently when considering initial imaging (67%). Many different treatment modalities were used, but a core set of education/advice, foot orthoses, and foot specific as well as general exercise were most commonly chosen. Outcome measures routinely used were pain scale (96/269) and single leg heel raise (84/269), but patient reported outcome measures were not routinely used. The most frequent reason to escalate care was failure to manage symptoms with conservative management (106/123; 86.2%), followed by fixed deformity (10/123; 8.2%).
CONCLUSIONS
This survey provides evidence on current non-surgical management for PTTD from UK NHS practice. It provides a valuable marker for clinicians to use to compare their own practice and can be used in further research as a comparator.
Topics: Humans; United Kingdom; Posterior Tibial Tendon Dysfunction; Cross-Sectional Studies; Conservative Treatment; Female; Male; Podiatry; Practice Patterns, Physicians'; Physical Therapists; Foot Orthoses; Ultrasonography; Adult; Surveys and Questionnaires; Middle Aged; Physical Therapy Modalities; Health Care Surveys; State Medicine; Exercise Therapy
PubMed: 38898672
DOI: 10.1002/jfa2.12033 -
Journal of Multidisciplinary Healthcare 2023Although the inverted technique was shown to be more effective compared to other orthotic designs for the treatment of flatfeet, the biomechanical mechanisms underlying...
BACKGROUND
Although the inverted technique was shown to be more effective compared to other orthotic designs for the treatment of flatfeet, the biomechanical mechanisms underlying the therapeutic effect of the inverted angle orthoses is still unclear. Therefore, the aim of this study was to examine the effect of different inverted angles of foot orthoses on walking kinematics in females with flexible flatfeet.
METHODS
Thirty-one female adults with flexible flatfeet aged 18-35 years old participated in this study. Kinematic data of the hip, knee, and ankle were collected via BTS motion-capture system during walking under three test conditions in random order: with shoes only; with 15° inverted orthoses; and with 25° inverted orthoses.
RESULTS
Compared to the shoes only condition, both the 15° and 25° inverted orthotic conditions significantly decreased the maximum ankle plantarflexion angle during loading response, maximum ankle dorsiflexion angle during mid-stance, maximum ankle external rotation angle, and maximum ankle internal rotation angle. The maximum ankle plantarflexion angle at toe-off showed a significant decrease with the 25° inverted angle orthosis compared to both the 15° inverted angle and shoes only conditions. No significant differences were found in the knee kinematic variables, maximum hip extension angle, and maximum hip adduction angle between test conditions.
CONCLUSION
Using inverted orthoses at 15° and 25° inverted angles resulted in significant changes in ankle joint kinematics during walking in female adults with flexible flatfeet. A 25° inverted angle orthosis significantly decreased ankle plantarflexion during push-off, potentially impacting gait mechanics. This suggests that a smaller inverted angle may be more effective for managing flexible flatfeet in female adults.
PubMed: 37693854
DOI: 10.2147/JMDH.S420003 -
Orthopadie (Heidelberg, Germany) Jan 2024Minimally invasive calcaneal osteotomy (MICO) is already an established surgical procedure for correcting hindfoot deformities using a lateral approach. So far, no...
INTRODUCTION
Minimally invasive calcaneal osteotomy (MICO) is already an established surgical procedure for correcting hindfoot deformities using a lateral approach. So far, no description of a medial approach for MICO has been published.
MATERIAL AND METHODS
Between August 2022 and March 2023, 32 consecutive patients (MICO with medial approach, MMICO: n = 15; MICO with lateral approach, LMICO: n = 17) underwent MICO as part of complex reconstructive surgery of the foot and ankle with concomitant procedures. The amount of correction in the axial view of the calcaneus and consolidation rates were evaluated radiographically. Subjective satisfaction, stiffness of the subtalar joint, and pain level (numeric rating scale, NRS) at the level of the heel were assessed clinically. The last follow-up was at 6 months.
RESULTS
All osteotomies consolidated within 6 months after surgery. Displacement of the tuber was 9 mm on average in either group. Relevant subtalar joint stiffness was detected in 5 MMICO and 6 LMICO patients. No relevant differences between the groups were detected for wound healing problems, nerve damage, heel pain or patient satisfaction.
CONCLUSION
In this study lateral and medial approaches for MICO were performed. Similar degrees of correction and low complication rates were found in both groups. The medial approach for MICO is safe and can be beneficial regarding patient positioning and arrangement of the C‑arm.
Topics: Humans; Case-Control Studies; Flatfoot; Feasibility Studies; Osteotomy; Pain
PubMed: 38078936
DOI: 10.1007/s00132-023-04460-9 -
Frontiers in Pediatrics 2023Subtalar arthroereisis (STA) has gained growing acceptance as a viable approach solution for the management of pediatric flexible flatfoot. However, STA still remains...
Mid-term assessment of subtalar arthroereisis with Talar-Fit implant in pediatric patients with flexible flatfoot and comparing the difference between different sizes and exploring the position of the inserted implant.
BACKGROUND
Subtalar arthroereisis (STA) has gained growing acceptance as a viable approach solution for the management of pediatric flexible flatfoot. However, STA still remains controversial. The purpose of this study is to assess the effect of STA using the Talar-Fit implant for treating pediatric flexible flatfoot. Specifically, the aims of the study are as follows: first, to present the mid-term outcomes of STA using the Talar-Fit implant; second, to compare the radiographic and clinical outcomes associated with varying sizes of Talar-Fit implant; and third, to analyze the optimal position of the inserted implants.
METHODS
A retrospective analysis was conducted on a cohort of 57 pediatric patients diagnosed with flexible flatfoot (77 feet) who underwent STA utilizing Talar-Fit between January 2014 and December 2021. The participants were categorized into five groups according to the size of the implant: Group 8, Group 9, Group 10, Group 11, and Group 12. The evaluation included the assessment of clinical function using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, as well as the assessment of radiographic data such as the calcaneal pitch angle (CPA), lateral Meary angle (LMA), talar declination angle (TDA), and medial longitudinal arch angle (MLAA) were evaluated. Furthermore, the position of the inserted implants was also recorded, including angle, depth, and distance. The comparison of pre- and postoperation was conducted using the paired Student's -test, whereas the analysis of differences among subgroups was performed using the Wilcoxon rank-sum test. A -value < 0.05 is considered statistically significant.
RESULTS
In total, 57 pediatric patients (77 feet) were successfully followed-up for an average period of 26.8 months. The overall AOFAS score significantly improved from 58.6 ± 10.9 to 85.2 ± 8.6 ( < 0.001). Furthermore, the LMA decreased from 20.3° ± 3.6° to 4.5° ± 1.3°, the CPA increased from 14.8° ± 1.6° to 23.6° ± 2.7°( < 0.05), the TDA decreased from 40.2° ± 2.3° to 25.5° ± 3.2°( < 0.05), and the MLAA decreased from 140.1° ± 2.8° to 121.4° ± 3.9°( < 0.05). No statistically significant differences were observed among subgroups regarding the final outcomes. The improvements of CPA, TDA, and MLAA among different groups were significantly different; however, the adjusted -values were all greater than 0.05. The implant were inserted at a mean angle of 89.5° ± 2.4°, a mean depth of 0.9 mm ± 2.1 mm, and a mean distance of 9.9 mm ± 0.9 mm. Eight patients experienced complications, including six cases of pain occurrence and two cases of implant dislocation.
CONCLUSION
STA with Talar-Fit has demonstrated satisfactory mid-term outcomes. A Talar-Fit with a larger size may demonstrate a superior effect when compared with that of a smaller size. The implants were inserted in a similar position, indicating that the medial edge of the implant may be possible to transcend the midline of the talus neck.
PubMed: 37849498
DOI: 10.3389/fped.2023.1258835 -
Journal of Physical Therapy Science Apr 2024[Purpose] We aimed to develop a noninvasive specific ultrasonographic assessment of the talonavicular joint during loading to facilitate the analysis of treatment of...
[Purpose] We aimed to develop a noninvasive specific ultrasonographic assessment of the talonavicular joint during loading to facilitate the analysis of treatment of flatfoot. [Participants and Methods] Sixty healthy participants underwent ultrasound imaging of the talonavicular joint while sitting and standing. The talonavicular angle was defined as the intersection of the line connecting the navicular and talar heads and the line connecting the talar head and sustentaculum tali. Talonavicular coverage was assessed using X-ray images of 15 participants. [Results] Ultrasonographic assessment of the talonavicular joint showed a lateral shift of the navicular relative to the head of the talus from sitting to standing. The talonavicular angle was significantly larger when standing than in the sitting position. The difference in talonavicular angle values between sitting and standing significantly correlated with the differences in the talonavicular coverage values. [Conclusion] We showed that ultrasonographic talonavicular angle assessment has good reliability and moderate validity for detecting significant alignment changes in the talonavicular joints due to loading. In the future, this evaluation method should be performed before and after exercise therapy to assess and develop appropriate exercise therapy for flatfoot.
PubMed: 38562531
DOI: 10.1589/jpts.36.208 -
European Journal of Pediatrics Mar 2024The objective of this study was to establish the accuracy of the resting calcaneal stance position (RCSP) for the assessment of flat foot (FF) in children, aligned to...
The objective of this study was to establish the accuracy of the resting calcaneal stance position (RCSP) for the assessment of flat foot (FF) in children, aligned to the validity of the foot posture index (FPI). The RCSP cut-off point was explored, in context of both FF prevalence and the relationship between FF and body weight. A total of 205 healthy children, aged 5 to 10 years, participated in a cross-sectional study. Correlation was performed between RCSP and FPI. ROC curve technique was calculated to assess differentiation between groups. A score equal to or greater than 7 on the FPI was used as the 'gold standard' for analysis. The correlation between FPI and RCSP was significant (r = 0.63; p < 0.01). The discrimination score on the ROC curve (6 points/degrees) shows that the model can be used to identify FF through RCSP, with a sensitivity of 67% and specificity of 85% returned. Conclusion: The results of this study indicate the role of RCSP for simple, accessible and quick screening of paediatric FF. This is especially pertinent for non-podiatric healthcare professional without specialised paediatric foot knowledge. What is Known: • Most children develop a normal arch quickly, and flat feet usually resolve on their own between 2 and 6 years of age. • The measurement used to diagnose flat foot in children must be accurate, consistent, and valid to characterize the standard foot position. The Resting Calcaneal Stance Position (RCSP) is another widely used measure to evaluate the position of the flat foot in children. What is New: • The RCSP cut-off point 6 shows a sensitivity of 67% and a specificity of 85% thanks to the FPI as the Gold standard. • The RCSP is useful for health professionals who are not specialised in pediatric foot health. The RCSP is useful to detect flat foot in children.
Topics: Child; Humans; Child, Preschool; Flatfoot; Cross-Sectional Studies; Foot; Posture; Body Weight
PubMed: 38103102
DOI: 10.1007/s00431-023-05354-w -
Journal of Clinical Medicine Jul 2023There have been no reports on arthroereisis screw insertion into the talus in patients with flexible flatfoot. We aimed to conduct a clinical and radiological assessment...
BACKGROUND
There have been no reports on arthroereisis screw insertion into the talus in patients with flexible flatfoot. We aimed to conduct a clinical and radiological assessment in patients with symptomatic pes planovalgus deformity treated with a talar screw.
METHODS
This study involved a prospective assessment of 27 patients treated surgically for symptomatic flexible flatfoot deformity in the period 2021-2022. The following parameters were assessed in this study: Meary's angle, the Costa-Bartani angle, the calcaneal pitch angle, surgery duration, the length of hospital stay, patient satisfaction, patients' retrospective willingness to consent to the treatment they received, postoperative complications, and the use of analgesics.
RESULTS
The mean follow-up period was 14.76 months. Meary's angle decreased from 18.63° before surgery to 9.39° at follow-up ( = 0.004). The Costa-Bartani angle decreased significantly from 154.66° before surgery to 144.58° after surgery ( = 0.012). The calcaneal pitch angle changed from 16.21° before to 19.74°. Complications were reported in three patients (11.11%). The mean surgery duration was 32 min. The mean hospital stay was 2.2 days. Fourteen patients (51.85%) were highly satisfied with the treatment, and 12 patients (44.44%) were quite satisfied with treatment. Twenty-five (92.59%) of the evaluated patients would choose the same type of treatment again. Six patients (22.22%) needed to use analgesics prior to surgical treatment, whereas none of the patients needed to use them by the final follow-up.
CONCLUSION
Spherus screw arthroereisis helps improve radiological parameters in patients with flexible flatfoot. We observed good clinical outcomes after treatment with a talar screw, with a majority of patients reporting moderate-to-high levels of satisfaction with treatment. Both short- and medium-term treatment outcomes of pes planovalgus treatment with the use of Spherus screw are good.
PubMed: 37568440
DOI: 10.3390/jcm12155038 -
BMC Musculoskeletal Disorders Sep 2023
PubMed: 37773126
DOI: 10.1186/s12891-023-06898-6 -
Foot & Ankle Orthopaedics Jan 2024For the younger, more active patient with flexible symptomatic progressive collapsing foot deformity (PCFD), joint-sparing procedures may be preferred to preserve...
BACKGROUND
For the younger, more active patient with flexible symptomatic progressive collapsing foot deformity (PCFD), joint-sparing procedures may be preferred to preserve functional motion. Isolated talonavicular (TN) arthrodesis has been described for treatment of rigid and flexible PCFD for patients that are older and less active whose deformity is still correctable through the TN joint. The purpose of this study was to evaluate radiographic and clinical outcomes in patients with PCFD treated with isolated triplanar correction with a TN joint arthrodesis.
METHODS
Forty-nine patients (53 feet) with flexible PCFD underwent isolated TN arthrodesis. Weightbearing radiographs were performed pre- and postoperatively, and measurements included lateral talar-first metatarsal angle, calcaneal pitch, TN coverage angle, and the anteroposterior (AP) talar-first metatarsal angle. The Foot and Ankle Ability Measure (FAAM) and Veterans-Rand 12-Item Health Survey (VR-12) scores were also collected.
RESULTS
Thirty-five females and 14 males were evaluated with a mean age of 63 years, at an average follow-up of 41.3 months. Significant improvements were found radiographically. Lateral radiographs demonstrated improvements in lateral talar-first metatarsal angle from 25.2 degrees preoperatively to 9.5 degrees postoperatively ( < .001) and calcaneal pitch from 14.9 degrees preoperatively to 17.5 degrees postoperatively ( < .001). AP radiographs showed the TN coverage angle improving from 35.0 degrees to 4.9 degrees postoperatively ( < .001) and AP talar-first metatarsal angle improving from 17.3 degrees to 5.9 degrees postoperatively ( < .001). Clinical outcomes were improved in the FAAM pain score (48.6 to 39.2, = .130), FAAM ADL score (53.8 to 69.2, = .002), FAAM Sport score (29.5 to 40.7, = .099), and the overall FAAM score (47.7 to 63.1, = .006). Patient satisfaction with medical care was 85.2/100 postoperatively.
CONCLUSION
Isolated TN arthrodesis is a viable surgical option for older, lower-demand patients with flexible PCFD. This study demonstrated significant improvements in radiographic alignment and FAAM scores. Comparative studies with other surgical procedures should be performed to determine which is the best technique for older, lower-demand patients with flexible PCFD.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
PubMed: 38516057
DOI: 10.1177/24730114241235672 -
Journal of Personalized Medicine Aug 2023Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or...
Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or clear treatment approach. There are multiple conservative and surgical treatments, the implantation of foot orthoses (FO) being the most used treatment. The evidence supporting FO is very thin. It is not clearly known what the effect of these is, nor when it is convenient to recommend them. The main objective of this protocol is to design a randomized controlled trial to determine if personalized FO, together with a specific exercise regimen, produce the same or better results regarding the signs and symptoms of PFF, compared to only specific exercises. In order to respond to the stated objectives, we have proposed a randomized controlled clinical trial, in which we intend to evaluate the efficacy of FO together with strengthening exercises, compared to a control group in which placebos will be implanted as FO treatment along with the same exercises as the experimental group. For this, four measurements will be taken throughout 18 months (pre-treatment, two during treatment and finally another post-treatment measurement). The combination of FO plus exercise is expected to improve the signs and symptoms (if present) of PFF compared to exercise alone and the placebo FO group. In addition, it is expected that in both conditions the biomechanics of the foot will improve compared to the initial measurements.
PubMed: 37623519
DOI: 10.3390/jpm13081269