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Foot & Ankle Orthopaedics Jan 2019Adult-acquired flatfoot deformity (AAFD) comprises a wide spectrum of ligament and tendon failure that may result in significant deformity and disability. It is often... (Review)
Review
Adult-acquired flatfoot deformity (AAFD) comprises a wide spectrum of ligament and tendon failure that may result in significant deformity and disability. It is often associated with posterior tibial tendon deficiency (PTTD), which has been linked to multiple demographic factors, medical comorbidities, and genetic processes. AAFD is classified using stages I through IV. Nonoperative treatment modalities should always be attempted first and often provide resolution in stages I and II. Stage II, consisting of a wide range of flexible deformities, is typically treated operatively with a combination of soft tissue procedures and osteotomies. Stage III, which is characterized by a rigid flatfoot, typically warrants triple arthrodesis. Stage IV, where the flatfoot deformity involves the ankle joint, is treated with ankle arthrodesis or ankle arthroplasty with or without deltoid ligament reconstruction along with procedures to restore alignment of the foot. There is limited evidence as to the optimal procedure; thus, the surgical indications and techniques continue to be researched.
PubMed: 35097314
DOI: 10.1177/2473011418820847 -
Orthopaedics & Traumatology, Surgery &... Feb 2015Adult flatfoot is defined as a flattening of the medial arch of the foot in weight-bearing and lack of a propulsive gait. The 3 lesion levels are the talonavicular,... (Review)
Review
Adult flatfoot is defined as a flattening of the medial arch of the foot in weight-bearing and lack of a propulsive gait. The 3 lesion levels are the talonavicular, tibiotarsal and midfoot joints. The subtalar joint is damaged by the consequent rotational defects. Clinical examination determines deformity and reducibility, and assesses any posterior tibialis muscle deficit, the posterior tibialis tendon and spring ligament being frequently subject to degenerative lesions. Radiographic examination in 3 incidences in weight-bearing is essential, to determine the principal level of deformity. Tendon (posterior tibialis tendon) and ligamentous lesions (spring ligament and interosseous ligament) are analyzed on MRI or ultrasound. In fixed deformities, CT explores for arthritic evolution or specific etiologies. 3D CT reconstruction can analyze bone and joint morphology and contribute to the planning of any osteotomy. Medical management associates insoles and physiotherapy. Acute painful flatfoot requires strict cast immobilization. Surgical treatment associates numerous combinations of procedures, currently under assessment for supple flatfoot: for the hindfoot: medial slide calcaneal osteotomy, calcaneal lengthening osteotomy, or arthroereisis; for the midfoot: arthrodesis on one or several rays, or first cuneiform or first metatarsal osteotomy; for the ankle: medial collateral ligament repair with tendon transfer. Fixed deformities require arthrodesis of one or several joint-lines in the hindfoot; for the ankle, total replacement after realignment of the foot, or tibiotalocalcaneal fusion or ankle and hindfoot fusion; and, for the midfoot, cuneonavicular or cuneometatarsal fusion. Tendinous procedures are often associated. Specific etiologies may need individualized procedures. In conclusion, adult flatfoot tends to be diagnosed and managed too late, with consequent impact on the ankle, the management of which is complex and poorly codified.
Topics: Adult; Diagnostic Imaging; Flatfoot; Foot Joints; Humans; Orthopedic Procedures; Orthotic Devices; Osteoarthritis; Physical Examination; Shoes
PubMed: 25595429
DOI: 10.1016/j.otsr.2014.07.030 -
Journal of Foot and Ankle Research Nov 2021Flatfoot is characterised by the falling of the medial longitudinal arch, eversion of the hindfoot and abduction of the loaded forefoot. Furthermore, flatfoot leads to a... (Review)
Review
BACKGROUND
Flatfoot is characterised by the falling of the medial longitudinal arch, eversion of the hindfoot and abduction of the loaded forefoot. Furthermore, flatfoot leads to a variety of musculoskeletal symptoms in the lower extremity, such as knee or hip pain. The standard conservative treatment for flatfoot deformity is exercise therapy or treatment with foot orthoses. Foot orthoses are prescribed for various foot complaints. However, the evidence for the provision of foot orthoses is inconsistent. The aim of this systematic review is to synthesize the evidence of foot orthoses for adults with flatfoot.
METHODS
A computerized search was conducted in August 2021, using the databases PubMed, Scopus, Pedro, Cochrane Library, and the Cochrane Central Register of Controlled Trials. Intervention studies of any design investigating the effects of foot orthoses were included, apart from case studies. Two independent reviewers assessed all search results to identify eligible studies and to assess their methodological quality.
RESULTS
A total of 110 studies were identified through the database search. 12 studies met the inclusion criteria and were included in the review. These studies investigated prefabricated and custom-made foot orthoses, evaluating stance and plantar pressure during gait. The sample sizes of the identified studies ranged from 8 to 80. In most of the studies, the methodological quality was low and a lack of information was frequently detected.
CONCLUSION
There is a lack of evidence on the effect of foot orthoses for flatfoot in adults. This review illustrates the importance of conducting randomized controlled trials and the comprehensive development of guidelines for the prescription of foot orthoses. Given the weak evidence available, the common prescription of foot orthoses is somewhat surprising.
Topics: Adult; Flatfoot; Foot; Foot Orthoses; Gait; Humans; Lower Extremity
PubMed: 34844639
DOI: 10.1186/s13047-021-00499-z -
Australian Journal of General Practice May 2020Flat foot (pes planus) describes a reduction or absence of the medial longitudinal arch (MLA) of the foot, with or without additional deformities of the foot and ankle....
BACKGROUND
Flat foot (pes planus) describes a reduction or absence of the medial longitudinal arch (MLA) of the foot, with or without additional deformities of the foot and ankle. Flat feet are relatively common in childhood, affecting up to 14% of children. Flexible flat feet can be part of a normal developmental profile, and foot arches usually develop with age, although there is a wide range of normal variation. Up to 25% of the total population has a deficient MLA in at least one foot; therefore, it is likely a general practitioner (GP) will encounter this issue relatively frequently in their practice.
OBJECTIVE
This article outlines a method for paediatric pes planus assessment and management. A multidisciplinary approach involving GPs, rehabilitation physicians, orthopaedic surgeons, physiotherapists, orthotists and podiatrists is discussed.
DISCUSSION
Paediatric pes planus treatment has long been a contentious topic, with a lack of clarity in the literature regarding which children require treatment and the efficacy of intervention. However, there is increasing evidence that non-surgical interventions, such as orthoses and physiotherapy, may be beneficial for certain groups of children.
Topics: Disease Management; Flatfoot; Foot Orthoses; Humans; Pediatrics; Physical Therapy Modalities
PubMed: 32416653
DOI: 10.31128/AJGP-09-19-5089 -
The Cochrane Database of Systematic... Jan 2022Paediatric flat feet are a common presentation in primary care; reported prevalence approximates 15%. A minority of flat feet can hurt and limit gait. There is no... (Review)
Review
BACKGROUND
Paediatric flat feet are a common presentation in primary care; reported prevalence approximates 15%. A minority of flat feet can hurt and limit gait. There is no optimal strategy, nor consensus, for using foot orthoses (FOs) to treat paediatric flat feet.
OBJECTIVES
To assess the benefits and harms of foot orthoses for treating paediatric flat feet.
SEARCH METHODS
We searched CENTRAL, MEDLINE, and Embase to 01 September 2021, and two clinical trials registers on 07 August 2020.
SELECTION CRITERIA
We identified all randomised controlled trials (RCTs) of FOs as an intervention for paediatric flat feet. The outcomes included in this review were pain, function, quality of life, treatment success, and adverse events. Intended comparisons were: any FOs versus sham, any FOs versus shoes, customised FOs (CFOs) versus prefabricated FOs (PFOs).
DATA COLLECTION AND ANALYSIS
We followed standard methods recommended by Cochrane.
MAIN RESULTS
We included 16 trials with 1058 children, aged 11 months to 19 years, with flexible flat feet. Distinct flat foot presentations included asymptomatic, juvenile idiopathic arthritis (JIA), symptomatic and developmental co-ordination disorder (DCD). The trial interventions were FOs, footwear, foot and rehabilitative exercises, and neuromuscular electrical stimulation (NMES). Due to heterogeneity, we did not pool the data. Most trials had potential for selection, performance, detection, and selective reporting bias. No trial blinded participants. We present the results separately for asymptomatic (healthy children) and symptomatic (children with JIA) flat feet. The certainty of evidence was very low to low, downgraded for bias, imprecision, and indirectness. Three comparisons were evaluated across trials: CFO versus shoes; PFO versus shoes; CFO versus PFO. Asymptomatic flat feet 1. CFOs versus shoes (1 trial, 106 participants): low-quality evidence showed that CFOs result in little or no difference in the proportion without pain (10-point visual analogue scale (VAS)) at one year (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.67 to 1.07); absolute decrease (11.8%, 95% CI 4.7% fewer to 15.8% more); or on withdrawals due to adverse events (RR 1.05, 95% CI 0.94 to 1.19); absolute effect (3.4% more, 95% CI 4.1% fewer to 13.1% more). 2. PFOs versus shoes (1 trial, 106 participants): low to very-low quality evidence showed that PFOs result in little or no difference in the proportion without pain (10-point VAS) at one year (RR 0.94, 95% CI 0.76 to 1.16); absolute effect (4.7% fewer, 95% CI 18.9% fewer to 12.6% more); or on withdrawals due to adverse events (RR 0.99, 95% CI 0.79 to 1.23). 3. CFOs versus PFOs (1 trial, 108 participants): low-quality evidence found no difference in the proportion without pain at one year (RR 0.93, 95% CI 0.73 to 1.18); absolute effect (7.4% fewer, 95% CI 22.2% fewer to 11.1% more); or on withdrawal due to adverse events (RR 1.00, 95% CI 0.90 to 1.12). Function and quality of life (QoL) were not assessed. Symptomatic (JIA) flat feet 1. CFOs versus shoes (1 trial, 28 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain (0 to 10 scale, 0 no pain) between groups (MD -1.5, 95% CI -2.78 to -0.22). Low-quality evidence showed improvements in function with CFOs (Foot Function Index - FFI disability, 0 to 100, 0 best function; MD -18.55, 95% CI -34.42 to -2.68), child-rated QoL (PedsQL, 0 to 100, 100 best quality; MD 12.1, 95% CI -1.6 to 25.8) and parent-rated QoL (PedsQL MD 9, 95% CI -4.1 to 22.1) and little or no difference between groups in treatment success (timed walking; MD -1.33 seconds, 95% CI -2.77 to 0.11), or withdrawals due to adverse events (RR 0.58, 95% CI 0.11 to 2.94); absolute difference (9.7% fewer, 20.5 % fewer to 44.8% more). 2. PFOs versus shoes (1 trial, 25 participants, 3-month follow-up): very low-quality evidence showed little or no difference in pain between groups (MD 0.02, 95% CI -1.94 to 1.98). Low-quality evidence showed no difference between groups in function (FFI-disability MD -4.17, 95% CI -24.4 to 16.06), child-rated QoL (PedsQL MD -3.84, 95% CI -19 to 11.33), or parent-rated QoL (PedsQL MD -0.64, 95% CI -13.22 to 11.94). 3. CFOs versus PFOs (2 trials, 87 participants): low-quality evidence showed little or no difference between groups in pain (0 to 10 scale, 0 no pain) at 3 months (MD -1.48, 95% CI -3.23 to 0.26), function (FFI-disability MD -7.28, 95% CI -15.47 to 0.92), child-rated QoL (PedsQL MD 8.6, 95% CI -3.9 to 21.2), or parent-rated QoL (PedsQL MD 2.9, 95% CI -11 to 16.8).
AUTHORS' CONCLUSIONS
Low to very low-certainty evidence shows that the effect of CFOs (high cost) or PFOs (low cost) versus shoes, and CFOs versus PFOs on pain, function and HRQoL is uncertain. This is pertinent for clinical practice, given the economic disparity between CFOs and PFOs. FOs may improve pain and function, versus shoes in children with JIA, with minimal delineation between costly CFOs and generic PFOs. This review updates that from 2010, confirming that in the absence of pain, the use of high-cost CFOs for healthy children with flexible flat feet has no supporting evidence, and draws very limited conclusions about FOs for treating paediatric flat feet. The availability of normative and prospective foot development data, dismisses most flat foot concerns, and negates continued attention to this topic. Attention should be re-directed to relevant paediatric foot conditions, which cause pain, limit function, or reduce quality of life. The agenda for researching asymptomatic flat feet in healthy children must be relegated to history, and replaced by a targeted research rationale, addressing children with indisputable foot pathology from discrete diagnoses, namely JIA, cerebral palsy, congenital talipes equino varus, trisomy 21 and Charcot Marie Tooth. Whether research resources should continue to be wasted on studying flat feet in healthy children that do not hurt, is questionable. Future updates of this review will address only relevant paediatric foot conditions.
Topics: Child; Flatfoot; Foot Orthoses; Humans; Pain; Pain Measurement; Quality of Life
PubMed: 35080267
DOI: 10.1002/14651858.CD006311.pub4 -
Medicina (Kaunas, Lithuania) Dec 2022: Tibialis posterior tendon pathologies have been traditionally categorized into different stages of posterior tibial tendon dysfunction (PTTD), or adult acquired... (Review)
Review
: Tibialis posterior tendon pathologies have been traditionally categorized into different stages of posterior tibial tendon dysfunction (PTTD), or adult acquired flatfoot deformity (AAFD), and more recently to progressive collapsing foot deformity (PCFD). The purpose of this scoping review is to synthesize and characterize literature on early stages of PTTD (previously known as Stage I and II), which we will describe as tibialis posterior tendinopathy (TPT). We aim to identify what is known about TPT, identify gaps in knowledge on the topics of TPT, and propose future research direction. : We included 44 studies and categorized them into epidemiology, diagnosis, evaluation, biomechanics outcome measure, imaging, and nonsurgical treatment. : A majority of studies (86.4%, 38 of 44 studies) recruited patients with mean or median ages greater than 40. For studies that reported body mass index (BMI) of the patients, 81.5% had mean or median BMI meeting criteria for being overweight. All but two papers described study populations as predominantly or entirely female gender. Biomechanical studies characterized findings associated with TPT to include increased forefoot abduction and rearfoot eversion during gait cycle, weak hip and ankle performance, and poor balance. Research on non-surgical treatment focused on orthotics with evidence mostly limited to observational studies. The optimal exercise regimen for the management of TPT remains unclear due to the limited number of high-quality studies. : More epidemiological studies from diverse patient populations are necessary to better understand prevalence, incidence, and risk factors for TPT. The lack of high-quality studies investigating nonsurgical treatment options is concerning because, regardless of coexisting foot deformity, the initial treatment for TPT is typically conservative. Additional studies comparing various exercise programs may help identify optimal exercise therapy, and investigation into further nonsurgical treatments is needed to optimize the management for TPT.
Topics: Adult; Humans; Female; Flatfoot; Foot; Posterior Tibial Tendon Dysfunction; Gait; Tendinopathy
PubMed: 36557060
DOI: 10.3390/medicina58121858 -
Journal of Physiotherapy Jan 2023In people with flexible flat foot, what is the effect of a comprehensive exercise program on navicular drop height and medial longitudinal arch angle compared with a... (Randomized Controlled Trial)
Randomized Controlled Trial
QUESTION
In people with flexible flat foot, what is the effect of a comprehensive exercise program on navicular drop height and medial longitudinal arch angle compared with a control regimen of brief active range of motion exercises?
DESIGN
Randomised controlled trial with concealed allocation, blinding of assessors and intention-to-treat analysis.
PARTICIPANTS
Fifty-two people with flexible flat foot.
INTERVENTION
The experimental group undertook 30-minute exercise sessions three times per week for 6 weeks. The exercises involved active dorsiflexion and plantarflexion, foot shortening exercises, gluteal muscle strengthening, and stretching. The control group performed active dorsiflexion and plantarflexion only for 6 weeks.
OUTCOME MEASURES
Navicular drop height and longitudinal arch angle.
RESULTS
Randomisation allocated 26 participants to each group. One participant from the experimental group and two from the control group did not complete the study. After 6 weeks, the participants in the experimental group improved their navicular drop height by 0.4 cm (95% CI 0.4 to 0.5) more than those in the control group. These participants also improved their longitudinal arch angle by 16 deg (95% CI 13 to 19) more than those in the control group.
CONCLUSION
In people with flexible flat foot, a comprehensive 6-week exercise program improved the navicular drop height and longitudinal arch angle more than active dorsiflexion and plantarflexion alone. This improved the cosmetic appearance of the foot and reduced progression towards more severe flat foot, which typically becomes symptomatic.
TRIAL REGISTRATION
CTRI/2021/07/034599.
Topics: Humans; Flatfoot; Foot; Exercise Therapy; Muscle, Skeletal
PubMed: 36526555
DOI: 10.1016/j.jphys.2022.11.011 -
Journal of Orthopaedic Science :... Jan 2019We describe the pathology and treatment of flexible flat foot in children. The flexible flat foot is seen in the overly flexible foot and usually involves hypermobility...
We describe the pathology and treatment of flexible flat foot in children. The flexible flat foot is seen in the overly flexible foot and usually involves hypermobility of the subtalar joint. It typically occurs in childhood and may continue to adulthood. The arch develops spontaneously during the first decade of life in most children and comes within the normal range observed in adult feet. We prescribed orthoses for the treatment of flexible flat foot patients. Lateral weight-bearing radiographs and ultrasonography were helpful for the evaluation of the flat foot. Bleck recommended the UCBL shoe insert in cases of flexible flat foot if the standing or lateral rentgenogram demonstrates a talar plantar flexion angle (TPF) of 45° or greater. Bordelon suggested that cases of flexible flat foot should be treated if the standing or lateral roentgenogram demonstrates a Meary's talo-1st metatarsal angle (T1-MTA) of -15°or greater. However, the radiograph of a young child's foot poses some difficulties in making an accurate evaluation, because of the radiolucent cartilage zone. In this situation, a sagittal image obtained by ultrasonography has proved to be a powerful aid to evaluate the type of the flat foot. We classified the flat foot into three types: talo-navicular sag (T-N sag), naviculo-cuneiform sag (NC sag) and talo-navicular and naviculo-cuneiform sag (Mixed sag) following the criteria of Tachdjian. We recommended the NC sag and Mixed sag groups to be treated by using orthoses, while we kept a status of watchful waiting for the T-N sag group. However, we should consider the increasing complaints of children and their parents during the orthotic treatment. A through discussion between the parents of patients and the pediatric orthopedic doctors is necessary before orthotic treatment is started.
Topics: Child; Disease Management; Flatfoot; Humans; Orthotic Devices; Radiography; Tarsal Bones; Weight-Bearing
PubMed: 30366675
DOI: 10.1016/j.jos.2018.09.018 -
International Journal of Environmental... Jul 2022Background: This study aimed to explore the risk factors for flatfoot in children and adolescents to provide a reference basis for studying foot growth and development... (Meta-Analysis)
Meta-Analysis Review
Background: This study aimed to explore the risk factors for flatfoot in children and adolescents to provide a reference basis for studying foot growth and development in children and adolescents. Methods: We examined the cross-sectional research literature regarding flatfoot in children and adolescents published in the past 20 years, from 2001 to 2021, in four electronic databases: PubMed, Web of Science, EBSCO, and Cochrane Library. Two researchers independently searched the literature according to the inclusion and exclusion criteria and evaluated the literature quality of the selected research; from this, a total of 20 articles were included in our review. After the relevant data were extracted, the data were reviewed using Manager 5.4 software (The Cochrane Collaboration, Copenhagen, Denmark), and the detection rate and risk factors for flatfoot in children were analyzed. Results: In total, 3602 children with flatfoot from 15 studies were included in the analysis. The meta-analysis results showed that being male (OR = 1.33, 95% CI: 1.09, 1.62, p = 0.005), being aged <9 years (age <6, OR = 3.11, 95% CI: 2.47, 3.90, p < 0.001; age 6−9 years, OR = 0.54, 95% CI: 0.41, 0.70, p < 0.001), joint relaxation (OR = 4.82, 95% CI: 1.19, 19.41, p = 0.03), wearing sports shoes (OR = 2.97, 95% CI: 1.46, 6.03, p = 0.003), being a child living in an urban environment (OR = 2.10, 95% CI: 1.66, 2.64, p < 0.001) and doing less exercise (OR = 0.25, 95% CI: 0.08, 0.80, p = 0.02) were risk factors for the detection of flatfoot. Conclusion: In summary, the detection rate of flatfoot in children in the past 20 years was found to be 25% through a meta-analysis. Among the children included, boys were more prone to flatfoot than girls, and the proportion of flatfoot decreased with age.
Topics: Adolescent; Child; Cross-Sectional Studies; Female; Flatfoot; Foot; Humans; Male; Risk Factors; Shoes
PubMed: 35886097
DOI: 10.3390/ijerph19148247