Cavus Foot Research Articles

Hubungan Antara Pes Planus Dengan Keseimbangan Dinamis Pada Murid MI Nurul Karim Colomadu

Background: The ability to balance children at the age of development is very important to be reviewed, both in terms of balance sitting, standing, and walking. One of the factors that can cause balance disorders in children is musculoskeletal disorders in the form of deformity of the soles of the feet. The shape of the human foot is divided into three types, namely normal foot, pes planus and cavus foot according to the arcus structure or arches on the soles of the feet. Normally the arch is formed from the first 5 years with a 2-6 year age range. The critical period for arch formation is the age of 6 years (Campbell, 2012). In the early age of school there were 28% - 35% of children experiencing deformity of pes planus, 80% of which were categorized as "moderate". Methods: This research is a type of correlational research with a cross sectional design which aims to determine the relationship between pes planus and the dynamic balance in MI Nurul Karim Colomadu's students. The subjects used were grade 1-5 students with the condition of pes planus at MI Nurul Karim Colomadu, who had determined the inclusion and exclusion criteria. The number of subjects was 40 people with male and female sex from a total population of 92 people. Result: Using the Spearman Correlation Test Based on the table above, it is known that the value of p = 0.869 shows that there is no significant relationship between sex and dynamic balance. The value of r = 0.27 indicates the strength of the weak correlation. While the value of p = 0,000 shows there is a significant relationship between pes planus and dynamic balance. The value of r = -0,599 shows the strength of the medium correlation. Conclusion: One conclusion is 1. The prevalence of pes planus in girls is greater than that of boys, ie 16 boys and 24 girls have Pes Planus.

Hind- and midfoot bone morphology varies with foot type and sex.

Foot type has been associated with pain, injury, and altered gait mechanics. Morphological variations in foot bones due to foot type variation may impact surgical and therapeutic treatments. The purpose of this study was to utilize principal component analysis (PCA) to determine how morphology of the hind- and midfoot bones differs among foot types and sex. The calcaneus, talus, navicular, and cuboid were segmented using previously obtained computed tomography (CT) scans and converted to surface models. The CTs were sorted into four foot types-cavus, neutrally aligned, asymptomatic planus, and symptomatic planus. Morphometric shape analysis software (Geomorph) was used to perform a PCA to determine which components varied between foot types and between sexes. The calcaneus showed planus feet of both types to have calcanei that have decreased height and increased length compared to neutrally aligned feet. The talus demonstrated increased posterior mass for cavus feet compared to neutrally aligned feet. For the navicular, symptomatic planus had a more posteriorly positioned tuberosity and were wider than asymptomatic planus feet. The cuboid did not exhibit any differences between foot types. Sex differences, found only at the talus and navicular, were subtle. PCA is an objective technique that helped elucidate differences in bone morphology between foot types and sex without needing to determine the features of interest before comparing groups. Understanding these variations can help inform diagnosis of foot pathologies and surgical protocols as well as improve computer models of the foot. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. J Orthop Res 9999:1-16, 2019.

Tc-99m HDP Single Photon Emission Computed Tomography/Computed Tomography in Stress Fracture of Base of Metatarsal Bone.

Proximal metatarsal stress fractures are common at base of the second metatarsal, typically seen in repetitive impact athletes, dancers, and those with cavus feet. It is caused by increased bone resorption rather than formation in a state of abrupt increased physical activity or intensity, leading to repetitive microfractures and eventually stress fracture. It is characterized by swelling and tenderness of a prolonged duration. We report a case of a 40-year-old female having left foot pain diagnosed with stress fracture on Tc-99m HDP single-photon emission computed tomography (SPECT)-CT. We emphasize the use of SPECT/CT in allocating active source of pain in the feet.

The effect of foot type on the Achilles tendon moment arm and biomechanics

BackgroundThe aim was to calculate the Achilles tendon moment arm in different degrees of plantarflexion for pes planus, pes cavus and normal arched feet. Methods99 patients (99 radiographs; 40 males, 59 females; mean age 49 years, SD 15) with a healthy ankle joint and a preoperative weightbearing lateral radiograph of the foot were included. Three groups (pes planus, pes cavus and normal-arched feet) with equal sample sizes (n=33) were formed. On radiographs, the angle formed between a horizontal line and the line connecting the insertion of the Achilles tendon with the center of rotation of the ankle, was measured. The interrater reliabilities (ICC) of the angle alpha were compared on radiographs and on MRIs. Using the angle alpha, the Achilles tendon moment arm was calculated in different plantarflexion positions. ResultsThe ICC of alpha was higher on radiographs (0.84, [0.73–0.91]) than on MRIs (0.61, [0.27–0.81]). The average alpha was statistically significantly different (normal arched foot 31 degrees (°), pes planus 24°, pes cavus 36°, p=0.021), resulting in a significant shorter Achilles tendon moment arm for pes cavus than for pes planus (p<0.0001) and normal arched feet (p=0.006) in neutral position. ConclusionThe data suggests that it is feasible to use radiographs to measure the Achilles tendon moment arm. The maximum Achilles tendon moment arm is reached at different angles of ankle flexion for pes cavus, pes planus and normal-arched feet. This has to be taken into consideration when planning surgeries.

A Review of Extensor Hallucis Longus Variants Featuring a Novel Extensor Primi Internodii Hallucis Muscle Merging With Extensor Hallucis Brevis

The extensor hallucis longus (EHL) muscle/tendon complex has been used in a variety of tendon transfer and tenodesis surgeries to correct iatrogenic hallux varus deformity, equinovarus foot deformity, clawed hallux associated with a cavus foot, and dynamic hyperextension of the hallux and, even, to prevent pedal imbalance after transmetatarsal amputation. Although it is usually considered a unipennate muscle inserting into the dorsum of the base of the distal phalanx of the hallux, a vast majority of EHL muscles possess ≥1 accessory tendinous slips that insert into other neighboring bones, muscles, or tendons, which can complicate these surgeries. The present report reviewed the reported data on EHL variants and describe a new variant, in which the tendons of the extensor primi internodii hallucis muscle of Wood and extensor hallucis brevis muscle merged together proximal to the tarsometatarsal (Lisfranc) joint, a site of rupture for extensor tendons of the foot. The reported variant might have contributed to the development of the clawed hallux seen in our patient and could complicate its operative management by mimicking the normal extensor digitorum longus tendon. Knowledge of the EHL variants and the particular muscular pattern described in the present review could improve the diagnosis and tendon transfer and tenodesis operative planning and outcomes.

Muscle activation during fast walking with two types of foot orthoses in participants with cavus feet

The aim of this study was to quantify the effects of foot orthoses (FOs) with and without a lateral bar on muscle activity of participants with cavus feet. Fifteen participants were recruited from the Université du Québec à Trois-Rivières students and podiatry clinic. The muscle activity of the tibialis anterior, fibularis longus, gastrocnemius lateralis and medialis, vastus medialis and lateralis, biceps femoris and gluteus medius were recorded during fast walking under two experimental conditions (FOs with and without a lateral bar) and a control condition (shoes). Experimentations were completed after a one-month adaptation period to each experimental condition. The root mean square of the electromyography (EMG) data was analyzed. To compare the effects between conditions, a curve analysis was performed using one-dimensional statistical parametric mapping. The main result of this study was an increased gastrocnemius lateralis muscle activity (maximum mean difference: +28%) during the propulsion phase of gait (44–46%) when participants wore FOs compared to the control condition. This result will help researchers and clinicians better understand the FOs’ EMG effects of individuals with cavus feet. As FOs are mainly prescribed for symptomatic patients, future studies should assess their effects on individuals suffering of a pathology, such as Achilles tendinopathy.

The LiLiPUT for Ligamentous Lisfranc Injury

Category: Trauma Introduction/Purpose: The Lisfranc ligament complex is integral to the stability of the 2nd tarsometarsal joint (TMTJ). Injury causes the 2nd metatarsal to displace dorsally and laterally. Injuries are often missed acutely because of subtle findings that are not always apparent on both weight bearing and non-weight bearing radiographs. The concept of the LiLiPUT (Ligamentous Lisfranc Push Up Test) originated from observations during operative cases that dorsal displacement appeared to be the major direction of instability. A sensitive and reproducible out-patient ‘stress test’ for occult Lisfranc injury is, as yet, elusive. The aims of the study were to assess the ability of the LiLiPUT (a raised block beneath the 2nd metatarsal) to reveal an occult ligamentous Lisfranc injury. Methods: Ten fresh frozen cadaveric lower limbs were used. Postero-anterior and lateral foot radiographs were obtained prior to simulation of a ligamentous Lisfranc injury via a dorsal approach incising the dorsal and plantar ligaments of the 2nd TMTJ. Radiographs were obtained with: Blocks of increasing size placed underneath the 2nd metatarsal. The foot in 3 different positions of increasing dorsiflexion over the blocks. 10Kg load applied skeletally to the leg over the same blocks and positions. A pressure sensor was at the interface between the 2nd TMTJ and block obtaining pressure maps with maximal load readings for each test. Results: The introduction of a 2 x 1 cm block beneath the 2nd metatarsal, with downward force coming from the weight of the amputated limb, revealed an occult injury on the lateral radiographs in 8 of the 10 specimens. A positive test was taken as any discernible dorsal displacement. An increase in block size did not change the force transmitted through the 2nd TMTJ (p=0.32 to 0.42) and had no significant effect on diagnostic yield. Increasing dorsiflexion and increasing load also had no effect on the diagnostic yield. The two specimens without displacement had cavus type foot deformities. Conclusion: A small raised block beneath the 2nd metatarsal in a non weight-bearing patient with the foot in a neutral position may be an adequate means of identifying occult ligamentous Lisfranc injuries on lateral radiographs. Further evaluation in the clinical setting is required as this test may not demonstrate instability in the cavus foot variant.

Minimally invasive calcaneal osteotomy

Category: Hindfoot Introduction/Purpose: A calcaneal osteotomy can be used to treat a variety of pathologic entities in which the hindfoot needs realignment. Minimally invasive calcaneal osteotomy (MICO) is becoming increasingly popular due to being soft tissue friendly, its ability to place other incisions nearby and high union rate. Previous studies have look specifically at medialising MICO or comparing open calcaneal osteotomy versus MICO. The purpose of our study was to compare 3 different types of commonly used MICO in our centre. Methods: Sixty-two MICO which fit the criteria were included in this study. They were performed in our unit from 2010 and 2016 and all patients had at least one year follow up data. The type of osteotomies was as follows: Medialising, n = 34, Lateralising, n =15 and Zadek (Dorsal closing wedge), n =13. Clinical and radiographic data were recorded. The diagnosis for 31/34 of the medialising MICO was Stage 2 PTTD, the diagnosis for 12/15 of the lateralising MICO was cavus foot, while the diagnosis for all Zadek MICO was for insertional Achilles tendinopathy. Apart from the Zadek MICO, the other MICO were all associated with other procedures. The average age (years) were as follows: Medialising, 58 (30 – 74); Lateralising, 33 (14 – 67) and Zadek, 47 (42-62). Results: The average calcaneal displacement was 10.2 (range: 8 – 12) mm for medialising MICO, and 6.6 (4 – 8) mm for lateralising MICO(p=0.021). Average time to union was 7.8 (5.4 – 11.6) weeks for medialising MICO, 6.2 (4.6 to 7.9) weeks for lateralising MICO, and 6.1 (4.1 – 7.6) weeks for Zadek MICO. All the MICO healed radiologically and clinically. Five (8%) patients (Medialising, n = 2; Lateralising n =2; Zadek, n =1) reported transient sural nerve paraesthesia following surgery. Wound problems developed in 5 patients (Lateralising, n =3; Zadek, n =2). The number of total complications were as follow: Medialising, n = 5, Lateralising, n = 7 and Zadek, n =5. Average length of stay was as follows: Medialising, 2(0-8) days; Lateralising, 1(0-3) day and Zadek, 1(0-3) day. Conclusion: Minimally invasive calcaneal osteotomy was safe with a high union rate and low complication rates and length of stay across all 3 common osteotomies. The average calcaneal displacement was significantly less for lateralising than medialising which is similar to reported figures for open osteotomy. Wound problems were more likely for lateralising and Zadek MICO compared to medialising and this could be because of how the osteotomies are shifted.

Subtle Cavus Deformities

Category: Sports Introduction/Purpose: Lateral ankle ligament injuries are common conditions accounting for 25% of musculoskeletal injuries. Prior reports have found increased risk of failed lateral ankle reconstruction in those with a subtle cavus deformity, and therefore, correcting the deformity is often advocated. However, other studies have been unable to identify subtle cavus deformity as a clear risk factor for recurrent injury. The purpose of this study was to 1) compare PROMIS physical function (PF), pain interference (PI), and depression scores in patients with subtle cavus deformities to those without deformity who underwent lateral ankle ligament reconstruction, 2) compare PROMIS scores in allograft and modified Brostrom-Gould (BG) reconstructions in those with subtle cavus, and 3) to evaluate for any post-operative complications in those with subtle cavus. Methods: PROMIS CAT scores were prospectively obtained from patients evaluated in a specialty foot and ankle clinic between February 2015 and December 2017. Using CPT codes, 145 patients who underwent lateral ankle ligament reconstruction were identified. Exclusion criteria consisted of less than three-month follow-up, incomplete PROMIS scores, or multiple surgeries unrelated to the reconstruction during the follow-up period. A total of 78 patients were included in the study. Pre- and post-operative PROMIS PF, PI, and depression were collected. Patients were then divided into two groups: subtle cavus foot (n=23) and non-cavus foot (n=55). A foot was considered cavus based on physical exam and previously published radiographic parameters. The cavus group was further subdivided into allograft reconstruction and BG reconstruction. Post-operative complications were also recorded. Student t-tests were used to evaluate for differences in PF, PI, and depression t-scores in cavus vs. non-cavus groups as well as allograft vs. BG. Results: The average follow-up was 28.59+/-13.27 weeks in the cavus and 29.77+/-16.15 weeks in the non-cavus group (p=0.76). There were no differences in pre-operative PF, PI, or depression t-scores between the two groups (p&gt;0.05). The cavus group had significantly better post-operative PF compared to the non-cavus group (49.24+/-8.14 vs. 43.17+/-6.64, p=0.001). PI was also better in the cavus group (51.12+/-8.33) compared to the non-cavus group (55.09+/-9.45), however not statistically significant (p=0.08). There were no differences in post-operative depression (p=0.58). When subdividing the cavus group, allograft reconstruction (49.49+/-7.48) had better post-operative PI t-scores compared to BG (57.17+/-8.16, p=0.04). In the cavus group, there were no instances of recurrent instability; one patient required a repeat ankle arthroscopy for debridement. One patient in the non-cavus group developed recurrent instability. Conclusion: Patients with subtle cavus deformity undergoing lateral ankle ligament reconstruction had significantly higher post-operative PROMIS PF t-scores compared to those without deformity and a trend towards improved pain post-operatively. When subdividing the subtle cavus group, allograft reconstruction demonstrated better PI scores post-operatively, and thus may be a more favorable technique in patients who have a subtle cavus deformity. Though longer follow-up is needed, our study suggests that patients with subtle cavus deformities may not require a more complex reconstruction with osteotomies to correct their deformity in order to achieve clinically meaningful improved outcomes.

Influence of Foot Position on the Measurement of First Metatarsal Pronation Using the First Metatarsal Axial Radiographs

Category: Other Introduction/Purpose: In hallux valgus (HV) surgery, the importance of correcting first metatarsal (1MT) pronation, as well as correcting adduction, has been increasingly recognized. A 1MT axial radiograph is a simple method to quantify 1MT pronation (see figure). However, this view does not provide the exact axial projection, and 1MT is angled on the image. Furthermore, the 1MT angle is dependent on the foot position and alignment. Therefore the measured pronation angle on the radiograph may not be the same as the “true” pronation along the 1MT long axis. The purposes of this study were to 1) quantify the difference between the measured 1MT pronation on the axial radiograph and the true pronation angle, and 2) determine the influence of foot position on the measurement. Methods: CT images of 10 feet from HV patients (HV group; age, 58 years; HV angle, 44°) and 10 feet from those without HV (non-HV group; age, 47years; HV angle, 12°) were obtained. Digitally reconstructed radiographs of the 1MT were generated from the CT images in a three-dimensional virtual space (see figure). 1MT was pronated along the long axis (true pronation angle). Then, images with different plantarflexion (25° to 35° in 5° increments) and adduction (-10° to 10°) angles were created. This procedure was repeated for different pronation angles (-10° to 30°), and 135 simulated 1MT axial radiographs were obtained from each bone. We measured the 1MT pronation angles in all images. Differences in the measured pronation angle and true pronation angle were calculated for each group. Correlations between the measurement difference and 1MT plantarflexion/adduction angles were assessed using the Spearman correlation coefficient. Results: The mean measurement differences were 0.7° and 1.0° for the HV group and non-HV group, respectively. The standard errors of the measurement were 0.5° and 0.6° for the HV group and non-HV group, respectively. There was no significant correlation between the measurement difference and plantarflexion angle (P = 0.92 and P = 0.92 for the HV group and non-HV group, respectively), nor between the measurement difference and adduction angle (P = 0.82 and P = 0.74). Conclusion: The measurement differences were low in both HV and non-HV feet, indicating that the 1MT pronation angle measured on the axial radiograph represented the true pronation angle along the long axis of 1MT. The measurement differences were consistent regardless of plantarflexion and adduction angles. Therefore, a variation of 1MT angle on the image, which can be caused by the misalignment of foot position while taking the radiograph and difference in foot alignment (such as flatfeet and cavus feet), did not affect the measurement. 1MT axial radiograph could be used as a valid and robust method to quantify 1MT pronation.

Custom 3D-printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot

Category: Hindfoot Introduction/Purpose: Third generation total talar prostheses (TTP) are viable options for talar avascular necrosis (AVN) in the absence of neighboring joint pathology. The use of modern three-dimensional (3D) printing allows for the production of custom implants that exactly mimic the patient’s anatomy. The aim of this study is to determine the accuracy of 3D printing in reproducing a synthetic talus, and in doing so, restoring more normal anatomic relationships. We hypothesize that this mode of replication will restore and maintain normal radiographic alignment of the ankle, subtalar, and forefoot joints in the setting of talar AVN. Methods: A retrospective analysis was performed on all patients undergoing TTP implantation for the treatment of talar AVN between 2016 and 2017. Pertinent demographic and operative factors were recorded. Radiographic measurements were taken pre- and post-operatively to determine native talar dimensions, TTP implant dimensions, and the corresponding radiographic alignment about the forefoot, hindfoot, and ankle. Results: Fourteen patients, treated for AVN between 2016-2017, were identified in our cohort. Talar arc length and width were not found to be significantly changed, however talar height was significantly increased with use of TTP. Five alignment dimensions were measured (tibiotalar alignment, talar tilt angle, Boehler’s angle, talar declination angle, and Meary’s Angle), of which, only talar tilt angle was significantly changed. Instances of Meary’s angle correction were observed in cavus and planus foot deformity. Conclusion: This study represents the largest case series of TTP performed in the United States, and is the first to investigate the 3D printed TTP. As a proof-of-concept, 3D printed TTP was successful in restoring talar height and talar tilt in the setting of AVN. Additionally, the procedure maintained normal alignment in non-pathologic joints. Total talar prosthesis, based on our cohort, is a viable option to restore more normal anatomic alignment.

Subtle cavus foot

Objective: To identify the prevalence of ankle and foot disorders in patients with subtle cavus foot (SCF). Methods: This was a retrospective case series. Patients with lower limb disorders who upon clinical examination were also diagnosed with SCF were evaluated. Patients diagnosed with disorders that could lead to this deformity, such as trauma sequelae and neurological disorders, and those with the presence of cavovarus foot with severe deformity were excluded. Correlations between ankle and foot disorders and the presence of SCF were evaluated. Results: A total of 119 patients (67 males/52 females) were evaluated, totalling 238 feet. One hundred forty-one feet had subtle cavus, and 97 feet had physiological alignment. Of the 141 SCF, 76 feet were right feet, and 65 were left feet. Twenty-two patients had bilateral SCF. One undred forty complaints were identified, which led to 18 diagnoses: ankle instability (37 cases/26.2%), peroneal tendon tendinopathy (31 cases/22.0%), plantar fasciitis (18 cases/12.8%), Achilles tendon tendinopathy (10 cases/7.1%), osteochondral talar lesion (7 cases/5.0%), mechanical metatarsalgia (6 cases/4.3%), hallux sesamoid disorders (5 cases/3.5%), Morton’s neuroma (5 cases/3.5%), hallux valgus (5 cases/3.5%), pain in the lateral side of the foot (4 cases/2.8%), anterior impact (3 cases/2.1%), pain in the medial side of the tibia (2 cases/1.4%), plantar plate injury (2 cases/1.4%) and other disorders with a prevalence &lt;1%. Conclusion: We found a clear correlation between SCF and acute and chronic ankle instability, peroneal and Achilles tendon tendinopathy and plantar fasciitis. &#x0D; Level of Evidence IV; Therapeutic Studies; Case Series.

Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot.

Third generation total talar prostheses (TTPs) are viable options for talar avascular necrosis (AVN) in the absence of neighboring joint pathology. The use of modern three-dimensional (3D) printing allows the production of custom implants that exactly mimic the patient's anatomy. The aim of this study is to determine the accuracy of 3D printing in reproducing a synthetic talus and, in doing so, restoring more normal anatomical relationships. We hypothesize that this mode of replication will restore and maintain normal radiographic alignment of the ankle, subtalar, and forefoot joints in the setting of talar AVN. A retrospective analysis was performed on all patients undergoing TTP implantation for the treatment of talar AVN between 2016 and 2017. Radiographic measurements were taken preoperatively and postoperatively to determine native talar dimensions, TTP implant dimensions, and the corresponding radiographic alignment about the forefoot, hindfoot, and ankle. A total of 14 patients were identified in our cohort. Talar arc length and width were not found to be significantly changed; however, talar height was significantly increased with use of TTP. Five alignment dimensions were measured, of which, only talar tilt angle was significantly changed. Instances of Meary's angle correction were observed in cavus and planus foot deformity. As a proof of concept, 3D-printed TTP was successful in restoring talar height and talar tilt in the setting of AVN. Additionally, the procedure maintained normal alignment in nonpathological joints. TTPs, based on our cohort, are a viable option to restore more normal anatomical alignment. Level IV: Case series.

Foot posture is associated with plantar pressure during gait: A comparison of normal, planus and cavus feet

BackgroundVariations in foot posture, such as pes planus (low medial longitudinal arch) or pes cavus (high medial longitudinal arch) are associated with some lower limb injuries. However, the mechanism that links foot posture to injury is not clear. Research question The aim of this study was to compare plantar pressure between healthy individuals with normal, planus or cavus feet. MethodsNinety-two healthy volunteers (aged 18 to 45) were classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on the Foot Posture Index, Arch Index and normalised navicular height truncated. Barefoot walking trials were conducted using an emed®-x400 plantar pressure system (Novel GmbH, Munich, Germany). An 11 region mask was used that included the medial heel, lateral heel, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsophalangeal joints, hallux, 2nd toe, and the 3rd, 4th and 5th toes. Peak pressure, pressure-time integral, maximum force, force-time integral and contact area were calculated for each region. One way analyses of variance and effect sizes were used to compare the three foot posture groups. ResultsOverall, the largest differences were between the planus and cavus foot groups in forefoot pressure and force. In particular, peak pressures at the 4th and 5th MTPJs in the planus foot group were lower compared to the normal and cavus foot groups, and displayed the largest effect sizes. Significance This study confirms that foot posture does influence plantar pressures, and that each foot posture classification displays unique plantar pressure characteristics.

Does arthroscopic resection of a too-long anterior process improve static disorders of the foot in children and adolescents?

A too-long anterior process of the calcaneus is a common cause of pain and hind-foot instability. Our goal was to evaluate the early results of arthroscopic resection in terms of static foot disorders in children and adolescents. We retrospectively studied 11ft (10 patients). The inclusion criteria were treatment of TLAP by arthroscopic resection and a minimum follow-up period of six months. Surgery was indicated in cases with persistent symptomatic TLAP resistant to orthopaedic treatment. The mean age at surgery was 11 (range, 7-15) years. The mean follow-up duration was 15 (range, 8-28) months. Pre-operatively, we diagnosed four flat feet, two cavus feet and five feet with normal footprints, but loss of physiological hind-foot valgus. All patients presented with subtalar joint stiffness. At the last follow-up, four feet with no hind-foot valgus were normal, two were unchanged and the other feet had improved. The mean AOFAS increased from 61.9 (range, 47-73) to 89.1 (range, 71-97; P = 0.009). The mean radiological angles were near normal, exhibiting significant improvements in the lateral talo-metatarsal and Djian-Annonier angles. Arthroscopic resection of a TLAP is safe. In the short term, the restoration of subtalar mobility reduces pain, and improves instability and static disorders. Longer follow-up of a larger patient series is required.

Centre of pressure characteristics in normal, planus and cavus feet

BackgroundThe aim of this study was to compare centre of pressure (COP) characteristics between healthy adults with normal, planus or cavus feet who were allocated to groups based on reliable foot posture measurement techniques.MethodsNinety-two healthy adult participants (aged 18 to 45) were recruited and classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on Foot Posture Index, Arch Index and normalised navicular height truncated measurements. Barefoot walking trials were conducted using an emed®-x 400 plantar pressure system (Novel GmbH, Munich, Germany). Average, maximum, minimum and range (difference between maximum and minimum) values were calculated for COP velocity and lateral-medial force index during loading response, midstance, terminal stance and pre-swing phases of stance. The COP excursion index was also calculated. One-way analyses of variance were used to compare the three foot posture groups.ResultsThe cavus foot exhibited the slowest average and minimum COP velocity during terminal stance, but this pattern was reversed during pre-swing, when the cavus foot exhibited the fastest maximum COP velocity. The planus foot exhibited the smallest lateral medial force index range during terminal stance. There were no differences between the groups for COP excursion index.ConclusionThese findings indicate that there are differences in COP characteristics between foot postures, which may represent different mechanisms for generating force to facilitate forward progression of the body during the propulsive phases of gait.

Long-term follow-up of patients undergoing tibialis posterior transfer: Is acquired pes planus a complication?

In this retrospective study, a series of 10 elective patients treated with transfer of the tibialis posterior (TP) tendon for pes cavus and drop foot are described. Since TP transfer completely subtracts the role of this tendon, this cohort of patients provides an opportunity to examine the consequences of tibialis posterior (TP) deficiency. After a mean follow up period of 44.7 months, only one patient showed evidence of strain in the spring ligament but none of the patients in this series developed clinical or radiological evidence of planovalgus deformity. The authors conclude that planovalgus deformity is not an inevitable sequelae of TP Tendon transfer and that established theory underestimates the role of static soft tissue restraints such as spring ligament in hindfoot stability.

The relationship between flat feet and cavus foot with body mass index in girl students

Background and Aims: The aim of this study was to investigate the relationship between flat feet and cavus foot with body mass index in girl students.&#x0D; Methods: The study population consisted of the Mazandaran University students that their number was 260 (130 girl college students and 130 girl students of non-physical education) formed. Sampling of participants over the two days. Height and weight of the subjects were measured, then they were placed on a mirror box and were taken the photographs of the Plantar foot. for picture Plantar foot was used of the mirror box (pedescope). data analyzed by Pearson and Spearman correlation coefficient.&#x0D; Results: The results of Pearson correlation coefficient test in physical education subjects showed there was no relationship the between BMI and flat feet (0.306). Also, the relationship between BMI and cavus foot was significant and direct (0.330). The results of Spearman correlation coefficient test in physical education subjects showed that the relationship between BMI and flat feet was significant (0.457). Also, there was no relationship between BMI and cavus foot (-0.026). The results in non-physical education subjects showed the relationship between BMI and flat feet was significant, but was in the opposite direction (-0.493). Also, the relationship between BMI and cavus foot was significant and direct (0.424). The results of Spearman correlation test showed that the relationship and flat feet was significant but was in the opposite direction (-0.648). Also, the relationship between BMI and cavus foot was significant (0.413). &#x0D; Conclusion: According to the results of this study, it seems to there was no relationship between flat feet and cavus foot with body mass index in girl students.

Distribuição da pressão plantar e morfologia do pé de crianças com paralisia cerebral e crianças com desenvolvimento típico

RESUMO A paralisia cerebral (PC) é caracterizada por desordens de movimento e postura, que causam limitações na execução de atividades facilmente desempenhadas por crianças com desenvolvimento típico (DT). Este estudo objetivou comparar a distribuição da pressão plantar e a morfologia do pé entre crianças com PC e DT, utilizando uma pesquisa analítica observacional transversal do tipo comparativa, com 32 crianças entre 6 e 11 anos, pareadas por sexo e idade e distribuídas em grupo estudo (GE) e grupo controle (GC). A distribuição plantar foi avaliada por meio do sistema de baropodometria eletrônica Footwork e o tipo de pé classificado pelo índice de Chippaux-Smirak. O GE obteve maior descarga de peso no sentido anterior e menor no sentido posterior (p=0,02), além de menores valores das pressões médias dos pés direito (p=0,00) e esquerdo (p=0,01) em relação ao GC. A maioria das crianças apresentou o mesmo tipo de pé bilateralmente, com prevalência de pés planos no GE e cavos no GC. Crianças com PC espástica, que apresentaram o desempenho locomotor preservado ou com alguma disfunção, revelaram antepulsão corporal, menores pressões plantares médias e prevalência do pé plano, em comparação às crianças com DT.

The role of the cavus foot in peroneal tendon pathology

The role of the cavus foot in peroneal tendon pathology