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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 -
Foot & Ankle International Jan 2021Previous studies have found an increased rate of deformity recurrence in hallux valgus (HV) patients with concomitant metatarsus adductus (MA) undergoing metatarsal...
BACKGROUND
Previous studies have found an increased rate of deformity recurrence in hallux valgus (HV) patients with concomitant metatarsus adductus (MA) undergoing metatarsal osteotomies. The purpose of this paper was to determine if there were radiographic or clinical outcome differences between HV patients with and without MA undergoing a modified Lapidus procedure.
METHODS
One hundred forty-seven feet that underwent a modified Lapidus procedure for HV were divided into 2 groups based on their preoperative modified Sgarlato's angle: (1) the MA group had an angle ≥20 degrees and (2) the HV-only group had an angle <20 degrees. HV angle (HVA) and intermetatarsal angle (IMA) were measured on preoperative and ≥5-month postoperative weightbearing radiographs. Patient-Reported Outcome Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) scores were obtained preoperatively and postoperatively.
RESULTS
Patients in the MA group had a significantly higher mean postoperative HVA (10.8 vs 7.5 degrees; = .038). There was a trend toward higher PROMIS PI scores in the MA group at 1 year postoperatively (51.9 vs 47.6; = .088). Patients in the MA group were more likely to have a revision surgery (7.3% vs 0%; = .021), and there was a trend toward those patients having a higher recurrence rate (17.1% vs 6.6%; = .064).
CONCLUSION
Despite potentially worse postoperative outcomes in patients with HV and MA who undergo a modified Lapidus procedure, the recurrence rates reported here are lower than those reported in the literature for patients with MA undergoing metatarsal osteotomies, indicating that a modified Lapidus procedure may be an acceptable choice in these patients.
LEVEL OF EVIDENCE
Level III, retrospective comparative series.
Topics: Bunion; Hallux Valgus; Humans; Metatarsal Bones; Metatarsus Varus; Radiography; Range of Motion, Articular; Recurrence; Retrospective Studies; Weight-Bearing
PubMed: 32869652
DOI: 10.1177/1071100720952079 -
Foot and Ankle Clinics Sep 2020The windswept foot remains a reconstructive challenge. The hallux valgus associated with the medially displaced lesser metatarsal heads is hard to correct. Either the... (Review)
Review
The windswept foot remains a reconstructive challenge. The hallux valgus associated with the medially displaced lesser metatarsal heads is hard to correct. Either the lesser metatarsal heads need to be displaced laterally or the deformity accepted. With the deformity, all the toes tend to be aligned into valgus with the position of the flexor and extensor tendons. Several treatment alternatives exist and may require a combination of open and percutaneous surgery. The authors think that, in severe metatarsus adductus, proximal correction of the first, second, and third metatarsals is required.
Topics: Arthrodesis; Bone Malalignment; Foot Deformities; Humans; Metatarsus Varus; Minimally Invasive Surgical Procedures; Osteotomy; Toes
PubMed: 32736739
DOI: 10.1016/j.fcl.2020.05.005 -
Yonsei Medical Journal Jul 2020Cavovarus deformity is considered an anatomical risk factor for chronic lateral ankle instability (CLAI). However, subtle deformity can be difficult to detect, and its... (Review)
Review
Cavovarus deformity is considered an anatomical risk factor for chronic lateral ankle instability (CLAI). However, subtle deformity can be difficult to detect, and its correction is controversial. The current study aimed to evaluate clinical and radiographic outcomes of a modified Broström procedure (MBP) with additional procedures for CLAI with subtle cavovarus deformity and a positive peek-a-boo heel sign. We reviewed the records of 15 patients who underwent MBP with additional procedures for CLAI with a positive peek-a-boo heel sign between August 2009 and April 2015. Consecutive physical and radiographic examinations were performed. The visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Karlsson-Peterson (KP) ankle score were applied to assess clinical outcomes. Weight bearing radiographs, hindfoot alignment view, and ankle stress radiographs were also examined. The mean follow-up period was 58.5 months. Calcaneal lateral closing wedge osteotomy was performed in seven patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy was performed in 11 patients to correct plantarflexion of the first ray. Three patients underwent both procedures. Mean VAS, AOFAS, and KP ankle scores improved significantly (=0.001), and instability did not recur. Radiographically, all stress parameters improved significantly (=0.007). Simultaneous correction of a positive peek-a-boo heel sign and cavovarus deformity with MBP for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for subtle cavovarus deformity should be followed when treating patients with CLAI. This trial is registered on Clinical Research Information Service (CRiS, KCT0003287).
Topics: Adult; Ankle; Ankle Joint; Female; Foot; Heel; Humans; Joint Instability; Male; Metatarsal Bones; Metatarsus; Middle Aged; Osteotomy; Radiography; Plastic Surgery Procedures; Recovery of Function; Talipes Cavus; Treatment Outcome; Visual Analog Scale
PubMed: 32608208
DOI: 10.3349/ymj.2020.61.7.635 -
Foot and Ankle Surgery : Official... Jun 2021Foot bones in children have more rounded shapes in radiograms than adults. Thus, the goal of this work was assessing inter- and intra-observer reliability in paediatric...
BACKGROUND
Foot bones in children have more rounded shapes in radiograms than adults. Thus, the goal of this work was assessing inter- and intra-observer reliability in paediatric forefoot angle measurements.
MATERIAL AND METHODS
Six forefoot angles in 34 AP standing paediatric foot radiographs were measured by 5 researchers. A classic statistical analysis with use of IBM SPSS Statistics 25 was performed and a new method with two-way analysis of variance was applied.
RESULTS
Results of statistical analysis revealed the properties of a subjective assessment related to specific angles. Kilmartin's angle, calcaneus-fifth metatarsal angle and first ray angle are the most reliable; metatarsus adductus angle should be used with great caution in pediatric population. Engel's angle is the most difficult for measuring and measurement error is the highest.
CONCLUSION
The power of paediatric forefoot measurements is various. Several angles are reliable, while Engle's angle is the most doubtful.
Topics: Adolescent; Child; Child, Preschool; Female; Flatfoot; Foot; Foot Bones; Humans; Male; Metatarsus Varus; Observer Variation; Radiography; Reproducibility of Results; Retrospective Studies; Standing Position
PubMed: 32456981
DOI: 10.1016/j.fas.2020.04.015 -
Foot and Ankle Clinics Jun 2020The combination of hallux valgus and metatarsus adductus presents a surgical challenge even for the experienced foot and ankle surgeon, as the position of the lesser... (Review)
Review
The combination of hallux valgus and metatarsus adductus presents a surgical challenge even for the experienced foot and ankle surgeon, as the position of the lesser metatarsals restricts the space for metatarsal head displacement. We describe the application of concepts of minimally invasive techniques to correct this deformity. Proximal metatarsal osteotomy to correct the position of lesser metatarsals, followed by minimally invasive bunion surgery, shows promising results. In a short series, proximal metatarsal osteotomy showed excellent correction of the deformity. At final follow-up, all the deformed feet consolidated in correct positions.
Topics: Fracture Fixation, Internal; Hallux Valgus; Humans; Metatarsus Varus; Minimally Invasive Surgical Procedures; Osteotomy
PubMed: 32381319
DOI: 10.1016/j.fcl.2020.02.001 -
Foot and Ankle Clinics Mar 2020Metatarsus adductus is common clinical entity with an estimated prevalence of approximately 30%. Multiple radiographic methods exist to evaluate the extent of the... (Review)
Review
Metatarsus adductus is common clinical entity with an estimated prevalence of approximately 30%. Multiple radiographic methods exist to evaluate the extent of the deformity, with the Sgarlato and Engel methods most commonly used. Surgical treatment varies, consisting of proximal versus distal metatarsal osteotomies, TMT arthrodesis, and realignment of the lesser rays. Particularly in severe cases, addressing all deformities is critical to obtaining a good outcome.
Topics: Arthrodesis; Hallux Valgus; Humans; Metatarsus Varus
PubMed: 31997747
DOI: 10.1016/j.fcl.2019.10.003 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jan 2020To evaluate the short-term effectiveness of the first ray tri-plane osteotomy and other metatarsal basal osteotomy in treatment of hallux valgus with moderate and severe...
OBJECTIVE
To evaluate the short-term effectiveness of the first ray tri-plane osteotomy and other metatarsal basal osteotomy in treatment of hallux valgus with moderate and severe metatarsus adductus.
METHODS
Between February 2012 and September 2016, 10 patients (12 feet) of hallux valgus with moderate and severe metatarsus adductus were admitted and treated with the first ray tri-plane osteotomy and other metatarsal basal osteotomy and lateral soft tissue release. There were 1 male (2 feet) and 9 females (10 feet) with an average age of 34.5 years (range, 21-55 years). The disease duration ranged from 3 to 10 years (mean, 5.8 years). The degree of metatarsal adductus was moderate in 4 feet and severe in 8 feet according to modified Sgarlato measurement method. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 46.4±9.3. The metatarsus adductus angle (MAA) was (25.41±3.66)°, hallux valgus angle (HVA) was (41.42±9.67)°, and the first-second intermetatarsal angle (1-2IMA) was (10.72±2.26)°.
RESULTS
All incisions healed by first intention. All patients were followed up 18-24 months, with an average of 21.4 months. One patient (1 foot) had metastatic metatarsalgia after operation, but the symptoms disappeared after symptomatic treatment. X-ray re-examination showed that all osteotomies healed, and the healing time was 2.4-3.2 months, with an average of 2.8 months. At last follow-up, MAA was (8.42±0.71)°, HVA was (13.29±1.03)°, 1-2IMA was (4.41±0.48)°, and AOFAS score was 89.8±5.9. There were significant differences in clinical and radiographic indexes between pre- and post-operation ( <0.05).
CONCLUSION
The first ray tri-plane osteotomy combined with other metatarsal basal osteotomy has a significant short-term effectiveness in the treatment of hallux valgus with moderate and severe metatarsus adductus.
Topics: Adult; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Metatarsus Varus; Middle Aged; Osteotomy; Treatment Outcome; Young Adult
PubMed: 31939232
DOI: 10.7507/1002-1892.201906102 -
Foot & Ankle International Mar 2020Metatarsus primus varus correction is one of the primary surgical objectives for hallux valgus correction. Some soft tissue procedures have shown that the first... (Comparative Study)
Comparative Study
BACKGROUND
Metatarsus primus varus correction is one of the primary surgical objectives for hallux valgus correction. Some soft tissue procedures have shown that the first metatarsal can be adequately realigned without osteotomy. The hypothesis of this study was that this correctability should also be demonstrable preoperatively. The purpose of this study was to assess whether a simple forefoot taping technique could do so and whether it could also be correlated with operative results after the syndesmosis procedure.
METHODS
Between May 2014 and December 2015, 147 feet with hallux valgus from 85 patients with an average age of 46.2 years underwent the syndesmosis procedure. All were followed prospectively with standing radiographic assessment of their first intermetatarsal angle, metatarsophalangeal angle, and medial sesamoid position preoperatively without and with a forefoot wrapping technique and postoperatively at 10 days, 6 months, and 1 year.
RESULTS
Their average preoperative intermetatarsal angle was reduced from 14.4 to 8.4 degrees by the wrapping technique, and their average metatarsophalangeal angle was spontaneously reduced from 31.8 to 21.8 degrees. After a minimum 1-year follow-up, they stabilized at 7.4 and 18.6 degrees, respectively. There was significant correlation between hallux valgus and metatarsus primus varus corrections by both forefoot wrapping and surgical methods with Spearman's rank correlation of metatarsophalangeal angle and intermetatarsal angle corrections ( = 0.6077, < .0001 due to the wrapping method; = 0.7157, < .0001 due to the syndesmosis procedure). All raw working radiographic images for this study can be viewed in the Supplemental Material section.
CONCLUSION
This study found that a simple forefoot tape-wrapping technique could be used preoperatively to verify first metatarsal mobility for metatarsus primus varus correction by the soft tissue syndesmosis procedure without osteotomies.
LEVEL OF EVIDENCE
Level II, prospective comparative study.
Topics: Adolescent; Adult; Aged; Athletic Tape; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Preoperative Care; Prospective Studies; Radiography; Range of Motion, Articular; Young Adult
PubMed: 31801380
DOI: 10.1177/1071100719893339 -
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