Foot In Children Research Articles

Motorcycle Wheel Spoke Injury to the Ankle and Foot in Children: A Cross-sectional Observational Study.

In developing countries, motorcycles are a widespread transportation method, leading to a notable increase in road traffic injuries, particularly those involving the ankle and foot caused by motorcycle wheel spokes. Our study sought to understand the epidemiological features and characteristics of motorcycle-induced wheel spoke injuries to the ankle and foot in children. The objectives were to comprehend injury patterns, evaluate their severity and pinpoint clinical indicators predicting injury nature and extent, aiming to guide prevention strategies. We conducted a cross-sectional observational study with a retrospective data collection focused on children under the age of 16 years who sustained injuries from motorcycle rear wheel spokes while riding as pillion passengers and were admitted to our department over 11 years, from 1 January 2010 to 31 December 2020, with a minimum follow-up of 2 years. Soft tissue wounds were classified using the Oestern-Tscherne classification. Thirty patients were enrolled in this study. Before 2015, cases ranged from none to one annually, increasing to 2-7 cases per year after 2015. The average age was 6.7 ± 2.1 years. Significantly, more patients were older than 6 years (P < 0.001), injured on the right side (P < 0.001) and suffered the injuries in the afternoon (P < 0.001). All patients were pillion and were injured by the motorcycle's rear wheel. Twenty-five patients (83%) had a Grade 3 injury. There was a tendon rupture in 22 (73%) and a bone fracture in 15 (50%) patients. Loss of soft tissue (P = 0.036) and reduced ankle mobility (P = 0.046) were linked to tendon ruptures. Lengths of wound exceeding 6 cm (P = 0.025) and loss of soft tissue (P = 0.025) were associated with a bone fracture. Children's motorcycle wheel spoke injuries have increased in recent years. Loss of soft tissue and ankle mobility deficit proved to be reliable clinical signs of a tendon rupture. A wound length exceeding 6 cm and a loss of soft tissue were indicative of a related bone fracture.

Navigating the integration of knowledge and research evidence in clinical practice for children's foot health: A multi-professional survey.

Access to clinical services for children with foot and ankle problems are important, but unravelling the complexity of practice and service delivery can be challenging. The pursuit and implementation of research evidence is critical for driving positive change in practice, but little is understood about the approaches to knowledge and research acquisition in children foot health. The aim of the study was to: (1) explore multi-professional habits of knowledge and research evidence acquisition in children's foot health; and (2) understand how clinicians integrate information for children and their families into their practice. This was a descriptive, cross-sectional online survey. Participants were included if they worked in the UK and had experience of working within paediatric services. There were complete responses from 247 health professionals, representing physiotherapists (n=160), podiatrists (n=50), orthotists (n=25), nurses and specialists in community public health nurses (health visitors) (n=12). Three main themes were generated from the data: (1) Factors that influence knowledge and inform clinical practice. (2) The role of Professional Bodies in informing professional knowledge. (3) Health Professionals' views on managing health information for parents and caregivers. This work advances understanding of the value health professionals' place in the development of materials for informing professional knowledge, as well as highlighting some of the challenges with translation of knowledge into clinical practice. The findings offer a national perspective of health professionals working on children's foot health and have highlighted that some of the most valued influences on clinical practice come from peer-to-peer networking.

Hand Castings of Children With Terminal Illnesses From Cancer Can Provide Comfort to Grieving Families.

Registered nurses have voluntarily created hand casts for families, providing comfort during challenging moments. Hand casting moves the patient's family and nurses. As requested by parents, staff apply a quick-drying gel to sick children's hands and feet. After preparing the gel mold, alginate molding powder is poured in and hardened for many days. Parents mourn their children with great sensitivity. Every mold and hospital bedside we go to offers closure to the lost child's dying moments. A compelling benefit of a three-dimensional hand-cast is preserving a passing moment.

The Relationship Between Fundamental Movement Skills, Body Composition, and Flat Feet in Children Aged 3-6 Years

Background and Aims Children have a very high ability to learn. With correct planning, we can provide conditions for them to perform various movement patterns to increase their motor skills and thus reduce the risk of skeletal injuries and obesity. This study aims to investigate the relationship between fundamental movement skills, body composition, and flat feet in children. Methods This is a descriptive-correlational study on 50 healthy children (girls and boys) aged 3-6 (mean age: 5.13±0.831 years) who were selected using a convenience sampling method from Novak Kindergarten in Tehran, Iran. To evaluate the fundamental movement skills, Ulrich (2015)’s test of gross motor development was used. The InBody 270 device was used to examine the body composition, and a digital photo scanner was used to evaluate the flat feet deformity. Data analysis was performed by using the Pearson correlation test and multiple regression analysis in SPSS software, version 24. P≤.0.05 was considered statistically significant. Results The results showed a negative and significant relationship of body weight (P=0.001), body mass index (P=0.001), body fat percentage (P=0.001), and flat feet (P=0.009) with fundamental movement skills. Also, the relationship between musculoskeletal mass and fundamental movement skills was positive and significant (P=0.001), but its relationship with flat feet was negative and significant (P=0.004). The body weight had the highest power to predict fundamental movement skills, and musculoskeletal mass had the highest power to predict flat feet (P=0.001) in preschool children. Conclusion It seems that, by improving fundamental movement skills and musculoskeletal mass index, the development of flat feet and overweight in preschool children can be prevented.

A cross-sectional study of medial longitudinal arch development in children with different BMI.

The influence of excess weight on the development of children's feet remains a subject of debate. To further elucidate whether this relation occurs, this study compared arch morphology and flexibility in three groups of children: underweight, normal, and overweight. In total, 1,532 children (807 boys, 725 girls; age range 7-11 years) participated in the study. The researchers measured the participants' height and weight, calculated their body mass index, and categorized their weight status as underweight, normal weight, or overweight. A three-dimensional foot model was taken using a three-dimensional plantar scanner under non-weight-bearing and weight-bearing conditions to obtain arch morphometric indices (arch index and arch volume) and arch flexibility index (arch volume index). Analysis of the data showed that the arch index was higher in overweight children compared to underweight and normal weight children (p < 0.05), but the differences in arch volume and arch volume index in overweight children compared to underweight and normal weight children were not statistically significant (p > 0.05). All children were divided into flatfoot, normal, and pes cavus groups according to arch index, and the arch volume index was statistically significant (p < 0.01). Overweight was not absolutely associated with arch structure and arch flexibility in children from a three-dimensional perspective. Arch development is a long-term process, and it is not clear whether being overweight has an effect on soft tissue or bone formation. Future studies will focus on the effects of long-term overweight on foot structure and arch flexibility in children.

Protocol Article: A Cross-Sectional Evaluation of Children's Feet and Lower Extremities.

The health of children's lower extremities and feet is a focus area for caregivers and healthcare professionals such as doctors, school nurses, and podiatrists. Our study aims to investigate the general health status of Danish children's lower extremities and feet to identify anthropometric parameters that might be preconditions for pain and evaluate for foot diseases and whether they are associated with pain intensity and location, three-dimensional foot dimensions and foot pressure mapping, shoe dimensions, types and intensity of sports activity, quality of life, and foot health. The aim is that we will be able to identify parameters pre-dispositioning for pain, thus providing recommendations for sports activities in relation to the anthropometric conditions of a child as a potential preventive measure for pain. This analysis will be stratified by socioeconomic status on a group level, and this perspective will be able to provide preventative recommendations to prevent pain. This study is a cross-sectional examination of a thousand children in the first, fifth, and ninth grades in randomized selected Danish primary schools. We will perform a clinical examination of the lower extremities and feet for misalignments, deformities, and diseases as well as rotational status and range of motion. Moreover, we will evaluate their pain levels, sports activities, three-dimensional foot dimensions, plantar pressure, footwear, and patient-related outcome measures (PROMs) for foot health and quality of life. We aim to provide an anthropometrical overview of the lower extremities and feet in children. The obtained basic understanding of healthy normal material in children will be analyzed for its relationships with pain level, sports activities, and socioeconomic status on a group level. This could potentially provide us with an understanding of the factors that impact lower extremity and foot diseases in children. In conclusion, examining children's lower extremities and feet in Danish primary schools is a step toward identifying areas of improvement in self-care and shoe fitting, mapping podiatry-related needs of care in children's feet, and providing parental recommendations for preventive actions on shoe fitting and the choice and intensity of sports activity concerning pain. The tenet of this study is a long-term follow-up to evaluate the long-term socioeconomic course on a group level, foot status, and sports activity, using patient-related outcome measures evaluating quality of life and other lifestyle factors such as emotional functioning, social functioning and interaction, and school functioning. Potentially, this will improve children's quality of life and prevent future diseases.

A Biomechanical Investigation of Children with Type 1 Diabetes Mellitus: Are Children's Feet a Precursor to Adulthood Foot Complications?

There is limited evidence on the biomechanical effects of type 1 diabetes mellitus (T1DM) on children's feet. This study aimed to determine whether children living with T1DM aged 10 to 16 years have altered foot structure and gait parameters compared with same-aged children without medical conditions. A nonexperimental, case-control study was conducted. Thirty-four healthy children and children living with T1DM were recruited. Participants underwent a clinical biomechanical examination followed by instrumented gait analysis using the Oxford Foot Model to investigate foot segment motion. Children with T1DM demonstrated more dermatologic lesions and structural foot abnormalities, including claw toes (33.3%), hammertoes (22.2%), and hallux abducto valgus (11.1%), than their healthy counterparts. Gait analysis results indicate a significant difference between the two groups at the hindfoot-to-tibia angle at heel strike and toe-off, suggesting limited ankle joint motion. Children with T1DM demonstrated a higher frequency of structural foot pathologies than did healthy children possibly associated with limited ankle sagittal plane movement. Screening is warranted to identify and manage these conditions early to reduce their risk of more significant foot problems associated with DM in adulthood.

Ultrasound and Clinical Alterations in the Foot of Children with Obesity and Diabetes.

Alterations in plantar soft tissues are often reported in adults with diabetes, whereas data on children are conflicting. Also, the extent of foot damage caused by excess body fat in children has not been fully characterized yet. This study aimed to address the relationship between body mass and structural changes of the foot in children and adolescents with and without diabetes. In a case-control study, 43 participants (age 13 ± 2.6 years) were recruited, 29 (67%) with type 1 diabetes (T1D) and 14 (33%) controls. Anthropometric parameters [body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR)], foot posture index-6 (FPI-6) for static foot posture, and navicular drop test (NDT) for medial longitudinal arch height (MLA) were measured in all participants. The thickness of the midfoot plantar fascia (MPF) and medial midfoot fat pad (MMFP) were quantified using ultrasound. No differences in clinical and ultrasonographical parameters were observed between the study groups. MMFP thickness was correlated with MPF thickness (p = 0.027). MMFP and MPF thicknesses were positively associated with BMI (p < 0.001 and p = 0.013, respectively), WC (p < 0.001 and p = 0.013), and WHtR (p < 0.001 and p = 0.026). The NDT measured on the right and left foot correlated with WHtR (p = 0.038 and p = 0.009, respectively), but not with WC and BMI. Children with T1D show structural alterations of plantar soft tissues which seem related to body mass increase rather than diabetes pathology. Ultrasound is a valuable tool to assess early structural changes of the foot in young people with an elevated BMI.

Biomechanics of transverse axis of medial longitudinal arch of children's foot based on 3D scanning.

To explore the application value of 3D scanning to obtain the parameters of transverse axis of medial longitudinal arch of foot in the biomechanical evaluation of transverse axis of medial longitudinal arch of foot in children. The feet of children with flat foot, normal foot and high arched foot were scanned with the Foot Secret 3D scanner in the sitting and standing positions. The scanning data were imported into CATIA v5 software for measurement, to obtain four parameters of transverse axis of medial longitudinal arch from transverse arch angle, external transverse arch angle, curvature and transverse arch cross-sectional area. There were statistically significant difference in transverse arch angle, external transverse arch angle and cross-sectional area between sitting and standing positions (p < 0.05). There were statistically significant differences in transverse arch angle, external transverse arch angle, curvature and transverse arch cross-sectional area among children with flat foot, normal foot and high arch foot (p < 0.05). The four parameters of transverse arch angle, external transverse arch angle, maximum curvature and cross-sectional area obtained by three-dimensional scanning can detect the changes of transverse axis of children's foot arch in different body positions with different foot types, which can be effectively used for the biomechanical evaluation of transverse axis of children's foot arch.

Investigation of the changes in reflective properties of reflective tapes due to various effects

Mankind's need to protect itself from various dangers, cold, heat and other natural phenomena have survived from the first days of its existence to the present day. Materials with high visibility have also been developed primarily with the need for protection. These materials are widely used on bicycle wheels, road signs and traffic signs in daily life. Materials used in various textile products such as activewear, sportswear, children's clothing, accessories, hats, uniforms, foot and armbands, and backpacks make life easier by providing safety for the people who walk with their pets, as well as road workers, traffic policemen, firefighters, pedestrians and bicycle riders people who do sports and walking at night due to their busy life. Many of the traffic accidents occurring today are due to the inability to notice individuals moving on the side of the road. In conditions where the lighting is not sufficient, the reflective feature of the clothes worn will allow people to be noticed more easily. Reflective tapes are used to add reflective properties to clothes. However, these tapes may lose their reflective properties as a result of the various effects they are exposed to. A performance loss that may occur in reflective tape properties due to these effects will put the wearer's life at risk. For this reason, in this study, the changes in the reflective properties of retroreflective tapes after various effects were investigated.

Comparison of 2 Conservative Treatment Approaches for the Flat Foot in Children Aged 5 to 10: Foot Orthoses Versus Foot Orthoses Supplemented With Zukunft-Huber Manual Therapy.

The aim was to find if foot orthotics alone can improve flat feet in children and analyze how the addition of Zukunft-Huber manual therapy and corrective bandaging changes the outcome. Forty-nine children aged 5 to 10 with asymptomatic flexible flat feet were divided into 2 groups. The first was treated with foot orthoses alone, in the second wearing foot orthoses was supplemented with Zukunft-Huber manual therapy and corrective bandaging. Pedobarography during gait was performed before the therapy and after a year. In the first group decrease in arch index, width, force, and area of midfoot, increase in force MH2 and area hindfoot was found, in the second decrease in arch index, width, force, and area of midfoot, increase in force under metatarsal head second, third, fourth, and fifth, area metatarsal head fourth and area hindfoot. Both methods showed positive changes, but foot orthoses with additional intervention were more effective.

성장기 아동을 위한 러닝화 디자인 개발연구

As the increase of number of childrens under China’s three-child policy, the demand for children’s running shoes is also expected to rise. In consideration of the physiological function, developmental characteristics, and biomechanical characteristics during children’s development, the running shoes are designed to protect their feet and accelerate their development. Subject to the biomechanical characteristics and preference of design, children’s running shoes have to be designed systematically. Considering the features of children’s feet, all-around researches and analysises were conducted to develop shoes that protect children’s feet. To protect the feet and the long-term development of children from pes valgus and flatfoot, the development of running shoe with protection was proposed. As the development direction, the outsole design should be in form with anti-slippery and force dispersion features while the midsole was air cushion structure to relieve the possible pressure from body weight and generated during movements. Secondly, it was a shape that support the ankle joint of the shoe upper.&#x0D; As a method of the experiment, two types of running shoes of the related comparative experimental group were selected, performance analysis, and subjective preference analysis were conducted. In the preference analysis, prototype running shoes were more aesthetic than the other two types of running shoes, and in terms of stability, the range of joint activity was better than that of the comparative group, and in terms of force absorption, prototype running shoes were higher than that of the comparative control group. Combining the research and developing running shoes for the protection of growing children's feet through biomechanical experiments can help to protect their feet more effectively, convincing consumers through persuasive marketing approach, and establishing a helpful design process for developing running shoe.

The effect of epiphysiodesis on the longitudinal bone growth of hands or feet in children with macrodactyly based on long-term quantitative analysis.

Treatment protocols for macrodactyly have not been elucidated due to its rarity and variety of clinical manifestations. This study aims to share our long-term clinical results of epiphysiodesis in children with macrodactyly. A retrospective chart review was performed for 17 patients with isolated macrodactyly treated with epiphysiodesis over 20 years. Length and width of each phalanx in both the affected finger and the corresponding unaffected finger in the contralateral hand were measured. Results were presented in ratios of the affected to unaffected side for each phalanx. Measuring of length and width of phalanx was performed preoperatively and postoperatively at 6, 12, and 24 months, and the last follow-up session. Postoperative satisfaction scoring was done with visual analogue scale. The mean follow-up period was 7 years and 2 months. In the proximal phalanx, length ratio significantly decreased compared with preoperative state at after more than 24 months, in the middle phalanx after 6 months, in the distal phalanx after 12 months. When classified by the growth patterns, the progressive type showed significant decrease in length ratio at after 6 months, and the static type after 12 months. Patients were overall satisfied with the results. Epiphysiodesis effectively regulated longitudinal growth with different degree of control for different phalanges in the long-term follow-up.

Scales Feature Foot Scanners as Parameters of Flat Feet in Children

The primary function of the legs is to provide the necessary support and encouragement for human bipedal movements. Flat feet or also known as pes planus, is a problem that is often encountered in daily pediatric practice for most children. This study aims to classify the shape of the soles of the feet in children aged 6-9 years to be divided into three parts, namely high arch, normal arch and flat arch. Clarke's angel is defined as the angle obtained by a tangent that joins the medial edge of the first metatarsal head and the heel, on the second line connects the metatarsal caput one with the centre of the longitudinal arch of the medial side. Of the 30 children, 66.67% (20 students) had a flatfoot foot shape and 33.33% (10 students) had a normal foot sole shape and none of the students had a cavus arch foot sole shape. The mode in children with normal legs is Enough with a percentage of 60% and in children with flatfoot is bad with a percentage of 75%. This proves the relationship between flatfoot and static balance in children. From the research we conducted, it can be concluded that the featured scales we made can capture the image of a child's feet to identify flat feet and the relationship between flat feet and the static balance of a child. From the research that has been carried out, we compare existing data using three methods. The primary method we use is Matlab software with comparison data using wet footprints and stork stand tests, which shows excellent accuracy and can be a reference for measuring the soles of the feet in the future.

Management Of Spastic Equinovarus Foot in Children with Cerebral Palsy: An Evaluation of Anatomical Landmarks for Selective Nerve Blocks of the Tibial Nerve Motor Branches

To define the anatomical landmarks of tibial motor nerve branches for selective motor nerve blocks of the gastrocnemii, soleus and tibialis posterior muscles in the management of spastic equinovarus foot. Observational study. Twenty-four children with cerebral palsy with spastic equinovarus foot. Considering the affected leg length, motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles were tracked using ultrasonography, and located in the space (vertical, horizontal, deep) according to the position of fibular head (proximal/distal) and a virtual line from the middle of popliteal fossa to the Achilles tendon insertion (medial/lateral). Location of motor branches was defined as percentage of the affected leg length. Mean coordinates were: for the gastrocnemius medialis 2.5 ± 1.2% vertical (proximal), 1.0 ± 0.7% horizontal (medial), 1.5 ± 0.4% deep; for the gastrocnemius lateralis 2.3 ± 1.4% vertical (proximal), 1.1 ± 0.9% horizontal (lateral), 1.6 ± 0.4% deep; for the soleus 2.1 ± 0.9% vertical (distal), 0.9 ± 0.7% horizontal (lateral), 2.2 ± 0.6% deep; for the tibialis posterior 2.6 ± 1.2% vertical (distal), 1.3 ± 1.1% horizontal (lateral), 3.0 ± 0.7% deep. These findings may help the identification of tibial motor nerve branches to perform selective nerve blocks in patients with cerebral palsy with spastic equinovarus foot.

Arch-related alteration in foot loading patterns affected by the increasing extent of body mass index in children: A follow-up study

BackgroundA high load on children 's feet can cause arch deformation and negatively affect their normal development. Studies have yet to document how the foot arch varied with different body mass index (BMI) increments and its influence on foot loading patterns. MethodsBarefoot walking trails were conducted using a Footscan® plate system. A follow-up check was performed after twenty-four months. Participants were selected with an initial BMI between 14.5 kg/m2 and 16.5 kg/m2. Totally 75 participants were classified into groups 0–7 according to the BMI increment levels of 0–0.49 kg/m2, 0.50–1.49 kg/m2, 1.50–2.49 kg/m2, 2.50–3.49 kg/m2, 3.50–4.49 kg/m2, 4.50–5.49 kg/m2, 5.50–6.49 kg/m2, 6.50–7.49 kg/m2, respectively. Paired t-tests and effect sizes were used to compare the data. ResultsThe arch index significantly decreased when the BMI reached 20.8 kg/m2. Significantly increased normalized maximum forces were found in the great toe and 1st MTPJ in groups 4–5. Meanwhile, the absence of significance showed under the 3rd-5th, midfoot, and rearfoot in those groups. The normalized maximum force increments under the 3rd-5th MTPJs, midfoot and rearfoot regions in groups 4–5 after the follow-up study were significantly decreased compared with the increments found in groups 0–3, followed by a sudden increase arising under those regions in group 6. It indicates a transition period that leads to alteration in gait pattern characteristics when BMI increases to 18.6–19.9 kg/m2 (between group 3 and group 4). Group 6 displayed significantly increased peak pressure amplitudes under the great toe, 1st-3rd MTPJs, midfoot, and medial rearfoot compared to other groups. SignificanceThere was a transition period when the BMI of normal-weighted children increased to a certain extent and failed to reach the obesity level, resulting in changes in foot arch structure and loading patterns.

Mosca's Technique in Surgical Treatment of Symptomatic Flexible Flat Foot in Children and Adolescents

Mosca's Technique in Surgical Treatment of Symptomatic Flexible Flat Foot in Children and Adolescents

РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ КОМБИНИРОВАННОГО СПОСОБА ПРИ ЛЕЧЕНИИ ДЕТЕЙ С ПЛОСКО-ВАЛЬГУСНОЙ ДЕФОРМАЦИЕЙ В СТАЦИОНАРНЫХ УСЛОВИЯХ

Abstract. Patients (n = 66) were divided into 2 groups. In the main group, tendon-muscle plasty was performed in the form of transposition and tenodesis of the tendon of the anterior tibial muscle in the cleft of the navicular bone, and in the control, a combination of this type of tendon-muscle plasty and subtalar arthroeresis. In the period from 2016-2021, the ortho-paediatric department of Clinic of the Samara State Medical University carried out a comprehensive treatment of 66 children with plano-valgus deformity of the feet, which included surgical correction, immobilization of the limb in the postoperative period and rehabilitation treatment for all periods of postoperative observation. Our results indicate the need for an integrated approach in the treatment of flat-valgus deformity of the feet, which includes the formation of an anatomically correct installation of all elements that make up the child's foot and ankle joint, correction of biomechanics and the development of the correct walking skill in the postoperative period.

Long-term Outcomes of Talonavicular Arthrodesis for the Treatment of Planovalgus Foot in Children With Cerebral Palsy.

Planovalgus foot (PVF) in cerebral palsy (CP) tends toward progression and rigidity in adolescence, especially in patients with greater functional impairment. Deformity at the talonavicular joint justifies the use of talonavicular arthrodesis as a corrective surgical technique. This study aims to assess patient or caregiver functional satisfaction and radiographic outcomes of talonavicular arthrodesis for PVF in CP patients with assisted ambulation in the long-term. Retrospective comparative study of level III and level IV pediatric CP patients who underwent talonavicular arthrodesis for PVF between 1999 and 2010 as part of multilevel surgery and with a minimum follow-up of 10 years. Radiologic correction at 10 years was compared with preintervention values, and functional impact at 10 years was measured by the foot function index (FFI); correlation between radiologic measurements and FFI were obtained, and complications were recorded. Forty-nine PVFs in 25 patients with CP (72% level III and 28% level IV) were included; 52% were male. The patients had a median age of 12 years at the time of surgery (range: 11 to 15) and 23 years at the time of the study (21 to 26). Significant (P<0.01) pre-post radiologic improvements were obtained in Meary angle (37.86±10.7/8.37±5.5 degrees), calcaneal pitch (3.20±8.1/13.22±5.6 degrees), lateral talocalcaneus angle (42.18±12.1/25.29±2.9 degrees), Moreau-Costa-Bartani angle (167.04±8/146.12±7.1 degrees), talus-first metatarsal angle (27.92±13.9/9.69±4.4 degrees), anteroposterior talocalcaneal angle (37.61±7.4/22.61±2.4 degrees), and talus coverage angle (37.04±11.11/2.45±2.5 degrees). At 10 years postoperatively, functional outcome measured with the FFI was satisfactory (33.9±15.2%) and the mean maximum pain was 3.04; 56% of cases had mild pain. All patients were able to wear an ankle-foot orthosis and 8 no longer needed the device. A significant correlation was found between the talofirst metatarsal angle and the FFI (P=0.024). There were 8% of cases with screw protrusion and 14% presented pseudarthrosis, most of them asymptomatic. The adequate functional outcome, as well as the persistence of long-term radiologic correction and acceptable number of complications, enables us to recommend talonavicular arthrodesis as an alternative treatment to consider in level III and level IV CP patients with PVF. Level III-retrospective comparative study.

Assessing Span Between Feet of Squatting-Type Toilet for Childhood Based on Antropometric Data in Pos PAUD Aqila Kids Desa Rimbo Panjang

The use of toilets in Indonesia mostly uses the squat toilet type. The squat toilet is a type of toilet that is comfortable and stable in its use. The type of squat toilet in Indonesia, especially in Riau, has the most widely used toilet for adults, this is very difficult for young children in a smaller time span than adults so that children are not comfortable and stable when using a squat toilet. The service method was carried out at the Aqila Kids PAUD Post in Rimbo Panjang Village, and was attended by 15 students along with parental assistance. The result of this socialization is that it can increase knowledge about the distance between children's feet by measuring the distance between the legs when children squat, education on the importance of using squat toilets from an early age and knowledge in using squatting toilet training. The empowerment of teachers and parents in monitoring the use of squatting toilet training is expected to be realized properly by presenting several examples of squatting properly and correctly so as to create a comfortable and safe atmosphere.