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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 -
Physical Therapy Jul 2021It has been suggested that overweight/obesity (OW/OB) impairs the normal alignment of children and adolescents' musculoskeletal system. However, to date, no study has... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
It has been suggested that overweight/obesity (OW/OB) impairs the normal alignment of children and adolescents' musculoskeletal system. However, to date, no study has systematically reviewed or quantified the effect of OW/OB on the development of joint malalignments in children and adolescents. The purpose of this study was to systematically review the association between OW/OB and joint alignment in children and adolescents and to quantify the evidence on whether children and adolescents with OW/OB have a higher risk of developing joint malalignments than their peers of normal weight.
METHODS
PubMed and Web of Science databases were systematically searched from inception to March 9, 2020. Studies investigating the association between OW/OB and joint alignment in children and adolescents were selected. Nonoriginal articles, participants with movement pattern diseases, and adolescents studied while pregnant were excluded. Two independent reviewers conducted the study selection and data extraction. Qualitative synthesis of evidence and random effect meta-analyses (risk ratio [RR]) were performed.
RESULTS
Seventy-three studies (5 longitudinal and 68 cross-sectional) met the inclusion criteria involving 1,757,107 children and adolescents. There was consistent evidence supporting associations of OW/OB with rounded shoulder, lumbar hyperlordosis, genu valgum, and flatfoot. Our meta-analysis showed that children and adolescents with OW/OB had a significantly higher risk of lumbar hyperlordosis (RR = 1.41), genu valgum (RR = 5.92), flatfoot (RR = 1.49), and any joint malalignment (RR = 1.68) when compared with their peers of normal weight. The presence of genu valgum and flatfoot were the most robust results.
CONCLUSION
Based on these findings, OW/OB is associated with the presence of joint malalignments in children and adolescents.
IMPACT
This is the first study that has systematically reviewed the effect of OW/OB on the development of joint malalignments in children and adolescents.
Topics: Humans; Joints; Musculoskeletal Diseases; Pediatric Obesity
PubMed: 33580953
DOI: 10.1093/ptj/pzab066 -
Foot & Ankle Specialist Aug 2022Adult acquired flatfoot deformity (AAFD) is a condition affecting approximately 3% of the adult population. It can lead to severe morbidity, and therefore, prompt...
BACKGROUND
Adult acquired flatfoot deformity (AAFD) is a condition affecting approximately 3% of the adult population. It can lead to severe morbidity, and therefore, prompt treatment is of the upmost importance in maintaining and restoring function. Recently, the use of subtalar arthroereisis has become more widespread in the treatment of AAFD. The purpose of this systematic review is to examine the clinical and radiological outcomes of AAFD when treated with subtalar arthroereisis.
METHODS
Studies involving the use of subtalar arthroereisis for the management of AAFD were reviewed, and appropriate studies selected based on inclusion and exclusion criteria. Studies were reviewed for both clinical and radiological outcomes following the use of subtalar arthroereisis as well as reported complications.
RESULTS
Nine studies met our inclusion criteria, with most of these involving stage II AAFD. A total of 190 subtalar arthroereisis procedures were performed with all studies demonstrating improvement in both clinical and radiological scores with a low rate of complications.
CONCLUSION
Subtalar arthroereisis may have benefits when used as an adjunct to treat stage II AAFD. However, more high-quality studies are needed to establish its best use.
LEVELS OF EVIDENCE
.
Topics: Adult; Flatfoot; Humans; Radiography; Retrospective Studies; Subtalar Joint
PubMed: 33511862
DOI: 10.1177/1938640020987775 -
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 -
Obesity Reviews : An Official Journal... Mar 2021There is evidence that a number of medical conditions and co-morbidities are associated with obesity in young children. This review explored whether there is evidence of... (Meta-Analysis)
Meta-Analysis Review
Obesity in young children and its relationship with diagnosis of asthma, vitamin D deficiency, iron deficiency, specific allergies and flat-footedness: A systematic review and meta-analysis.
There is evidence that a number of medical conditions and co-morbidities are associated with obesity in young children. This review explored whether there is evidence of associations with other conditions or co-morbidities. Observational studies of young children (mean age < 10 years) were identified using electronic searches of five databases (MEDLINE, Embase, CINAHL, AMED and SPORTDiscus). Of 27 028 studies screened, 41 (comprising 44 comparisons) met the inclusion criteria. These studies provided data on five distinct diseases/conditions: asthma (n = 16), vitamin D deficiency (n = 10), iron deficiency (n = 10), allergies (n = 4) and flat-footedness (n = 4). Thirty-two studies were appropriate for meta-analysis using random-effects models, and revealed obesity was significantly associated with having asthma (OR 1.5, 95% CI 1.3-1.7), vitamin D deficiency (OR 1.9, 95% CI 1.4-2.5) and iron deficiency (OR 2.1, 95% CI 1.4-3.2). Heterogeneity (I ) ranged from 57% to 61%. Narrative synthesis was conducted for all studies. There was no evidence of a consistent association between obesity in young children and eczema, dermatitis or rhinitis due to the low number of studies. However, there was an association with flat-footedness. These results have implications for health policy and practice and families. Further research leading to a greater understanding of the associations identified in this review is suggested.
Topics: Anemia, Iron-Deficiency; Asthma; Child; Child, Preschool; Flatfoot; Humans; Pediatric Obesity; Vitamin D Deficiency
PubMed: 32808447
DOI: 10.1111/obr.13129 -
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 -
The Journal of Foot and Ankle Surgery :... May 2019Naviculocuneiform (NC) joint arthrodesis is an effective procedure to treat pain and provide stability to the medial column. Various forms of fixation have been...
Naviculocuneiform (NC) joint arthrodesis is an effective procedure to treat pain and provide stability to the medial column. Various forms of fixation have been described for NC arthrodesis. Despite this, the available literature is scant and questions remain regarding nonunion rate and contributory factors. A systematic review of the literature was undertaken to determine the rate of nonunion for NC joint arthrodesis. Seven studies involving 139 NC joint arthrodeses met inclusion criteria. The nonunion rate was 6.5% at a weighted mean follow-up of 73.2 months. There is insufficient evidence to provide a practice guideline based on the current literature. Adequately powered prospective clinical trials comparing well-matched patient groups with long-term follow-up are required to limit systematic error and enhance external validity. Specific outcomes measures should include union, functional assessment, complications, and cost-benefit analysis.
Topics: Arthrodesis; Humans; Incidence; Tarsal Bones; Tarsal Joints
PubMed: 30876812
DOI: 10.1053/j.jfas.2018.09.014 -
Foot and Ankle Surgery : Official... Feb 2020We aimed to evaluate the structural effects of the long-term use of orthoses for pediatric flexible flat foot (PFFF) using an algorithmic approach and a structured...
BACKGROUND
We aimed to evaluate the structural effects of the long-term use of orthoses for pediatric flexible flat foot (PFFF) using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies.
METHODS
A comprehensive literature search using five databases, namely MEDLINE, the Cochrane Library, Scopus, the Web of Science, and EMBASE, was performed for pertinent articles published before March 30, 2018. Studies with quantitative data on the effects of the long-term use of orthoses for PFFF were included. The search strategy was adapted as appropriate for all other databases searched considering the differences in indexing terms and search syntax for each database.
RESULTS
Randomized controlled trials and prospective cohort studies could not prove the estimated effects of orthoses on the medial longitudinal arch. They revealed that flexible flat feet in young children slowly improved with growth, regardless of the type of footwear used. However, three of four case series studies revealed that positive long-term effects could be achieved using orthoses.
CONCLUSION
There is no strong evidence that the long-term use of orthoses improved the structural problem of PFFF.
Topics: Child; Flatfoot; Foot; Foot Orthoses; Humans
PubMed: 30765257
DOI: 10.1016/j.fas.2019.01.007 -
International Orthopaedics May 2019This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and... (Comparative Study)
Comparative Study
PURPOSE
This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and arthroereisis (AR) for treating symptomatic flatfoot in children.
METHODS
We conducted a comprehensive search on MEDLINE, EMBASE, and Cochrane Library databases. Literature search, data extraction, and quality assessment were conducted by two independent reviewers. The outcomes analyzed included radiographic parameters, clinical scores, satisfaction, complications, and re-operations.
RESULTS
Twenty-one and 13 studies were included in the LCL and AR groups, respectively. The change in anteroposterior talo-first metatarsal angle was greater in the LCL (9.5° to 21.7°) than in the AR group (10.6° to 12.8°). The change in calcaneal pitch was greater in the LCL (2.1° to 26.53°) than in the AR group (- 1.3° to 3.23°). Improvements in the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were greater in the LCL (27.7 to 39.1) than in the AR group (17 to 22). The percentage of satisfaction was similar between the LCL (68% to 89%) and AR (78.5% to 96.4%) groups. The complication rate was higher in the LCL (0% to 86.9%) than in the AR group (3.5% to 45%). The most common complications were calcaneocuboid subluxation and persistent pain in the LCL and AR groups, respectively. The re-operation rate was similar between the LCL (0% to 27.3%) and AR (0% to 36.4%) groups.
CONCLUSIONS
The LCL group has achieved more radiographic corrections and more improvements in the AOFAS score than the AR group. Complications were more common in the LCL group than in the AR group, and the re-operation rates were similar between the two groups.
Topics: Bone Transplantation; Child; Flatfoot; Foot Bones; Humans; Retrospective Studies; Subtalar Joint
PubMed: 30701302
DOI: 10.1007/s00264-019-04303-3 -
Revista Do Colegio Brasileiro de... Dec 2018Flexible flatfoot is a common condition in small children, which shows a strong tendency to spontaneously correct with their growth or to become moderate or mild in...
Flexible flatfoot is a common condition in small children, which shows a strong tendency to spontaneously correct with their growth or to become moderate or mild in adults, which will not cause future problems. However, in a small number of cases, this condition is more severe, does not improve spontaneously, which may cause mechanical impairment, deformity, and, eventually, pain. In such cases, surgical treatment should be considered. The aim of this systematic review was to evaluate the literature results on the treatment of the symptomatic flexible flatfoot in children or adolescents through a very frequent procedure: calcaneal lateral column lengthening osteotomy, A systematic electronic search in PubMed, Web of Science, Cochrane, CINAHL, SciELO, SCOPUS and LILACS databases was performed. We searched articles published between March 1975 and September 2016. After applying the eligibility criteria, the selected publications were evaluated in relation to their clinical and radiographic results and complications. We found 341 articles in the mentioned databases, but selected only eight studies, according to the inclusion and exclusion criteria. These studies included a total of 105 patients and 167 treated feet. Only three authors performed prospective studies, but without case-control or randomization. The majority of publications were descriptive studies or case series (level of evidence III or IV), with great methodological variations, but with a high satisfaction rate on the part of both patients and surgeons in relation to the results. However, more prospective and randomized studies are required, with adequate control groups and validated evaluation criteria.
Topics: Adolescent; Bone Lengthening; Calcaneus; Child; Flatfoot; Follow-Up Studies; Humans; Osteotomy; Postoperative Complications; Postoperative Period; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 30569951
DOI: 10.1590/0100-6991e-20181969