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Surgical and Radiologic Anatomy : SRA Jul 2021To describe a rare case of bilateral mirror feet with varus deformity and review of literature.
OBJECTIVES
To describe a rare case of bilateral mirror feet with varus deformity and review of literature.
METHODS
AP and oblique radiographs of both feet were taken.
RESULTS
On radiographs, right foot showed eight toes and seven metatarsals while left foot showed eight toes and seven metatarsals, the three extra toes were present preaxially (on hallux side) in both feet, showing characteristics of postaxial toes termed as "mirror foot". Varus deformity was noted at the subtalar joint, otherwise tarsal bones appeared normal. No any syndromatic association was present.
CONCLUSION
Mirror foot is a very rare congenital anomaly, we put forward this case for its rarity and unusual late presentation at the age of 22.
Topics: Female; Foot; Foot Deformities, Congenital; Humans; Metatarsus Varus; Polydactyly; Young Adult
PubMed: 33388861
DOI: 10.1007/s00276-020-02658-6 -
Journal of the American Podiatric... 2022Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. However, this...
BACKGROUND
Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. However, this possible underlying mechanism behind recurrence has not been investigated sufficiently to date. This study aimed to explore whether there is a relationship between Achilles tendon elongation and recurrent metatarsus adductus deformity in children with unilateral clubfeet treated by the Ponseti method.
METHODS
A retrospective chart review was performed on 20 children (14 boys and six girls; mean age, 7 years; age range, 5-9 years) with a recurrent metatarsus adductus deformity treated by the Ponseti method for unilateral idiopathic clubfoot. At the final follow-up, isometric muscle strength was measured using a portable, hand-held dynamometer in reciprocal muscle groups of the ankle. The length of the tendons around the ankle was measured ultrasonographically.
RESULTS
The plantarflexion-to-dorsiflexion ratio was lower on the involved side (P = .001). No significant differences in the strength ratio of inversion to eversion were found (P = .4). No difference was observed in lengths of tibialis anterior and posterior tendons (P = .1), but the Achilles tendon was longer on the involved side (P = .001; P < .01). A significant negative correlation was discovered between involved-to-uninvolved Achilles tendon length ratios and involved-to-uninvolved plantarflexion strength ratios (r = -0.524; P = .02) Conclusions: Achilles tendon elongation may be a contributor to the muscle imbalance in clubfeet with relapsed forefoot adduction treated by the Ponseti technique.
Topics: Achilles Tendon; Casts, Surgical; Child; Child, Preschool; Clubfoot; Female; Follow-Up Studies; Humans; Infant; Male; Metatarsus Varus; Retrospective Studies; Treatment Outcome
PubMed: 32931561
DOI: 10.7547/20-048 -
Journal of Pediatric Orthopedics. Part B Jul 2020In-toeing gait is common after treatment for clubfoot deformity and is often secondary to residual internal tibial torsion. The purpose of the current study was to...
In-toeing gait is common after treatment for clubfoot deformity and is often secondary to residual internal tibial torsion. The purpose of the current study was to characterize the gait pattern in children with an intoeing gait pattern associated with talipes equinovarus (TEV) deformity, identify secondary changes at the hip that occur with intoeing, and determine if these secondary effects resolve after correction of tibial torsion. Patients with a diagnosis of TEV deformity, in-toeing gait secondary to residual internal tibial torsion corrected with tibial rotation osteotomy (TRO) and complete preoperative and postoperative motion analysis studies obtained approximately 1 year apart, were included in the study. Nineteen children (19 left extremities) with a TRO at a mean age of 8.2 years met inclusion criteria. Clinical examination showed improvement in tibial torsion assessment by measure of the thigh foot axis and transmalleolar axis. Kinematically, an abnormal internal FPA was present in all cases preoperatively, was corrected to normal in 12 (63%), remained internal in 5 (26%), and was abnormally external in 2 (11%). External hip rotation was identified in 13 (68%) cases preoperatively. Hip rotation was normalized postoperatively in 7 (54%), and was unchanged in the remaining 6 (46%). TRO provides effective correction of excessive internal tibial torsion, resolution of kinematic internal knee rotation, and normalization of the internal foot progression angle in the majority of patients with TEV deformity. External hip rotation resolved in approximately 50% of cases. Overcorrection of the internal FPA is possible when secondary changes at the hip do not resolve.
Topics: Biomechanical Phenomena; Child; Clubfoot; Female; Gait Analysis; Humans; Lower Extremity; Male; Metatarsus Varus; Osteotomy; Perioperative Period; Postoperative Complications; Retrospective Studies; Tibia; Torsion Abnormality; United States
PubMed: 31651746
DOI: 10.1097/BPB.0000000000000688 -
Gait & Posture Mar 2024In-toeing gait is defined as the internal rotation of the long axis of the foot to the line of progression. Although most of the time it is corrected spontaneously but... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In-toeing gait is defined as the internal rotation of the long axis of the foot to the line of progression. Although most of the time it is corrected spontaneously but sometimes causes torsional misalignment syndrome and maybe patellofemoral instability and arthritis of the knee.
RESEARCH QUESTION
What is the effect of gait plate insoles and lateral sole wedged shoes on foot progression angle (FPA) in children with in-toeing?
METHOD
In this study, a randomized control trial was conducted with 11 participants (18 feet) who were girls aged between seven and ten years old. They were randomly assigned to either the gait plate group (6 girls, 11 feet) or the lateral sole wedge group (5 girls, 11 feet). The foot progression angle was measured using the RS scanner pressure platform before and after four weeks of intervention, both with and without interventions. The interaction effects of time and group on outcomes were analyzed using Mixed ANOVA and post-hoc complementary tests with a confidence interval of 95%.
RESULTS
It was observed that none of the interventions had an immediate impact on the FPA (P > 0.05). However, after four weeks, the FPA increased by 9.96 degrees with the lateral sole wedge and by 3.51 degrees with the gate plate insole. During the immediate and short-term evaluation, no significant difference was noticed between the two groups (P > 0.05). However, there was a large effect size (eta square = 0.269) observed in the time group interaction between the two groups (P = 0.028).
SIGNIFICANCE
Conservative methods like using a gait plate insole or modifying shoes with a lateral sole wedge can improve the foot progression angle in children with in-toeing gait. However, longer studies with larger sample sizes are needed to reach a conclusion.
Topics: Child; Female; Humans; Male; Metatarsus Varus; Prospective Studies; Shoes; Gait; Foot; Osteoarthritis, Knee; Foot Orthoses; Biomechanical Phenomena
PubMed: 38301334
DOI: 10.1016/j.gaitpost.2024.01.026 -
Foot (Edinburgh, Scotland) Dec 2020The surgical correction of a hallux valgus deformity presenting with a pes adductus has long proven to be a difficult undertaking. The medial shift of the metatarsal...
The surgical correction of a hallux valgus deformity presenting with a pes adductus has long proven to be a difficult undertaking. The medial shift of the metatarsal bones limits the scope for surgical correction and leads to inherently high reoccurrence rates. Current invasive treatments often give rise to profound soft tissue trauma and prolonged swelling, while requiring strict relief from weight-bearing in the affected foot. In this paper, it is aimed to introduce an easy and useful modification of the Distal Metatarsal Minimal-invasive Osteotomy (DMMO) to perform the effective, simultaneous correction of a pes adductus during surgical treatment of a hallux valgus. We followed-up 143 patients with a hallux valgus and simultaneous pes adductus deformity who underwent one of three additional interventions contemporaneous to the lateralising DMMO: The assessment of radiological and clinical outcomes after a follow-up period of 12-25 months showed a sustained and effective correction of the pes adductus with a well-aligned hallux. The surgery was characterised by a low incidence of postoperative complications and high patient satisfaction while allowing for pain-adapted, post-operative weight-bearing. Level of Clinical Evidence: 3.
Topics: Arthrodesis; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Metatarsus Varus; Middle Aged; Osteotomy; Retrospective Studies; Treatment Outcome
PubMed: 33181398
DOI: 10.1016/j.foot.2020.101722 -
Orthopaedics & Traumatology, Surgery &... Nov 2020Soft tissue surgery to address in-toeing gait in young cerebral palsy (CP) patients may be an alternative in some cases to femoral derotation osteotomy (FDO), which is...
BACKGROUND
Soft tissue surgery to address in-toeing gait in young cerebral palsy (CP) patients may be an alternative in some cases to femoral derotation osteotomy (FDO), which is the currently accepted treatment. The relative contribution of muscular contracture, spasticity and bone deformity is still controversial. In this study, we determined the outcomes of soft tissue surgery on hip internal rotation (HIR) when femoral anteversion was less than 45° and the soft tissues were identified as being the cause.
METHODS
This prospective study included select adolescent patients who were operated in the context of single-event multilevel surgery. The soft tissues' contribution to the HIR was identified beforehand. The surgical procedures focused on the hamstrings, adductor magnus and gluteus minimus muscles.
RESULTS
Over a 6-year period, 21 patients (mean age 14 years) and 25 lower limbs were treated. The HIR improved by an average of 17.4°±4.8° (95% CI). The gait deviation index and gait profile score also improved significantly. At a mean follow-up of 36 months, no loss of correction had occurred.
DISCUSSION
In-toeing gait in CP patents is due to the action of retracted and/or spastic muscles and the presence of excessive bone torsion. When femoral anteversion<45°, confirming soft tissue involvement allows us to do a surgical procedure on the soft tissues only to correct the dynamic aspect of HIR. Our findings suggest that, under the right conditions, soft tissue surgery can improve in-toeing gain in the long term. This technique has its place alongside FDO in certain CP patients who do not have severe femoral anteversion.
Topics: Adolescent; Cerebral Palsy; Femur; Gait; Humans; Metatarsus Varus; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 33008781
DOI: 10.1016/j.otsr.2020.06.008 -
Journal of Orthopaedic Case Reports May 2024If not corrected, the first metatarsal pronation rotation deformity is deemed responsible for the high hallux valgus (HV) deformity recurrence rate. Its correction...
INTRODUCTION
If not corrected, the first metatarsal pronation rotation deformity is deemed responsible for the high hallux valgus (HV) deformity recurrence rate. Its correction method by osteotomy and arthrodesis has been recommended, just like the metatarsus primus varus (MPV) deformity correction. Since the pathogenesis of the first metatarsal pronation is not well understood, there may be other surgical approaches to correct it.
CASE REPORT
A 53-year-old female's HV feet presented with severe left hallux pronation, and positive radiological round head and inferior tubercle shift signs of the first metatarsal. She underwent a non-osteotomy non-arthrodesis soft-tissue procedure that was expected to correct the MPV deformity but not the pronation deformity. Post-operative hallux pronation was reversed, and round head and inferior tubercle signs were corrected.
CONCLUSION
The first metatarsal hypermobility and displacement of HV feet are probably in all three planes. Correction of MPV in the first metatarsal entirety in the transverse plane without osteotomy or arthrodesis can also induce a correction effect on its sagittal and frontal planes.
PubMed: 38784892
DOI: 10.13107/jocr.2024.v14.i05.4442