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European Journal of Pediatrics Sep 2021Approximately one in 100 babies has metatarsus adductus) MTA(. Although most deformities may resolve spontaneously, moderate and severe deformities might cause future...
Approximately one in 100 babies has metatarsus adductus) MTA(. Although most deformities may resolve spontaneously, moderate and severe deformities might cause future discomfort and are therefore often treated. Common treatment alternatives include stretching, serial casting, and orthoses. Surgery is reserved for severe cases that are unresponsive to conservative management. The purpose of this study was to present our experience with a novel orthosis designed to correct and maintain correction of MTA in infants. Seventy-three children between the ages of 4 and 11.5 months with moderate to severe MTA were treated using the Universal Neonatal Foot Orthosis (UNFO). Treatment was started in cases of rigid deformity when the child was first seen in the clinic, or after the age of 5 months in children with moderate or severe but flexible deformity that failed to improve spontaneously. The orthosis was applied for 23 h daily. Weaning was started after a complete correction of the deformity was achieved. Follow-up was continued at least until walking age. Results were assessed utilizing the heel bisector line (HBL) as a measure of foot deformity before, during, and after treatment completion, and at the end of follow-up. Seventy-one patients (114 feet (were followed from the time of diagnosis to at least walking age. There were 102 severe (HBL at, or lateral to, the 4 toe) and 12 moderate MTA (HBL between 3 and 4 toes). Average age at the beginning of treatment was 6.58 months (range 4-11.5). Of the study population, 56 patients (98 feet) improved significantly by the end of the follow-up. In 11 children (11 feet), no change was noted, and in 3 children (3 feet), worsening of the deformity was observed at the end of follow-up. In one child who discontinued treatment after 6 weeks, there was no change in one foot and worsening in the other. Minor side effects were observed in 11 patients, all resolved uneventfully.Conclusion: UNFO is an effective treatment for moderate and severe MTA in children younger than10 months, with only infrequent minor side effects. What is Known: • Debate exists as to which patient warrants treatment since spontaneous improvement is the rule. However, some deformities persist to adulthood and may be esthetically unpleasing. • Treatment modalities available vary from benign neglect, special shoe ware that are either static or need special tools, and knowledge to adjust or casting by an orthopedic surgeon What is New: • This is a description of the results of treatment with a new orthotics which may be applied by pediatricians to treat this very common neonatal deformity. The orthotics provides an excellent, short duration solution, easy for the baby and caregiver with results comparable to those of more elaborate orthotics and casting • The use of digital pictures to assess forefoot adduction deformity severity instead of radiographs is a reliable measurement method.
Topics: Adult; Child; Foot Orthoses; Humans; Infant; Infant, Newborn; Metatarsus Varus; Radiography; Time Factors; Treatment Outcome
PubMed: 33835248
DOI: 10.1007/s00431-021-04048-5 -
Bone & Joint Open Mar 2021The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus...
AIMS
The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures.
METHODS
We reviewed clinical records of a single surgical practice from its entire 2014 calendar year. In total, 71 patients (121 surgical feet) qualified for the study with a mean follow-up of 20.3 months (SD 6.2). We measured their metatarsus adductus angle with the Sgarlato's method (SMAA), and the intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) with Hardy's mid axial method. We also assessed their American Orthopaedic Foot & Ankle Society (AOFAS) clinical scale score, and photographic and pedobarographic images for clinical function results.
RESULTS
SMAA increased from preoperative 15.9° (SD 4.9°) to 17.2° (5.0°) (p < 0.001). IMA and MPA corrected from 14.6° (SD 3.3°) and 31.9° (SD 8.0°) to 7.2° (SD 2.2°) and 18.8° (SD 6.4°) (p < 0.001), respectively. AOFAS score improved from 66.8 (SD 12.0) to 96.1 (SD 8.0) points (p < 0.001). Overall, 98% (119/121) of feet with preoperative plantar calluses had them disappeared or noticeably subsided, and 93% (113/121) of feet demonstrated pedobarographic medialization of forefoot force in walking. We reported all complications.
CONCLUSION
This study, for the first time, reported the previously unknown metatarsus adductus side-effect of the syndesmosis procedure. However, it did not compromise function restoration of the forefoot by evidence of our patients' plantar callus and pedobarographic findings. Level of Clinical Evidence: III Cite this article: 2021;2(3):174-180.
PubMed: 33733823
DOI: 10.1302/2633-1462.23.BJO-2020-0195.R1 -
Foot & Ankle International Jul 2021This study aimed to compare clinical and radiographic outcomes and recurrence rates after reverse proximal chevron metatarsal osteotomy (PCMO) for patients with hallux...
BACKGROUND
This study aimed to compare clinical and radiographic outcomes and recurrence rates after reverse proximal chevron metatarsal osteotomy (PCMO) for patients with hallux valgus (HV) with or without metatarsus adductus (MA). We hypothesized that patients with MA would have poorer outcomes and a higher radiographic recurrence rate than those without MA.
METHODS
This retrospective single-surgeon series comprised 144 patients (173 feet) with moderate to severe HV, treated with PCMO and Akin osteotomy without lesser metatarsal procedures, who were grouped according to the presence (MA group) or absence of MA (non-MA group). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Radiographic assessments included metatarsus adductus angle (MAA), HV angle (HVA), and intermetatarsal angle (IMA).
RESULTS
The prevalence of the MA was 24.2%. The mean MAA was 23.1 ± 3.3 degrees in the MA group. There were no differences in the mean AOFAS score and pain VAS score at the final follow-up between the 2 groups (all > .05). The patient satisfaction rate was 73.8% in the MA group vs 90.1% in the non-MA group ( = .017). The mean postoperative HVA and IMA significantly improved at the final follow-up in both groups, respectively (all < .001). Preoperative and postoperative HVA were larger in the MA group vs non-MA group. However, no significant difference was found in the improvement of HVA and IMA after surgery between the 2 groups (all > .05). The recurrence rate was 28.6% in the MA group and 6.1% in the non-MA group ( < .001).
CONCLUSION
HV patients associated with the MA had a higher degree of preoperative HV, lower correction of the HVA, higher radiographic recurrence rate, and poorer patient satisfaction than those without MA post-PCMO without lesser metatarsal procedures. Therefore, a more extensive HV correction procedure or the addition of a lesser metatarsal realignment procedure may need to be considered.
LEVEL OF EVIDENCE
Level III, retrospective comparative series.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Metatarsus Varus; Osteotomy; Retrospective Studies; Treatment Outcome
PubMed: 33588635
DOI: 10.1177/1071100721990363 -
Ortopedia, Traumatologia, Rehabilitacja Oct 2020Forefoot adduction is a relatively common problem. It is usually mild or it can be effectively managed conservatively. Severe deformities may require surgical treatment....
BACKGROUND
Forefoot adduction is a relatively common problem. It is usually mild or it can be effectively managed conservatively. Severe deformities may require surgical treatment. The aim of the study was to perform a clinical and radiologic evaluation of forefoot adduction correction using medial cuboid and cuneiform osteotomy with a transposed wedge.
MATERIAL AND METHODS
This is a retrospective study involving 16 patients who underwent 20 procedures. Mean age at surgery was 6 years (3-13). Clinical evaluation was based on measurements of forefoot deviation and patients'/care-givers' subjective opinion. The radiologic parameters assessed comprised the first ray angle, talar-first metatarsal angle, calcaneal-fifth metatarsal angle, talocalcaneal angle, metatarsus adductus angle, and Kilmartin's angle. Results were then compared in children below and above 6 years of age. The mean duration of follow-up was 4.6 years (2-9).
RESULTS
The clinical and subjective outcome was rated as good in 16 procedures and satisfactory in 4. The talar-first metatarsal angle, calcaneal-fifth metatarsal angle, metatarsus adductus angle, and Kilmartin's angle were significantly reduced, while the talocalcaneal and first ray angle remained unchanged. A significantly better correction of metatarsus adductus and talar-first metatarsal angle was achieved In children below 6 years of age compared to older patients.
CONCLUSIONS
1. Medial cuneiform and cuboid osteotomy with a transposed wedge improves both clinical and radiological parameters, especially in children under the age of 6. 2. Besides the metatarsus adductus angle, the talar-first meta-tarsal, calcaneal-fifth metatarsal and Kilmartin's angles appear to be good radiologic indicators of correction.
Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Foot Deformities, Congenital; Humans; Male; Metatarsus Varus; Osteotomy; Poland; Radiography; Retrospective Studies; Tarsal Bones; Treatment Outcome
PubMed: 33568567
DOI: 10.5604/01.3001.0014.4226 -
The Journal of Foot and Ankle Surgery :... 2021Hallux valgus is a complex deformity with a variety of techniques described for correction. A biplanar plating system for triplanar correction system has been developed...
Hallux valgus is a complex deformity with a variety of techniques described for correction. A biplanar plating system for triplanar correction system has been developed to address both the translation and rotational component of the hallux valgus deformity and allow an accelerated weightbearing protocol. The purpose of this study was to determine the correction and complications using radiographic parameters and patient reported outcomes. We sought to determine prognostic factors for successful correction, including age, gender, and preoperative deformity. From the medical records, we collected preoperative data. Patient-reported outcomes were obtained using AOFAS Hallux Metatarsophalangeal-Interphalangeal score, FAAM, and SF-12 scores preoperatively and postoperatively. Imaging was reviewed at preoperative and postoperative visits to determine hallux valgus angle, intermetatarsal angle, and tibial sesamoid position. Fifty-seven procedures, in 55 patients, were performed. There were 7 complications and mean follow-up time was 45.7 weeks (+ 28.3 weeks). Age over 62.5 years were associated with an increased risk of complications (p = .018). Males had an increased rate of complications (71%) compared with females. Radiographic parameters were significantly improved from preoperative values at alltime points (p < .05). Only the AOFAS Hallux Metatarsophalangeal-Interphalangeal score was statistically significant at 3, 6 and 12 months. We sought to determine the effectiveness of biplanar plating and triplanar correction procedure with early weightbearing. Over a 12 month follow-up period, our results showed significant improvement in deformity and maintained correction. AOFAS Hallux Metatarsophalangeal-Interphalangeal scores significantly improved from the preoperative to the postoperative state. Our results show a nonunion rate of 5.2%, which is comparable to prior studies.
Topics: Bunion; Female; Hallux Valgus; Humans; Male; Middle Aged; Orthopedic Procedures; Retrospective Studies; Treatment Outcome; Weight-Bearing
PubMed: 33558095
DOI: 10.1053/j.jfas.2020.06.026 -
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 -
Clinical Biomechanics (Bristol, Avon) Jan 2021Ankle and hindfoot malalignment is a common finding in patients suffering from post-traumatic ankle osteoarthritis. However, no studies have addressed the effect of...
BACKGROUND
Ankle and hindfoot malalignment is a common finding in patients suffering from post-traumatic ankle osteoarthritis. However, no studies have addressed the effect of concomitant foot deformities on intrinsic foot kinematics and kinetics. Therefore, the objective of this study was to investigate the effect of ankle and hindfoot malalignment on the kinematics and kinetics of multiple joints in the foot and ankle complex in patients suffering from post-traumatic ankle osteoarthritis.
METHODS
Twenty-nine subjects with post-traumatic ankle osteoarthritis participated in this study. Standardized weight-bearing radiographs were obtained preoperatively to categorize patients as having cavus, planus or neutral ankle and hindfoot alignment, based on 4 X-ray measurements. All patients underwent standard gait assessment. A 4-segment foot model was used to estimate intrinsic foot joint kinematics and kinetics during gait. Statistical parametric mapping was used to compare foot kinematics and kinetics between groups.
FINDINGS
There were 3 key findings regarding overall foot function in the 3 groups of post-traumatic ankle osteoarthritis: (i) altered frontal and transverse plane inter-segmental angles and moments of the Shank-Calcaneus and Calcaneus-Midfoot joints in the cavus compared to the planus group; (ii) in cavus OA group, Midfoot-Metatarsus joint abduction sought to compensate the varus inclination of the ankle joint; (iii) there were no significant differences in inter-segmental angles and moments between the planus and neutral OA groups.
INTERPRETATION
Future studies should integrate assessment of concomitant foot and ankle deformities in post-traumatic ankle osteoarthritis, to provide additional insight into associated mechanical deficits and compensation mechanisms during gait.
Topics: Adult; Ankle; Biomechanical Phenomena; Female; Foot; Foot Injuries; Humans; Kinetics; Male; Middle Aged; Osteoarthritis; Radiography; Weight-Bearing
PubMed: 33246795
DOI: 10.1016/j.clinbiomech.2020.105239 -
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 -
Frontiers in Bioengineering and... 2020Hallux valgus is a common foot problem affecting nearly one in every four adults. Generalized ligament laxity was proposed as the intrinsic cause or risk factor toward...
Hallux valgus is a common foot problem affecting nearly one in every four adults. Generalized ligament laxity was proposed as the intrinsic cause or risk factor toward the development of the deformity which was difficult to be investigated by cohort clinical trials. Herein, we aimed to evaluate the isolated influence of generalized ligament laxity on the deterioration using computer simulation (finite element analysis). We reconstructed a computational foot model from a mild hallux valgus participant and conducted a gait analysis to drive the simulation of walking. Through parametric analysis, the stiffness of the ligaments was impoverished at different degrees to resemble different levels of generalized ligament laxity. Our simulation study reported that generalized ligament laxity deteriorated hallux valgus by impairing the load-bearing capacity of the first metatarsal, inducing higher deforming force, moment and malalignment at the first metatarsophalangeal joint. Besides, the deforming moment formed a deteriorating vicious cycle between hallux valgus and forefoot abduction and may result in secondary foot problems, such as flatfoot. However, the metatarsocuneiform joint did not show a worsening trend possibly due to the overriding forefoot abduction. Controlling the deforming load shall be prioritized over the correction of angles to mitigate deterioration or recurrence after surgery.
PubMed: 33015022
DOI: 10.3389/fbioe.2020.571192 -
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