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European Journal of Pediatrics Apr 2024The aim of the study was to determine the relationship between flatfoot morphology and body mass and height in children aged 6-12 years. A total of 6471 Chinese children...
UNLABELLED
The aim of the study was to determine the relationship between flatfoot morphology and body mass and height in children aged 6-12 years. A total of 6471 Chinese children (mean age 9.0 ± 1.9 years, 41% female) were assessed for foot morphometry, body height, and body mass index. Foot morphology, including foot length, width, girth, arch height, hallux valgus angle, and rearfoot valgus angle, was measured using a 3D laser scanner. Flatfoot evaluations were conducted using the Sztriter-Godunov index (KY) from footprints. All measurements were analyzed by age and sex using the mean values of the left and right sides. Comparisons were performed between flatfoot groups, between body mass index (BMI) groups, and between body height groups. The study revealed a significant decrease in the incidence of bipedal flatfoot with age (p < 0.001), whereas the prevalence of obesity remained consistent (p > 0.05). Bipedal flatfoot was associated with distinct morphological changes, including lower arches, reduced instep height, diminished ankle heights and a greater rearfoot valgus angle (p < 0.05). When comparing the BMI groups, overweight children had larger and thicker feet (p < 0.05), but no differences were found in arch height and ankle height (p > 0.05). When comparing the body height groups, short-statured children had a shorter feet girth, shorter arches, and shorter ankle height (p < 0.05), but no differences were found in the rearfoot valgus angle (p > 0.05).
CONCLUSION
The main characteristics of flat feet include lower arches and instep heights and ankle heights but higher rearfoot valgus angles. In general, overweight children's feet do not have the common features of flat feet. In contrast, short children had similar features of flatfoot except for rearfoot valgus. Assessment of posture, such as rearfoot valgus, can be critical in identifying children with flat feet.
WHAT IS KNOWN
• The morphology of children's feet is associated with body growth, but the relationship between flatfeet and body mass and height remains controversial.
WHAT IS NEW
• Three-dimensional foot measurement shows that body mass is generally not associated with flatfeet, while short children have lower arches but no rearfoot valgus.
Topics: Child; Humans; Female; Male; Flatfoot; Overweight; Body Height; Foot; Obesity
PubMed: 38337095
DOI: 10.1007/s00431-024-05471-0 -
BMC Sports Science, Medicine &... Feb 2024The Lower Quarter Y Balance Test (YBT-LQ) has been widely used to assess dynamic balance in various populations. Dynamic balance in flexible flatfoot populations is one...
BACKGROUND
The Lower Quarter Y Balance Test (YBT-LQ) has been widely used to assess dynamic balance in various populations. Dynamic balance in flexible flatfoot populations is one of the risk factors for lower extremity injuries, especially in college populations in which more exercise is advocated. However, no study has demonstrated the reliability of the YBT-LQ in a college student flexible flatfoot population.
METHODS
A cross-sectional observational study. 30 college students with flexible flatfoot were recruited from Beijing Sports University. They have been thrice assessed for the maximal reach distance of YBT under the support of the lower limb on the flatfoot side. Test and retest were performed with an interval of 14 days. The outcome measures using the composite score and normalized maximal reach distances in three directions (anterior, posteromedial, and posterolateral). The relative reliability was reported as the Intraclass Correlation Coefficient (ICC). Minimal Detectable Change (MDC), Smallest worthwhile change (SWC), and Standard Error of Measurement (SEM) were used to report the absolute reliability.
RESULTS
For inter-rater reliability, the ICC values for all directions ranged from 0.84 to 0.92, SEM values ranged from 2.01 to 3.10%, SWC values ranged from 3.67 to 5.12%, and MDC95% values ranged from 5.58 to 8.60%. For test-retest reliability, the ICC values for all directions ranged from 0.81 to 0.92, SEM values ranged from 1.80 to 2.97%, SWC values ranged from 3.75 to 5.61%, and MDC95% values ranged from 4.98 to 8.24%.
CONCLUSIONS
The YBT-LQ has "good" to "excellent" inter-rater and test-retest reliability. It appears to be a reliable assessment to use with college students with flexible flatfoot.
TRIAL REGISTRATION
This trial was prospectively registered at the Chinese Clinical Trial Registry with the ID number ChiCTR2300075906 on 19/09/2023.
PubMed: 38331956
DOI: 10.1186/s13102-024-00819-3 -
Journal of Orthopaedic Surgery and... Feb 2024Evans and Hintermann lateral column lengthening (LCL) procedures are both widely used to correct adult acquired flatfoot deformity (AAFD), and have both shown good...
BACKGROUND
Evans and Hintermann lateral column lengthening (LCL) procedures are both widely used to correct adult acquired flatfoot deformity (AAFD), and have both shown good clinical results. The aim of this study was to compare these two procedures in terms of corrective ability and biomechanics influence on the Chopart and subtalar joints through finite element (FE) analysis.
METHODS
Twelve patient-specific FE models were established and validated. The Hintermann osteotomy was performed between the medial and posterior facets of the subtalar joint; while, the Evans osteotomy was performed on the anterior neck of the calcaneus around 10 mm from the calcaneocuboid joint surface. In each procedure, a triangular wedge of varying size was inserted at the lateral edge. The two procedures were then compared based on the measured strains of superomedial calcaneonavicular ligaments and planter facia, the talus-first metatarsal angle, and the contact characteristics of talonavicular, calcaneocuboid and subtalar joints.
RESULTS
The Hintermann procedure achieved a greater correction of the talus-first metatarsal angle than Evans when using grafts of the same size, indicating that Hintermann had stronger corrective ability. However, its distributions of von-Mises stress in the subtalar, talonavicular and calcaneocuboid joints were less homogeneous than those of Evans. In addition, the strains of superomedial calcaneonavicular ligaments and planter facia of Hintermann were also greater than those of Evans, but both generally within the safe range (less than 6%).
CONCLUSION
This FE analysis study indicates that both Evans and Hintermann procedures have good corrective ability for AAFD. Compared to Evans, Hintermann procedure can provide a stronger corrective effect while causing greater disturbance to the biomechanics of Chopart joints, which may be an important mechanism of arthritis. Nevertheless, it yields a better protection to the subtalar joint than Evans osteotomy.
CLINICAL RELEVANCE
Both Evans and Hintermann LCL surgeries have a considerable impact on adjacent joints and ligament tissues. Such effects alongside the overcorrection problem should be cautiously considered when choosing the specific surgical method.
LEVEL OF EVIDENCE
Level III, case-control study.
Topics: Adult; Humans; Flatfoot; Case-Control Studies; Finite Element Analysis; Calcaneus; Osteotomy
PubMed: 38303071
DOI: 10.1186/s13018-024-04584-4 -
Journal of Pediatric Orthopedics Apr 2024
Topics: Humans; Flatfoot; Foot Deformities, Congenital; Talus
PubMed: 38297903
DOI: 10.1097/BPO.0000000000002627 -
Journal of Medical Genetics Jan 2024
PubMed: 38296636
DOI: 10.1136/jmg-2023-109656 -
Foot & Ankle International Mar 2024Flatfoot deformity is believed to play a role in hallux valgus development and recurrence. While symptomatic flatfoot deformity can be treated with separate procedures...
BACKGROUND
Flatfoot deformity is believed to play a role in hallux valgus development and recurrence. While symptomatic flatfoot deformity can be treated with separate procedures at the time of hallux valgus correction, the question remains whether the patient undergoing correction of a symptomatic hallux valgus deformity should have their asymptomatic flatfoot concurrently addressed. We aimed to investigate whether the presence of asymptomatic flatfoot influences patient-reported and radiographic outcomes of the minimally invasive chevron and Akin bunionectomy.
METHODS
A total of 104 patients were included in this study. Forty-two asymptomatic patients met the radiographic criteria for flatfoot while 62 had a normal arch. Patient-reported outcomes were evaluated and compared between the two groups using validated PROMIS measures preoperatively and at a minimum one-year postoperatively. Radiographic outcomes including hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch (CP), and talonavicular coverage angle (TNCA) were measured and compared preoperatively and minimum six-months postoperatively.
RESULTS
Both groups demonstrated similar preoperative and postoperative PROMIS scores with significant improvements in physical function, pain interference, pain intensity, and global physical health. Preoperatively, HVA was similar between both groups, however the flatfoot group showed a greater IMA, Meary's angle, TNCA, and lower CP. Postoperatively, HVA and IMA were similar between groups, although patients in the flatfoot group retained a significantly greater Meary's angle, TNCA, and lower CP. Both groups showed significant improvements in HVA, IMA, and TNCA.
CONCLUSION
Our study indicates that the minimally invasive chevron and Akin bunionectomy leads to improved clinical and radiographic hallux valgus outcomes without adversely impacting radiographic flatfoot parameters. Therefore, the MIS bunionectomy may be an effective option for hallux valgus correction in patients with mild, asymptomatic flatfoot.
LEVEL OF EVIDENCE
Level III, retrospective cohort.
Topics: Humans; Retrospective Studies; Hallux Valgus; Flatfoot; Osteotomy; Radiography; Bunion; Treatment Outcome
PubMed: 38281125
DOI: 10.1177/10711007231220553 -
Journal of Surgical Orthopaedic Advances 2023Pes planovalgus affects knee biomechanics but there are no studies describing its impact on total knee arthroplasty (TKA). We aim to characterize the demographics,...
Pes planovalgus affects knee biomechanics but there are no studies describing its impact on total knee arthroplasty (TKA). We aim to characterize the demographics, medical, and surgical complications of patients with pes planovalgus undergoing TKA. A Medicare database was queried using ICD-9 codes to identify 5,750 patients with and 23,000 patients without pes planovalgus who underwent TKA from 2005 to 2014. Standard descriptive statistics were used to compare medical and surgical complications at 90 days and 2 years, with alpha < 0.003 after a Bonferroni Correction. Patients with pes planovalgus had an elevated incidence of hypertension (80%, p < 0.001), pulmonary disease (31%, p < 0.001), hypothyroidism (28%, p < 0.001), diabetes (30%, p < 0.001), vascular disease (20%, p < 0.001), obesity (26%, p < 0.001), and depression (23%, p < 0.001). They also had increased odds of deep vein thrombosis (DVT) (odds ratio [OR] 1.3, p < 0.001), stiffness (OR 1.3, p < 0.003) and revision (OR 1.59, p < 0.003) at 90 days. At 2 years, odds of stiffness had increased (OR 1.34, p < 0.001) with similar rates of revision and medical complications. Pes planovaglus is associated with increased medical comorbidities and this patient population may be at an increased risk for postoperative stiffness, early revisions, and DVT after TKA. Arthroplasty surgeons should be conscious of these risks when considering TKA in a patient with pes planovalgus and counsel them appropriately. (Journal of Surgical Orthopaedic Advances 32(3):202-206, 2023).
Topics: United States; Humans; Aged; Arthroplasty, Replacement, Knee; Medicare; Flatfoot; Comorbidity; Knee Joint
PubMed: 38252610
DOI: No ID Found -
Foot & Ankle International Mar 2024The purpose of this study is to investigate the biomechanical effect of medial displacement calcaneal osteotomy (MDCO), subtalar joint fusion (SF), and medial ligament...
BACKGROUND
The purpose of this study is to investigate the biomechanical effect of medial displacement calcaneal osteotomy (MDCO), subtalar joint fusion (SF), and medial ligament reconstruction (MLR: deltoid-spring ligament) in a severe flatfoot model. We hypothesized that (1) combination of MDCO and SF improves the tibiotalar and foot alignment in severe progressive collapsing foot deformity (PCFD) cadaver model. (2) However, if a residual valgus heel alignment remains after MCDO and SF, it can lead to increased medial ligament strain, foot malalignment, and tibiotalar valgus tilt, which will be mitigated by the addition of MLR.
METHODS
Ten fresh-frozen cadaveric foot specimens were used to create a severe flatfoot model. The foot alignment changes, including the talo-first metatarsal angle in the axial and sagittal planes, subtalar angle, and tibiotalar angle in the coronal plane, were measured. The angles were measured at the initial condition, after creating the severe flatfoot model, and after each successive reconstructive procedure in the following order: (1) MDCO, (2) SF, and (3) MLR.
RESULTS
Tibiotalar valgus tilt was decreased with the MDCO procedure: 4.4 vs 1.0 degrees ( = .04). Adding in situ SF to the MDCO led to increased tibiotalar tilt to 2.5 degrees was different from the initial condition ( = .01). Although the tibiotalar valgus tilt was significantly decreased after adding the MLR to the MDCO/SF procedure compared with the severe flatfoot model (0.8 vs 4.4 degrees, = .03), no significant difference in the tibiotalar valgus tilt was observed between MDCO/SF and MDCO/SF with MLR.
CONCLUSION
Our results demonstrated that MDCO significantly improved forefoot abduction and medial arch alignment, with no significant additional improvement observed with addition of SF. Following SF, a residual valgus heel alignment can contribute to subsequent tibiotalar valgus tilt. The addition of MLR did not show significantly decreased tibiotalar valgus tilt following SF.
CLINICAL RELEVANCE
Residual valgus heel alignment after subtalar joint fusion in the surgical treatment of PCFD can lead to increased medial ligament strain. Although MLR might be considered for providing medial stability, it may not necessarily prevent the development of tibiotalar valgus tilt.
Topics: Humans; Flatfoot; Subtalar Joint; Foot Deformities; Foot; Ligaments, Articular
PubMed: 38240174
DOI: 10.1177/10711007231220940 -
The Journal of Maternal-fetal &... Dec 2024
Topics: Humans; Flatfoot; Talus; Abnormalities, Multiple
PubMed: 38238108
DOI: 10.1080/14767058.2024.2304280