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The relationship between foot posture and lower limb kinematics during walking: A systematic review.Gait & Posture Jul 2013Variations in foot posture, such as pes planus (low-arched foot) or pes cavus (high-arched foot), are thought to be an intrinsic risk factor for injury due to altered... (Review)
Review
Variations in foot posture, such as pes planus (low-arched foot) or pes cavus (high-arched foot), are thought to be an intrinsic risk factor for injury due to altered motion of the lower extremity. Hence, the aim of this systematic review was to investigate the relationship between foot posture and lower limb kinematics during walking. A systematic database search of MEDLINE, CINAHL, SPORTDiscus, Embase and Inspec was undertaken in March 2012. Two independent reviewers applied predetermined inclusion criteria to selected articles for review and selected articles were assessed for quality. Articles were then grouped into two broad categories: (i) those comparing mean kinematic parameters between different foot postures, and (ii) those examining associations between foot posture and kinematics using correlation analysis. A final selection of 12 articles was reviewed. Meta-analysis was not conducted due to heterogeneity between studies. Selected articles primarily focused on comparing planus and normal foot postures. Five articles compared kinematic parameters between different foot postures - there was some evidence for increased motion in planus feet, but this was limited by small effect sizes. Seven articles investigated associations between foot posture and kinematics - there was evidence that increasing planus foot posture was positively associated with increased frontal plane motion of the rearfoot. The body of literature provides some evidence of a relationship between pes planus and increased lower limb motion during gait, however this was not conclusive due to heterogeneity between studies and small effect sizes.
Topics: Biomechanical Phenomena; Flatfoot; Foot; Foot Deformities; Gait; Humans; Posture; Pronation; Supination; Walking
PubMed: 23391750
DOI: 10.1016/j.gaitpost.2013.01.010 -
The Journal of Foot and Ankle Surgery :... 2012The Evans calcaneal osteotomy is frequently implemented in flatfoot reconstructive surgery for correction of planar deformity. Rigid fixation across an osteotomy is a... (Review)
Review
The Evans calcaneal osteotomy is frequently implemented in flatfoot reconstructive surgery for correction of planar deformity. Rigid fixation across an osteotomy is a documented, accepted technique to gain stability. However, since the original description of this osteotomy, which involved no internal fixation, debate has existed regarding the necessity of fixation. Conventional wisdom suggests that the nonunion rate would increase with an unfixated osteotomy. Thus, in an effort to determine the incidence of nonunion of the unfixated, isolated Evans calcaneal osteotomy, we conducted a systematic review. Studies were eligible for inclusion only if they included the following: the nonunion rate for unfixated, isolated Evans calcaneal osteotomy, follow-up of at least 1 year and a sample size of at least 5 feet. After considering all potentially eligible studies, 2 evidence-based medicine level 2 and 3 evidence-based medicine level 3 studies met our inclusion criteria. A total of 73 feet, with a weighted mean age of 22.6 years, were included. The weighted mean follow-up of the included studies was 3.6 years. A total of 1 nonunion (1.4%) was reported. The results of our systematic review revealed an acceptably low rate of nonunion for the unfixated, isolated Evans calcaneal osteotomy. However, considering the limited data available, additional prospective investigations are warranted to further validate the nonunion rate with this technique.
Topics: Calcaneus; Flatfoot; Global Health; Humans; Incidence; Osteotomy; Postoperative Complications
PubMed: 22300686
DOI: 10.1053/j.jfas.2012.01.003 -
The Cochrane Database of Systematic... Jul 2010Paediatric pes planus ('flat feet') is a common childhood condition with a reported prevalence of 14%. Flat feet can result in pain and altered gait. No optimal strategy... (Review)
Review
BACKGROUND
Paediatric pes planus ('flat feet') is a common childhood condition with a reported prevalence of 14%. Flat feet can result in pain and altered gait. No optimal strategy for non-surgical management of paediatric flat feet has been identified.
OBJECTIVES
To assess the effectiveness of non-surgical interventions for treatment of paediatric pes planus (flat feet).
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, Index to Theses, and Dissertation Abstracts (up to June 2009).
SELECTION CRITERIA
All randomised and quasi-randomised trials of non-surgical interventions for paediatric pes planus were identified. The primary outcomes were pain reduction and adverse events; secondary outcomes included disability involving the foot, goniometric measurements, quality of life and patient comfort.
DATA COLLECTION AND ANALYSIS
Two authors independently extracted data and assessed the risk of bias of included trials.
MAIN RESULTS
Three trials involving 305 children were included in this review. Due to clinical heterogeneity, data were not pooled. All trials had potential for bias. Data from one trial (40 children with juvenile arthritis and foot pain) indicated that use of custom-made orthoses compared with supportive shoes alone resulted in significantly greater reduction in pain intensity (mean difference (MD) -1.5 points on a 10-point visual analogue scale (VAS), 95% CI -2.8 to -0.2; number need to treat to benefit (NNTB) 3, 95% CI 2 to 23), and reduction in disability (measured using the disability subscale of the Foot Function Index on a 100mm scale (MD -18.65mm, 95% CI -34.42 to -2.68mm). The second trial of seven to 11 year old children with bilateral flat feet (n = 178) found no difference in the number of participants with foot pain between custom-made orthoses, prefabricated orthoses and the control group who received no treatment. A third trial of one to five year olds with bilateral flat feet (n=129) did not report pain at baseline but reported the subjective impression of pain reduction after wearing shoes. No adverse effects were reported in the three trials.
AUTHORS' CONCLUSIONS
The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of non-surgical interventions for paediatric pes planus. Future high quality trials are warranted in this field. Only limited interventions commonly used in practice have been studied and there is much debate over the treatment of symptomatic and asymptomatic pes planus.
Topics: Child; Child, Preschool; Flatfoot; Foot Diseases; Humans; Infant; Orthotic Devices; Pain Management; Randomized Controlled Trials as Topic; Shoes
PubMed: 20614443
DOI: 10.1002/14651858.CD006311.pub2 -
Journal of the American Podiatric... 2008This article addresses the treatment of pediatric flatfoot with foot orthoses and explores the existing knowledge from an evidence-based perspective. (Review)
Review
BACKGROUND
This article addresses the treatment of pediatric flatfoot with foot orthoses and explores the existing knowledge from an evidence-based perspective.
METHODS
Studies investigating the use of foot orthoses for pediatric flatfoot were reviewed and ranked on the evidence hierarchy model according to research designs. Clinical guidelines and efficacy rating methods were also reviewed.
RESULTS
Three randomized controlled trials exist, and a systematic review and possible meta-analysis of these studies is in progress. The results of these studies, although not definitive for the use of orthoses for pediatric flatfoot, provide useful direction. Clinical guidelines for the management of flatfoot are a useful supplement for clinical decision making and have been enhanced.
CONCLUSION
This article presents a pragmatic and evidence-based clinical care pathway for clinicians to use for pediatric flatfoot. It uses a simple "traffic light" framework to identify three subtypes of pediatric flatfoot. The clinician is advised to 1) treat symptomatic pediatric flatfoot, 2) monitor (or with discretion simply treat) asymptomatic nondevelopmental pediatric flatfoot, and 3) identify and advise asymptomatic developmental pediatric flatfoot. (Children with juvenile arthritis should receive customized foot orthoses.) This approach will dispel much of the contention surrounding the use of foot orthoses in children.
Topics: Child; Child, Preschool; Female; Flatfoot; Humans; Infant; Male; Orthotic Devices
PubMed: 18820042
DOI: 10.7547/0980386