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Diagnostic and Interventional Radiology... May 2021Lateral hindfoot impingement (LHI) is a subtype of ankle impingement syndrome with classic MRI findings. Biomechanically, LHI is the sequela of lateral transfer of...
Lateral hindfoot impingement (LHI) is a subtype of ankle impingement syndrome with classic MRI findings. Biomechanically, LHI is the sequela of lateral transfer of weight bearing from the central talar dome to the lateral talus and fibula. The transfer occurs due to collapse of the medial arch of the foot, most commonly from posterior tibial tendon (PTT) and spring ligament (SL) insufficiency. Clinical features include lateral hindfoot pain, deformity, and overpronation on gait analysis. MRI changes continuously reflect the altered biomechanics as the syndrome progresses over time, including typical and often sequential changes of PTT and SL failure, increasing heel valgus, talocalcaneal and subfibular impingement, and finally lateral soft tissue entrapment. In addition to diagnosis, MRI is a useful adjunct to plan surgical treatment.
Topics: Biomechanical Phenomena; Flatfoot; Humans; Ligaments, Articular; Magnetic Resonance Imaging
PubMed: 34003130
DOI: 10.5152/dir.2021.20268 -
Medicine Mar 2020Flexible flatfoot is a condition characterized by the deformations of the foot where the calcaneus is pronated by weight support. Flat feet can affect balance and the... (Clinical Trial)
Clinical Trial
BACKGROUND
Flexible flatfoot is a condition characterized by the deformations of the foot where the calcaneus is pronated by weight support. Flat feet can affect balance and the entire chain of motion, causing indirect problems in adjacent joints. We investigated the effects of short foot exercise (SFE) using visual feedback on the static balance and function of proximal joints in subjects with flexible flat feet.
METHOD AND ANALYSIS
This study involved 30 participants who were assigned to either of the 2 groups: the flexible flatfoot group (n = 15, 8 men and 7 women, aged 22.00 ± 2.07 years) and normal foot group (n = 15, 7 men and 8 women, aged 22.13 ± 1.55 years). All subjects performed the SFE with visual feedback. SFE programs were performed 20 minutes a day, 5 times a week, for a total of 5 weeks. The static balance and accuracy of knee joint motions were compared before and after training.
RESULTS
There was a significant difference in static balance pre- and post-exercise in the flatfoot group but not in the normal foot group. Moreover, in the flatfoot group, the accuracy of knee joint motions was significantly different between pre- and post-exercise in the closed chain but not in the open chain.
CONCLUSION
This study examined the influence of SFE using visual feedback on the balance and accuracy of knee joint movements in subjects with flatfoot and demonstrated that this exercise, using visual feedback, improved the balance and accuracy of knee movement.
Topics: Biomechanical Phenomena; Exercise Therapy; Feedback, Sensory; Female; Flatfoot; Humans; Knee Joint; Male; Postural Balance; Prospective Studies; Young Adult
PubMed: 32221061
DOI: 10.1097/MD.0000000000019260 -
International Orthopaedics Apr 2023To analyze the results of a conservative method for treating congenital vertical talus in children with early start and to know in which cases surgical treatment was...
PURPOSE
To analyze the results of a conservative method for treating congenital vertical talus in children with early start and to know in which cases surgical treatment was needed.
METHODS
A retrospective analysis of all children diagnosed with idiopathic vertical talus was carried out during the years 2008-2021. Thirty-two children (46 feet) were finally included. Children were treated with serial manipulations, muscle stimulation, and corrective bandages. Age at the time of initiation of treatment, duration of treatment, and correction or not of the deformity without surgical intervention were recorded as variables of interest. The talocalcaneal angle, TAMBA, and ankle range of motion were measured before treatment, after treatment, and at the end of the follow-up period. Statistics decision tree was used to determine which variable best discriminated whether the patient needed surgery. To complement the tree diagram, a two-step cluster analysis was carried out.
RESULTS
After treatment, TAMBA and talocalcaneal angle changed from "vertical" to "oblique" category in 45 and 37 feet, respectively. The pathological dorsal flexion of the ankle changed to normal in 37 feet and ankle plantar flexion was normal in 46 feet. These variables showed significant changes between the three measurement moments. The results of the statistics decision tree and cluster analysis indicate that "No surgery" was associated with an age equal to or lower than one week when treatment was started, and with an ankle plantar flexion range of motion lower than 36°.
CONCLUSIONS
The beginning of this conservative treatment in the first week of life and having a plantar flexion of the ankle lower than 36° were related to the success of the treatment without surgery.
Topics: Child; Humans; Infant, Newborn; Follow-Up Studies; Flatfoot; Retrospective Studies; Talus; Orthopedic Procedures; Treatment Outcome
PubMed: 36629851
DOI: 10.1007/s00264-022-05685-7 -
American Family Physician Feb 2004An examination of the feet is an essential component of an evaluation of a newborn. A thorough examination can be performed quickly. Despite its small size, the newborn... (Review)
Review
An examination of the feet is an essential component of an evaluation of a newborn. A thorough examination can be performed quickly. Despite its small size, the newborn foot is a complex structure. Most deformities can be diagnosed easily with physical examination alone, using few diagnostic studies. A thorough examination includes assessment of vascular, dermatologic, and neurologic status of the lower extremities, and observation, palpation, and evaluation of joint range of motion in both feet. Common newborn foot abnormalities include metatarsus adductus, clubfoot deformity, calcaneovalgus (flexible flatfoot), congenital vertical talus (rigid flatfoot), and multiple digital deformities-polydactyly, syndactyly, overlapping toes, and amniotic bands. Most treatments include conservative measures, such as observation, stretching, and splinting, which can be performed easily in the family medicine setting. Cases that require surgical correction should be referred to a subspecialist with expertise in correcting lower extremity deformities in children. When surgery is indicated, procedures generally are postponed for six to nine months so that the child will better tolerate anesthesia.
Topics: Foot; Foot Deformities, Congenital; Humans; Infant, Newborn
PubMed: 14989573
DOI: No ID Found -
The Journal of Maternal-fetal &... Dec 2023This study aimed to analyze the ultrasound characteristics of fetal congenital vertical talus (CVT) to provide a detailed basis for the prenatal diagnosis of CVT.
OBJECTIVE
This study aimed to analyze the ultrasound characteristics of fetal congenital vertical talus (CVT) to provide a detailed basis for the prenatal diagnosis of CVT.
METHODS
We retrospectively analyzed the ultrasonographic findings of fetuses with CVT confirmed by X-ray, surgery, or autopsy from 2010 to 2020. Clinical characteristics and ultrasonographic findings of CVT, including foot morphology, ossification center of the calcaneus and talus, associated deformities, and chromosomal test results, were recorded.
RESULTS
Thirteen patients diagnosed with CVT by prenatal ultrasound were confirmed postpartum. Nine cases were bilateral, and four were unilateral. Under two-dimensional ultrasound, 13/13 cases had abnormal foot morphology, and 10 of 13 cases (76.9%) showed that the ossification center of the talus moved downward, and the calcaneus moved laterally. Under three-dimensional ultrasound, 11 cases (84.6%) presented a "rocking chair" appearance, and two cases did not obtain satisfactory three-dimensional image due to oligohydramnios and fetal position. In this group of cases, two cases (15.4%) were isolated CVT, and the other 11 cases (84.6%) were complicated with other abnormalities. Eleven cases of non-isolated CVT and 1 case of isolated CVT were induced, and another patient with isolated CVT had undergone postnatal surgery, which had been followed up for 8 years and recovered well.
CONCLUSIONS
The combination of fetal foot morphology, ossification center position of the calcaneus and talus, and three-dimensional ultrasound can provide a reliable diagnosis of CVT. Furthermore, we should pay more attention to the evaluation of other systemic and chromosomal abnormalities in CVT cases.
Topics: Female; Humans; Pregnancy; Flatfoot; Retrospective Studies; Prenatal Diagnosis; Talus; Ultrasonography, Prenatal
PubMed: 36948222
DOI: 10.1080/14767058.2023.2192323 -
Northern Clinics of Istanbul 2014While being one of the most frequent parental complained deformities, flatfoot does not have a universally accepted description. The reasons of flexible flatfoot are...
While being one of the most frequent parental complained deformities, flatfoot does not have a universally accepted description. The reasons of flexible flatfoot are still on debate, but they must be differentiated from rigid flatfoot which occurs secondary to other pathologies. These children are commonly brought up to a physician without any complaint. It should be kept in mind that the etiology may vary from general soft tissue laxities to intrinsic foot pathologies. Every flexible flatfoot does not require radiological examination or treatment if there is no complaint. Otherwise further investigation and conservative or surgical treatment may necessitate.
PubMed: 28058304
DOI: 10.14744/nci.2014.29292 -
Journal of Children's Orthopaedics Jun 2020Subtalar arthroereisis has been described for the treatment of flexible juvenile flatfoot. However, the mechanism responsible for deformity correction has not yet been... (Review)
Review
PURPOSE
Subtalar arthroereisis has been described for the treatment of flexible juvenile flatfoot. However, the mechanism responsible for deformity correction has not yet been investigated adequately. The aim of this study was to document the effect of subtalar arthroereisis on the tarsometatarsal bone morphology.
METHODS
We retrospectively reviewed the clinical and radiological data of 26 patients (45 feet) with juvenile flexible flatfoot deformity treated by subtalar arthroereisis at our department between 2000 and 2018. Radiological evaluation included angular measurements of tarsometatarsal bone morphology as well as hindfoot and midfoot alignment. Mean radiographic follow-up was 19.4 months (sd 8.8; 12 to 41).
RESULTS
A significant change of angular measurements of tarsometatarsal bone morphology was found after subtalar arthroereisis (p < 0.001). While there was an increase of the distal medial cuneiform angle (DMCA) and the medial cuneo-first metatarsal angle on the anteroposterior view, a decrease of the naviculo-medial cuneiform angle and the medial cuneo-first metatarsal angle was seen on the lateral view. Furthermore, we found significant improvements of all hindfoot and midfoot alignment parameters except the lateral tibio-calcaneal angle and the calcaneal pitch angle (p < 0.001).
CONCLUSION
Our data support the theory of tarsometatarsal bone remodelling, which may contribute to the effect of subtalar arthroereisis for the treatment of flexible juvenile flatfoot.
LEVEL OF EVIDENCE
IV.
PubMed: 32582390
DOI: 10.1302/1863-2548.14.190190 -
Clinical Orthopaedics and Related... Apr 2011Congenital vertical talus is a fixed dorsal dislocation of the talonavicular joint and fixed equinus contracture of the hindfoot, causing a rigid deformity recognizable...
BACKGROUND/RATIONALE
Congenital vertical talus is a fixed dorsal dislocation of the talonavicular joint and fixed equinus contracture of the hindfoot, causing a rigid deformity recognizable at birth. The etiology and epidemiology of this condition are largely unknown, but some evidence suggests it relates to aberrations of skeletal muscle. Identifying the tissue abnormalities and genetic causes responsible for vertical talus has the potential to lead to improved treatment and preventive strategies.
QUESTIONS/PURPOSES
We therefore (1) determined whether skeletal muscle abnormalities are present in patients with vertical talus and (2) identified associated congenital anomalies and genetic abnormalities in these patients.
METHODS
We identified associated congenital anomalies and genetic abnormalities present in 61 patients affected with vertical talus. We obtained abductor hallucis muscle biopsy specimens from the affected limbs of 11 of the 61 patients and compared the histopathologic characteristics with those of age-matched control subjects.
RESULTS
All muscle biopsy specimens (n = 11) had abnormalities compared with those from control subjects including combinations of abnormal variation in muscle fiber size (n = 7), type I muscle fiber smallness (n = 6), and abnormal fiber type predominance (n = 5). Isolated vertical talus occurred in 23 of the 61 patients (38%), whereas the remaining 38 patients had associated nervous system, musculoskeletal system, and/or genetic and genomic abnormalities. Ten of the 61 patients (16%) had vertical talus in one foot and clubfoot in the other. Chromosomal abnormalities, all complete or partial trisomies, were identified in three patients with vertical talus who had additional congenital abnormalities.
CONCLUSIONS
Vertical talus is a heterogeneous birth defect resulting from many diverse etiologies. Abnormal skeletal muscle biopsies are common in patients with vertical talus although it is unclear whether this is primary or secondary to the joint deformity. Associated anomalies are present in 62% of all cases.
Topics: Abnormalities, Multiple; Biopsy; Case-Control Studies; Chi-Square Distribution; Chromosome Aberrations; Female; Flatfoot; Foot Deformities, Congenital; Genetic Predisposition to Disease; Humans; Male; Minnesota; Missouri; Muscle Fibers, Skeletal; Muscle, Skeletal; Phenotype; Prospective Studies; Risk Assessment; Risk Factors
PubMed: 20645034
DOI: 10.1007/s11999-010-1475-5 -
Journal of Orthopaedic Surgery and... Apr 2023Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is dorsiflexed and forefoot is abducted due to a fixed dorsal...
Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is dorsiflexed and forefoot is abducted due to a fixed dorsal dislocation of the navicular on the head of the talus and the cuboid on the anterior part of the calcaneus. The epidemiology and etiology of vertical talus is unknown. Dobbs et al. (J Bone Joint Surg Am 88(6):1192-200, 2006) described a minimally invasive alternative which allowed to avoid the need for extensive soft tissue release procedures in treatment of congenital vertical talus. Eleven congenital vertical talus feet (group 5 according to Hamanishi) in eight children (four boys and four girls) constituted the study material. Upon the diagnosis, the patients' age ranged from 5 to 26 months old (the mean - 14.6). The treatment involved serial manipulation and casting according to the reverse Ponseti method (from 4 to 7 casts) followed by a minimally invasive approach consisting in temporary stabilization of the talonavicular joint with the use of K-wire and Achilles tenotomy according to the Dobbs technique. Then patients continued the shoe and bar program for 2 years. The X-ray measurements on lateral radiographic included the talocalcaneal angle, tibiotalar angle and talar axis-first metatarsal base angle whereas AP radiographic images-the talocalcaneal angle and talar axis-first metatarsal angle. The Wilcoxon test was used to compare dependent variables. The final clinical assessment made during the last follow-up (the mean: 35.8 months, the range: 25-52) revealed that neutral position of the foot and normal range of motion were observed in ten cases and recurrence of foot deformity in one case. The last X-ray examination showed normalization all of radiological parameters, except for one case, and examined parameters were statistically significant. The minimally invasive technique described by Dobbs should be the first option in treatment of congenital vertical talus. It allows to reduce the talonavicular joint, brings good results and preserves foot mobility. The attention should be put on early diagnosis.
Topics: Male; Child; Female; Humans; Infant; Child, Preschool; Flatfoot; Follow-Up Studies; Foot Deformities, Congenital; Talus; Foot Deformities
PubMed: 37069684
DOI: 10.1186/s13018-023-03708-6 -
Scientific Reports Aug 2019Adaptive scenarios of crown primate origins remain contentious due to uncertain order of acquisition and functional significance of the clade's diagnostic traits. A...
Adaptive scenarios of crown primate origins remain contentious due to uncertain order of acquisition and functional significance of the clade's diagnostic traits. A feature of the talus bone in the ankle, known as the posterior trochlear shelf (PTS), is well-regarded as a derived crown primate trait, but its adaptive significance has been obscured by poorly understood function. Here we propose a novel biomechanical function for the PTS and model the talus as a cam mechanism. By surveying a large sample of primates and their closest relatives, we demonstrate that the PTS is most strongly developed in extant taxa that habitually grasp vertical supports with strongly dorsiflexed feet. Tali of the earliest fossils likely to represent crown primates exhibit more strongly developed PTS cam mechanisms than extant primates. As a cam, the PTS may increase grasping efficiency in dorsiflexed foot postures by increasing the path length of the flexor fibularis tendon, and thus improve the muscle's ability to maintain flexed digits without increasing energetic demands. Comparisons are made to other passive digital flexion mechanisms suggested to exist in other vertebrates. These results provide robust anatomical evidence that the habitual vertical support use exerted a strong selective pressure during crown primate origins.
Topics: Analysis of Variance; Animals; Biological Evolution; Phylogeny; Primates; Talus
PubMed: 31451739
DOI: 10.1038/s41598-019-48651-x