Abstract
BackgroundIn planovalgus deformity with triceps contracture, a midfoot break happens, and ankle dorsiflexion (ADF) occurs at the mid-tarsal joint during gait. Results of standard 3D gait analysis may misinterpret the true ankle dorsiflexion because it recognizes the entire foot as a single rigid segment. We performed this study to investigate whether the severity of planovalgus deformity is associated with the discrepancy between the value of ADF evaluated by physical examination and 3-dimensional (3D) gait analysis. In addition, we aimed to identify the radiographic parameters associated with this discrepancy and their relationships.MethodsConsecutive 40 patients with 65 limbs (mean age, 11.7 ± 5.5 years) with planovalgus foot deformity and triceps surae contracture were included. All patients underwent 3D gait analysis, and weightbearing anteroposterior (AP) and lateral (LAT) foot radiographs. ADF with knee extension was measured using a goniometer with the patient’s foot in an inverted position.ResultsTwenty-one limbs underwent operation for planovalgus foot deformity, and 56 limbs underwent operation for equinus deformity. The difference between ADF on physical examination and ADF at initial contact on gait analysis was 17.5 ± 8.4°. Differences between ADF on physical examination and ADF at initial contact on gait analysis were significantly associated with the LAT talus-first metatarsal angle (p = 0.008) and calcaneal pitch angle (p = 0.006), but not associated with the AP talus-first metatarsal angle (p = 0.113), talonavicular coverage angle (p = 0.190), talocalcaneal angle (p = 0.946), and naviculocuboid overlap (p = 0.136).ConclusionThe discrepancy between ADF on physical examination and 3D gait analysis was associated with the severity of planovalgus deformity, which was evaluated on weightbearing LAT foot radiographs. Therefore, physicians should be cautious about interpreting results from 3D gait analysis and perform a careful physical examination to assess the degree of equinus deformity in patients with planovalgus foot deformity.
Highlights
In planovalgus deformity with triceps contracture, a midfoot break happens, and ankle dorsiflexion (ADF) occurs at the mid-tarsal joint during gait
Physicians should be cautious about interpreting results from 3D gait analysis when assessing the degree of ADF in patients with planovalgus foot deformity
We demonstrated that the discrepancy between ADF assessed by physical examination and 3D gait analysis is significantly associated with two radiographic parameters on weight-bearing LAT foot radiographs: LAT talo-1MT and calcaneal pitch angle (CP)
Summary
In planovalgus deformity with triceps contracture, a midfoot break happens, and ankle dorsiflexion (ADF) occurs at the mid-tarsal joint during gait. We performed this study to investigate whether the severity of planovalgus deformity is associated with the discrepancy between the value of ADF evaluated by physical examination and 3-dimensional (3D) gait analysis. Planovalgus is often associated with equinus deformity in patients with cerebral palsy or an idiopathic cause due to contracture of the triceps surae. Planovalgus deformity with triceps surae contracture in contrast to simple flexible planovalgus is known to often be symptomatic and cause pain, medial foot callosity, and functional disability [4, 5]. A previous study using gait analysis showed that increased forefoot abduction occurred throughout the stance phase in symptomatic feet compared to asymptomatic feet [6]. For patients with contracture of the triceps surae, triceps surae lengthening procedures, such as tendo-Achilles lengthening and the Strayer procedure, should be performed concomitantly
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