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EFORT Open Reviews Feb 2021Subtalar arthroereisis has a controversial history and has previously been associated with high failure rates and excessive complications.A database search for outcomes... (Review)
Review
Subtalar arthroereisis has a controversial history and has previously been associated with high failure rates and excessive complications.A database search for outcomes of arthroereisis for the treatment of symptomatic paediatric flexible pes planus provided 24 articles which were included in this review, with a total of 2550 feet operated on.Post-operative patient-reported outcome measures recorded marked improvement. Patient satisfaction was reported as excellent in 79.9%, and poor in 5.3%. All radiological measurements demonstrated improvement towards the normal range following arthroereisis, as did hindfoot valgus, supination, dorsiflexion and Viladot grade.Complications were reported in 7.1% of cases, with a reoperation rate of 3.1%.Arthroereisis as a treatment for symptomatic paediatric flexible pes planus produces favourable outcomes and high patient satisfaction rates with a reasonable risk profile. There is still a great deal of negativity and literature highlighting the complications and failures of arthroereisis, especially for older implants.The biggest flaws in the collective literature are the lack of high-quality prospective studies, a paucity of long-term data and the heterogeneity of utilized outcome measures between studies. Cite this article: 2021;6:118-129. DOI: 10.1302/2058-5241.6.200076.
PubMed: 33828855
DOI: 10.1302/2058-5241.6.200076 -
World Journal of Orthopedics Jun 2021Flexible flatfoot (FFF) is a very common condition in children, characterized by the loss of the medial arch and by an increase in the support base with valgus of the...
BACKGROUND
Flexible flatfoot (FFF) is a very common condition in children, characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot. Arthroereisis (AR) procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop (CS).
AIM
We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients. We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population, young athletes, and obese people according to material device.
METHODS
Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6, 2020. The research string used was (pediatric OR children OR Juvenile NOT adult) AND (flexible NOT rigid) AND (flat foot OR pes planus) AND (calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal). The risk of bias assessment was performed using the Dutch checklist form for prognosis.
RESULTS
A total of 47 articles were found. Ultimately, after reading the full text and checking reference lists, we selected 17 articles that met the inclusion and exclusion criteria. A total of 1864 FFFs were identified. Eight studies concerned the subtalar AR (47.1%) and nine concerning CS (52.9%). The average age of patients at start of treatment was 11.8 years, the average follow-up of the studies was 71.9 mo (range 29.1-130). Globally, complications occurred in 153 of the 1864 FFF treated, with a rate of 8.2%.
CONCLUSION
Both AR procedures are valid surgical techniques for treating FFF. Surgeon experience, implant cost, and cosmetic correction are the most common considerations included in the orthopedic device decision-making process. In obese patients, the subtalar AR is not recommended. In adolescents who need to improve sports performance, the CS screw had better results compared with other implants.
PubMed: 34189081
DOI: 10.5312/wjo.v12.i6.433 -
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 -
The Journal of Foot and Ankle Surgery :... 2020The purpose of this study was to evaluate the available clinical and radiographic evidence for incorporation of a gastrocnemius recession or tendo-Achilles lengthening... (Review)
Review
The purpose of this study was to evaluate the available clinical and radiographic evidence for incorporation of a gastrocnemius recession or tendo-Achilles lengthening into the surgical correction of adult acquired flatfoot deformity. A systematic review of the literature was performed using PubMed, Embase, Cochrane, CINAHL, and Google Scholar. Among the relevant articles, the level of evidence and quality was identified using the Methodological Index for Non-Randomized Studies tool. No study explicitly examined whether clinical or radiographic outcomes after adult acquired flatfoot deformity correction are improved when incorporating a gastrocnemius recession or tendo-Achilles lengthening compared with when no such procedure is performed, nor have they directly compared outcomes between 2 procedures. Studies demonstrated an overall improvement in postoperative range of motion and plantar flexion power after gastrocnemius recession, but such findings are hard to separate from the clinical contribution of concomitant corrective procedures to the foot itself. All studies that analyzed anteroposterior talo-calcaneal angle, anteroposterior lateral talo-first metatarsal angle and calcaneal inclination angle revealed improvement of each parameter postoperatively. There were no high-level evidence studies in the literature explicitly quantifying ankle range of motion, plantar flexion power, or radiographic impact of gastrocnemius recession or tendo-Achilles lengthening on adult acquired flatfoot deformity correction. Although gastrocnemius-soleus complex contractures have certainly been demonstrated to coexist with adult acquired flatfoot deformity, support for lengthening procedures is largely based on expert opinion or case series and is difficult to distinguish from the clinical contribution of associated corrective procedures.
Topics: Adult; Calcaneus; Contracture; Flatfoot; Foot; Humans; Retrospective Studies; Tenotomy
PubMed: 32828633
DOI: 10.1053/j.jfas.2020.03.016 -
Journal of Back and Musculoskeletal... Feb 2024With lifestyle changes, the prevalence of flatfoot is increasing year by year, with a prevalence of 29%. Flatfoot will lead to an inevitable injury and reduce the... (Review)
Review
BACKGROUND
With lifestyle changes, the prevalence of flatfoot is increasing year by year, with a prevalence of 29%. Flatfoot will lead to an inevitable injury and reduce the quality of life. Short foot exercises can enhance the strength of the intrinsic muscles of the foot and improve the symptoms of flatfoot. However, there is controversy regarding its specific efficacy.
OBJECTIVE
This meta-analysis quantitatively evaluates the effect of short foot training on patients with flatfeet and provides evidence to inform the clinical approach to short foot training in patients with flat feet.
METHODS
A total of eight databases were searched, including CNKI, WANFANG, VIP, and CBM in Chinese and PubMed, Cochrane, Web of Science, and Embase in English. The timeframe for searching the literature was March 2023 for each database build. English database search terms and search formulas were: (flat foot OR talipes valgus OR talipes calcaneovalgus) AND (short foot exercises OR physical therapy OR neurophysiotherapy).
RESULTS
The current pooled results show no significant difference in the improvement of the navicular drop test and foot posture index with short foot exercises compared to controls; only short foot exercises greater than 6 w showed a significant improvement in the navicular drop test, and sensitivity analysis showed a significant improvement in the foot posture index with short foot exercises.
CONCLUSION
This systematic review and meta-analysis showed that short foot exercises need a larger sample size to find their effect on improving flat feet; the duration of the intervention is a factor. As most studies are currently unclear whether the participants were patients with flat feet or asymptomatic individuals with flat feet the disease syndrome in patients with flatfoot may also be a factor.
PubMed: 38517769
DOI: 10.3233/BMR-230226 -
Assistive Technology : the Official... Mar 2023This systematic review aimed to evaluate custom-made 3D printed insoles for people with flatfeet. PubMed, Embase, ISI web of knowledge, ProQuest, Scopus, and Cochrane...
This systematic review aimed to evaluate custom-made 3D printed insoles for people with flatfeet. PubMed, Embase, ISI web of knowledge, ProQuest, Scopus, and Cochrane databases, were searched from inception until January 2022. The quality assessment of included studies was performed through the Downs and Black checklist. A narrative analysis was performed since a meta-analysis could not be conducted. Ten studies including 225 subjects with flexible flatfeet were chosen for final evaluation. Although the evidence from selected literature was generally weak, using insoles with 3D printing technology may positively affect pain (comfort score) and foot function, with no significant change in vertical loading rate during walking or running. There were discrepancies among studies for plantar pressures, center of pressure trajectories, 3D ankle joint kinematics and kinetics of gait while wearing these insoles. Dose-response effects of medial posting on 3D printed insoles suggested beneficial effects on lower limb gait biomechanics in people with flatfeet. There was insufficient evidence to conclude the comparison between 3D printed insoles and other types of insoles. In conclusion, using a 3D printed insole may improve comfort score and foot function in people with flatfeet.
Topics: Humans; Flatfoot; Equipment Design; Pressure; Foot Orthoses; Walking; Printing, Three-Dimensional; Biomechanical Phenomena
PubMed: 35882078
DOI: 10.1080/10400435.2022.2105438 -
Archives of Orthopaedic and Trauma... May 2021Subtalar arthroereisis has been increasingly accepted as a solution to manage symptomatic pes planus. However, despite the recent developments related to arthroereisis,... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Subtalar arthroereisis has been increasingly accepted as a solution to manage symptomatic pes planus. However, despite the recent developments related to arthroereisis, no other published literature has aimed to review the outcomes in paediatric patients since 2010. This systematic review and meta-analysis, therefore, aims to evaluate the current outcomes of subtalar arthroereisis in the treatment of symptomatic pes planus among the paediatric population.
MATERIALS AND METHODS
The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reported on the clinical outcomes of subtalar arthroereisis in children aged 21 or younger were included.
RESULTS
A total of 17 publications were included, with 1536 feet. The average duration of follow-up of the studies included in the review is 43.52 months. The studies consistently reported improvement in the radiological outcomes, approximating that of a normal population. Subtalar arthroereisis has shown to restore the collapsed medial longitudinal arch, supported by the decrease in Meary's angle to 5.267° (95% CI: 4.695°-5.839°, normal: 0°-10.0°) post-operatively and an increased calcaneal pitch of 15.70° (95% CI: 15.41°-15.99°, normal 18.0°-20.0°). Deformities associated with pes planus such as heel valgus was also significantly reduced, evident by the post-operative lateral talocalcaneal angle of 27.19° (95% CI: 26.44°-27.93°, normal: 25.0°-45.0°) and a post-operative Kite's angle of 18.13° (95% CI: 17.73°-18.52°, normal: 15.0°-30.0°). Subjectively, subtalar arthroereisis has generally resulted in an improvement in the grading of outcomes postoperatively from the patient's point of view.
CONCLUSIONS
Subtalar arthroereisis could serve as a procedure to correct radiological abnormalities, as well as relieve pain in selected patients with symptomatic pes planus.
Topics: Adolescent; Child; Child, Preschool; Female; Flatfoot; Humans; Male; Orthopedic Procedures; Subtalar Joint
PubMed: 32377845
DOI: 10.1007/s00402-020-03458-8 -
Acta Orthopaedica Mar 2022Albeit pediatric flexible flat foot (FFF) is a common condition, only a minority of patients become symptomatic. Long-term outcomes of surgically treated pediatric...
BACKGROUND AND PURPOSE
Albeit pediatric flexible flat foot (FFF) is a common condition, only a minority of patients become symptomatic. Long-term outcomes of surgically treated pediatric patients with symptomatic FFF are largely unknown. In this systematic review, studies providing outcomes at a mean follow-up of at least 4 years after the procedure in these patients were analyzed.
MATERIAL AND METHODS
A PubMed search was undertaken involving original articles published up to July 2021 on outcome in children aged 6 to 14 with surgically treated FFF and mean (or minimum) follow-up of at least 4 years. Radiographic and clinical outcomes were analyzed.
RESULTS
Of initially 541 entries, 10 could be included in the systematic review (all level IV), involving 846 pediatric patients with 1,536 symptomatic FFF. Pooled mean radiological (n = 8) and clinical follow-up (n = 10) was 5.3 (range 0.5-15) and 7.0 (range 4.1-15) years, respectively. Surgical procedures included arthroereisis (n = 8), lateral column lengthening (n = 1), and Horseman procedure (n = 1). Overall relative frequency of implant-associated complications and wound-healing problems was 3.2% and 1.3%, as well as 2.8% and 1.6% following subtalar arthroereisis only. From preoperative to latest radiological assessment following subtalar arthroereisis (including 3 studies with radiological follow-up < 48 months), pooled median decrease in talonavicular coverage angle (TNCA; -9.2°), anteroposterior talocalcaneal angle (A-TCA; -6.5°), lateral talocalcaneal angle (L-TCA; -3.5°), talar declination angle (TDA; -14°), Moreau Costa Bertani angle (MCB; -13°), and talo-firstmetatarsal angle (L-T1MA; -10°) was observed, as was an increase in calcaneal pitch (4.5°).
INTERPRETATION
In symptomatic pediatric FFF patients, surgery is associated with a manageable complication profile, and results in satisfactory long-term clinical as well as radiological outcome. Yet scientific evidence is low, warranting larger scaled studies in the future.
Topics: Adolescent; Calcaneus; Child; Flatfoot; Forecasting; Humans; Radiography; Retrospective Studies
PubMed: 35347339
DOI: 10.2340/17453674.2022.2254 -
Prosthetics and Orthotics International Feb 2023Equinus generally is linked to many foot and ankle pathologies. A reasonably convincing relationship was found between isolated gastrocnemius or Achilles contracture and...
BACKGROUND
Equinus generally is linked to many foot and ankle pathologies. A reasonably convincing relationship was found between isolated gastrocnemius or Achilles contracture and the flatfoot deformity. Achilles' tightness in flatfoot children can lead to future pain and disability, which makes it more important than other types of flatfeet. Findings in the literature suggest stretching and orthotic management as a conservative treatment for this compound disorder.
OBJECTIVE
This review aimed to examine the impact of orthotic managements on gastroc-soleus complex tightness in pediatric with flexible flatfoot.
STUDY DESIGN
Systematic review.
METHODS
A systematic search of electronic databases (PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science) was performed to find relevant articles. The level of evidence and quality was identified using Downs and Black (1998). This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
RESULTS
Three hundred fifty-seven studies were found by searching electronic databases. After removing duplicate documents, 190 documents remained. Three other articles were identified from the screened of related references. During title/abstract screening, 193 studies were excluded and no study was selected for full consideration for the present review.
CONCLUSIONS
In conclusion, no study assessed the impact of orthotic management on gastroc-soleus complex tightness in children with flexible flatfoot. These devices have been proposed in spastic and nonspastic patients. Hence, researches that show whether these devices can be effective on gastrocnemius or Achilles tendon tightness in flatfoot children or not will be worthwhile.
Topics: Humans; Child; Flatfoot; Muscle, Skeletal; Achilles Tendon; Lower Extremity
PubMed: 36791382
DOI: 10.1097/PXR.0000000000000150 -
Archives of Orthopaedic and Trauma... May 2024Progressive collapsing foot deformity (PCFD), formally known as "adult-acquired flatfoot deformity" (AAFFD), is a complex foot deformity consisting of multiple...
INTRODUCTION
Progressive collapsing foot deformity (PCFD), formally known as "adult-acquired flatfoot deformity" (AAFFD), is a complex foot deformity consisting of multiple components. If surgery is required, joint-preserving procedures, such as a medial displacement calcaneal osteotomy (MDCO), are frequently performed. The aim of this systematic review is to provide a summary of the evidence on the impact of MDCO on foot biomechanics.
MATERIALS AND METHODS
A systematic literature search across two major sources (PubMed and Scopus) without time limitation was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria. Only original research studies reporting on biomechanical changes following a MDCO were included. Exclusion criteria consisted of review articles, case studies, and studies not written in English. 27 studies were included and the methodologic quality graded according to the QUACS scale and the modified Coleman score.
RESULTS
The 27 included studies consisted of 18 cadaveric, 7 studies based on biomechanical models, and 2 clinical studies. The impact of MDCO on the following five major parameters were assessed: plantar fascia (n = 6), medial longitudinal arch (n = 9), hind- and midfoot joint pressures (n = 10), Achilles tendon (n = 5), and gait pattern parameters (n = 3). The quality of the studies was moderate to good with a pooled mean QUACS score of 65% (range 46-92%) for in-vitro and a pooled mean Coleman score of 58 (range 56-65) points for clinical studies.
CONCLUSION
A thorough knowledge of how MDCO impacts foot function is key in properly understanding the postoperative effects of this commonly performed procedure. According to the evidence, MDCO impacts the function of the plantar fascia and Achilles tendon, the integrity of the medial longitudinal arch, hind- and midfoot joint pressures, and consequently specific gait pattern parameters.
Topics: Humans; Biomechanical Phenomena; Calcaneus; Flatfoot; Foot; Foot Deformities, Acquired; Gait; Osteotomy
PubMed: 38554203
DOI: 10.1007/s00402-024-05267-9