Flexible Pes Research Articles

Subtalar arthroereisis for simultaneous treatment of flexible pes planus during surgical correction of hallux valgus

BackgroundScarf osteotomy is a well-established procedure for hallux valgus, yet recurrence rates range from 3.6% to 10%. Pes planus, which often coexisting with hallux valgus, is a risk factor for recurrence. This study aimed to evaluate the effectiveness of simultaneous correction of hallux valgus and flexible pes planus.MethodsA total of 85 feet with hallux valgus associated with adult flexible pes planus were retrospectively reviewed. All patients were treated with scarf osteotomy (SO). Subtalar arthroereisis using a HyProCure implant (SOH) was performed to correct hindfoot valgus based on shared decision-making. We collected and compared pre- and at least 2 year postoperative clinical outcomes (American Orthopaedic Foot & Ankle Society (AOFAS) forefoot, hindfoot score, Visual Analog Scale (VAS) pain intensity) and radiographic outcomes (hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary’s angle, talonavicular coverage angle (TNCA), and calcaneal pitch (CP) angle in both groups.ResultsOf the cases reviewed, 51 feet were allocated to SO group, and 34 feet were in SOH group. Recurrence frequency was 5 feet (9.8%) in the SO group, while no recurrences were reported in the SOH group. There was no significant difference in AOFAS forefoot and VAS scores between the groups, However, the SOH group demonstrated significant improvement in AOFAS hindfoot scores and CP angle, as well as a greater reduction in Meary’s angle and TNCA, compared to the SO group. Changes in HVA and IMA did not differ significantly between the groups. Three feet in the SOH group experienced sinus tarsi pain, which resolved after removal of the HyProCure implant.ConclusionsSubtalar arthroereisis with a HyProCure implant is an effective treatment option for adult flexible pes planus associated with scarf osteotomy for hallux valgus, leading to a steady improvement in the patients forefoot deformity and increased patient satisfaction at least 2 years postoperatively.

A Conv‐GEMM reconfigurable accelerator with WS‐RS dataflow for high throughput processing

AbstractConvolution and matrix operations are both important computations in Deep Neural Networks (DNNs). However, the significant differences between convolution and matrix computation patterns have posed a challenge in efficiently supporting both convolution (Conv) and general matrix multiplication (GEMM) on hardware design. This paper proposes a Conv‐GEMM reconfigurable accelerator architecture for high throughput edge processing. A weight stationary‐row streaming (WS‐RS) dataflow scheme is proposed, which maximizes data reuse through hierarchical memory structures and flexible PE connections, and supports high throughput edge‐based deep learning algorithms. Based on the proposed dataflow, multi‐scale memory access network (MMAN), reconfigurable accumulator array (RAA), and configurable instruction set architecture (ISA) are designed to optimize computation throughput and energy efficiency. The accelerator is designed under 65 nm technology, achieves peak performance of 1.15 TOPS at 250 MHz, with an energy efficiency of 1.14 TOPS/W. The GEMM computation achieves 85.7% latency improvement and the Mobilenet‐V1 processing achieves a throughput of 529 fps under a 256 × 224 image size and an 87.15% (top‐5) accuracy on the ImageNet dataset.

Immediate Impacts of Two Foot Orthotic Designs on Foot Posture Index, Gait, and Comfort in Adults With Asymptomatic, Flexible Pes Planus

ABSTRACT Introduction Flexible flatfeet are commonly treated with functional foot orthoses (FFOs) and University of California Berkeley Laboratory (UCBL) designs. This study sought to evaluate the immediate effects of low-profile FFOs and high-profile UCBL orthoses on Foot Posture Index (FPI), spatiotemportal measures of gait, and perceived comfort and compliance in adults with flexible flatfeet. Materials and Methods Fourteen individuals with self-reported asymptomatic flexible flatfeet participated in this randomized cross-sectional study. Custom FFOs and UCBL orthoses were fabricated for each participant, who then walked at a self-selected speed in each condition on a Zeno Mat. Foot Posture Index, perceived comfort and compliance, and spatiotemporal parameters were collected across conditions. Results There were no significant differences in velocity, cadence, step length, stride width, toe-in/toe-out, or stance center of pressure distance percentage. Stance phase duration significantly increased from baseline to UCBL condition. There was a statistically significant decrease bilaterally in FPI from baseline to FFO and from baseline to UCBL orthosis, but not between FFO and UCBL orthosis. There were no significant differences in comfort and compliance ratings between FFOs and UCBL orthoses. Conclusions With regard to immediate effects, both the UCBL and FFO designs improve foot posture without significant impact on spatiotemporal gait patterns or perceived comfort and compliance. Additional research is needed to determine the longevity of these effects. Clinical Relevance The results of this study support the use of both FFOs and UCBL orthoses when trying to provide foot posture correction for adults with asymptomatic flexible flatfeet.

The Effect of Customized and Silicon Insoles on Mid- and Hindfoot in Adult Flexible Pes Planovalgus.

BackgroundFlexible flat foot or pes planovalgus is a common foot deformity, and silicone and customized insole are commonly used as a non-operative treatment modality of flexible planovalgus. However, there are inadequate data and limited evidence available regarding the immediate effects of their use in midfoot and hindfoot of adults. The aim of this study is to quantify and compare the radiological parameters immediately on weightbearing with silicon and customized insoles and without them to assess the effect on midfoot and hindfoot of the flexible planovalgus in adults.MethodsA total number of 11 (8 females and 3 males) subjects with flexible pes planovalgus deformity without any other foot deformity were included in the study. Each patient was assessed three times in a random sequence without and with use of either silicon insoles or customized insole. The radiographic parameters without insole, with silicon insole, and with customized insole conditions were calculated using online available computer software Kinovea.ResultsOne-way ANOVA analysis was performed between groups (without insole, with silicone insole and with customized insole). The hindfoot parameters depicted that calcaneal inclination angle (CIA) was significant increased (P = 0.000) and talar declination angle (TDA) was significantly decreased (P = 0.003) only with the use of customized insole compared to without insole. The midfoot parameters depicted that the first metatarsal angle (FMA) and talonavicular coverage angle (TCA) were significantly lower with customized insole (P = 0.00) as compared to other two groups and significantly lower with silicone insole (P = 0.00) as compared to without insole group.ConclusionThe results imply that the compressibility of the insole material affects the forefoot and hindfoot biomechanics differently. This study concludes that silicone insole affects only the midfoot which bears 45% of bodyweight and customized insole affects both midfoot and more importantly the hindfoot which bears 55% of bodyweight.

Effect of Peroneus Longus Muscle Release on Abductor Hallucis Muscle Activity and Medial Longitudinal Arch before Toe-Tap Exercise in Participants with Flexible Pes Planus.

Pes planus is a medical condition of the foot wherein there is a flattening or lowering of the medial longitudinal arch. The abductor hallucis muscle starts at the heel bone and attaches to the medial side of the first toe. Whenever it contracts, it plays a key role in elevating the medial longitudinal arch. Hence, the abductor hallucis muscle should be strong enough to control the depression on the medial longitudinal arch. The peroneus longus muscle plantarflexes the ankle and everts the ankle and subtalar joint. If this muscle contracts more than the abductor hallucis muscle does, the medial longitudinal arch of the foot is depressed. This study aimed to investigate the effect of myofascial release of the peroneus longus before performing the toe-tap exercise for strengthening the abductor hallucis muscle in participants with flexible pes planus. This cross-over study included 16 volunteers with flexible pes planus. The participants performed a toe-tap exercise before and after the myofascial release of the peroneus longus. During the toe-tap exercise, the muscle activity of the abductor hallucis and peroneus longus were measured using a Delsys Trigno Wireless Electromyography System. The angle of the medial longitudinal arch was measured using Image J software. Photos in the sagittal plane were used. The peroneus longus activity and medial longitudinal arch angles were significantly decreased. On the other hand, the activity of the abductor hallucis significantly increased after the myofascial release of the peroneus longus before performing the toe-tap exercise (p < 0.05). Individuals with flexible pes planus should be encouraged to perform myofascial release of the peroneus longus before the toe-tap exercise to improve the abductor hallucis activity and to elevate the medial longitudinal arch.

Comparison between Malerba osteotomy and combined Evans/medial displacement calcaneal osteotomies for the management of flexible pes planus in young adults: a prospective randomised control trial, three years follow-up.

The aim of the current study is to evaluate the functional and radiological outcomes of Malerba osteotomy in comparison to the standardized combined Evans/Medial Displacement Calcaneal Osteotomy (MDCO) in the management of symptomatic flexible pes planus in young adults. Prospective randomized control trial included 34 feet (33 patients), 17 cases in each group. Functionally, patients were assessed by AOFAS and FADI scores. Radiographic evaluation included calcaneal pitch, lateral talo-1st metatarsal, AP talo-first metatarsal, AP talo-calcaneal angles, and the talar coverage percentage. Pre-operative and threeyears follow-up scores and angles were compared between both groups. No statistically significant difference could be detected between both groups (P value 0.87). However, the data showed statistically significant difference in each group when comparing (pre-operative and third year follow-up scores and angles) (P value < 0.001). The mean union rate was eightweeks in Malerba group and nineweeks in Evans/MDCO group. No incidence of nonunion. Complications like calcaneocuboid subluxation, calcaneal anterior process fracture, and lateral column pain were exclusively reported in Evans/MDCO group. Malerba osteotomy is a strong valid option for the operative management of flexible pes planus in young adults. Authors recommend Malerba osteotomy in all mild and moderate deformities due to lower complication rate while the combined Evans/MDCO is preferred in severe deformity due to relatively higher corrective power with consideration of possible complications.

The relationship between knee-ankle muscle strength and performance tests in young female adults with flexible pes planus

BackgroundA decrease in muscular activation of the knee and ankle is one of the primary reasons for pes planus. The muscle strength of the knee and ankle in patients with pes planus may affect the performance tests which consists of daily life activities. The aim of the study was to determine the relationship between knee and ankle muscle strength with performance tests in young female adults with flexible pes planus. In addition, we also aimed to observe whether the severity of pes planus affects the ankle muscle strength and performance test scores. We carried out a cross-sectional single-center study. The muscle strength measurement of knee flexion-extension, ankle dorsal-plantar flexion, and ankle inversion-eversion movements were evaluated with the manual muscle test (MMT) device. The timed up and go test (TUG), 5-repeat sit-and-stand test (5STS), and 10-m walk test (10MWT) were used to evaluate knee and ankle performance.ResultsA significant difference was found only for the five-repetitive sit-and-stand test among the classified groups considering the pes planus grade (p < 0.05). There was no significant difference between groups for other parameters (p > 0.05). In correlation analysis, there was only a relationship between the timed up and go test (TUG) with left foot dorsal flexor muscle strength and between 10-m walk test (10MWT) with right foot invertor muscle strength (r1 = − 0.288, r2 = − 0.288, p < 0.05).ConclusionsThe results of this study reveal that the duration of 5STS was significantly lower in the second degree pes planus group. TUG test score showed low negative correlation with left foot dorsal flexor muscle strength. In addition, the scores of 10MWT exhibited poor negative correlation with right foot invertor muscle strength. Regarding other parameters, no significant correlations were found.

Activated potassium ions as CO2 carriers for PEBAX-5513/KBF4 composite membranes

This study showed that potassium tetrafluoroborate (KBF4) could be used as a carrier to facilitate the transport of CO2. A polymer electrolyte membrane was prepared by incorporating KBF4 into poly (ether-block-amide) (PEBAX-5513) with a flexible PE group. The prepared PEBAX-5513/KBF4 electrolyte membrane exhibited CO2 separation performance that was improved by nine times compared to pure PEBAX-5513 and by about seven times compared to a PVP/KF electrolyte membrane. The membrane exhibited a selectivity of 27.9. This improved separation performance increased the transport of CO2 owing to the reversible interaction of the dissociated potassium ions with CO2 molecules. The dissociation of potassium ions upon thermal treatment of the material was confirmed by Fourier transform Raman spectroscopy, and the selective layer in which the separation mechanism was generated was confirmed by scanning electron microscopy.

The results of treatment of flexible pes planovalgus in children with cerebral palsy

The results of treatment of flexible pes planovalgus in children with cerebral palsy

TL 18193 - Efficacy of triple surgery for the treatment of pes cavus in Charcot-Marie-Tooth disease

Introduction: Pes cavus is a deformity characterized by a high longitudinal medial arch. It is classically associated with neurological conditions, among which Charcot-Marie-Tooth (CMT) disease is the most common. Treatment options depend on the flexibility of the deformity. Various procedures are available to correct flexible pes cavus; these procedures can be performed in combination, and there is no standardized technique. There is limited information in the literature on the long-term outcome of treatment, and thus far, there is no consensus on the ideal surgery. The objective of the present study was to assess the efficacy of triple surgery (TS) (plantar fasciotomy, valgising calcaneal osteotomy and first metatarsal extension osteotomy) in the long-term treatment of pes cavus of patients with CMT. Methods: Between 2000 and 2015, 15 patients with CMT and pes cavus who underwent TS were treated at our department, including a total of 18 feet from 8 women and 7 men. The mean age of the patients at the time of the surgery was 21 years (9 to 60 years), and the mean follow-up time was 11 years (4 to 19 years). Of the 18 feet that underwent TS, 14 required an additional procedure. To analyze the outcomes of TS, criteria were stipulated and divided into 3 categories: pain (A), deformity (B) and function (C). The following criteria were analyzed: category A: AOFAS pain subscale, pain visual analog scale; category B: clinical and radiographic pes cavus, clinical and radiographic hindfoot varus; category C: gait, flexibility and AOFAS-function subscale. Each analyzed subitem was scored (total score: 10 points) to determine whether correction was achieved and maintained until the final assessment according to different objective criteria. The outcome was considered good when the score was 8 points or more, fair when the score ranged from 5 to 7 points, and poor when it was 4 points or less. Results: When pre-established criteria were objectively applied, 10 feet had a good outcome, 5 feet had a fair outcome, and 3 feet had a poor outcome; thus, a total of 15 feet (83%) had a satisfactory long-term outcome. Conclusion: Triple surgery was effective for treating patients with CMT, providing good deformity correction of pes cavus in addition to long-term clinical and functional improvement.&#x0D;

Thermal performance and phase transformation of S-alkylated poly(vinyl chloride) comb-like polymers

A series of S-alkylated poly(vinyl chloride) (PVCS(n)) comb-like polymers, where the S atom acted as the chemical junction between PVC backbone and alkyl side chain, were prepared through the nucleophilic substitution reaction between PVC and n-alkyl mercaptan. Structure and properties of PVCS(n) are analyzed by 1H nuclear magnetic resonance (1H NMR), Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), thermogravimetric analysis and X-ray scattering. An ordered crystal structure for PVCS(n) comb-like polymers appears with the increased side-chain length, which is originated from the regular packed side-chain crystallites. The increased carbon atoms per side chain from n = 12 to 18 also brings an improved thermal property. Obviously regular packed orthorhombic (βO) phase easily appears at room temperature, indicating the flexible PE backbone can allow much more CH2 groups entering an ordered phase structure. Phase transformation from βO to hexagonal phase is demonstrated by the temperature-dependent FTIR and WAXS. The chain packing manner for the pended side alkyl chains onto PVC backbone shows a dependence upon side-chain length, and the chemical junction also presents a certain influence on the phase transformation of side-chain crystallites. The variations for the phase behavior, chain packing and thermal property of PVCS(n) are detailed analyzed and characterized from the aspect of side-chain crystallization.

The effectiveness of non-surgical intervention (Foot Orthoses) for paediatric flexible pes planus: A systematic review: Update

BackgroundFlexible pes planus (flat feet) in children is a common presenting condition in clinical practice due to concerns amongst parents and caregivers. While Foot Orthoses (FOs) are a popular intervention, their effectiveness remains unclear. Thus, the aim of this systematic review was to update the current evidence base for the effectiveness of FOs for paediatric flexible pes planus.MethodsA systematic search of electronic databases (Cochrane, Medline, AMED, EMBASE, CINHAL, SportDiscus, Scopus and PEDro) was conducted from January 2011 to July 2017. Studies of children (0–18 years) diagnosed with flexible pes planus and intervention to be any type of Foot Orthoses (FOs) were included. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. McMaster critical review form for quantitative studies, was used to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis of the included studies was undertaken.ResultsOut of 606 articles identified, 11 studies (three RCTs; two case-controls; five case-series and one single case study) met the inclusion criteria. A diverse range of pre-fabricated and customised FOs were utilised and effectiveness measured through a plethora of outcomes. Summarised findings from the heterogeneous evidence base indicated that FOs may have a positive impact across a range of outcomes including pain, foot posture, gait, function and structural and kinetic measures. Despite these consistent positive outcomes reported in several studies, the current evidence base lacks clarity and uniformity in terms of diagnostic criteria, interventions delivered and outcomes measured for paediatric flexible pes planus.ConclusionThere continues to remain uncertainty on the effectiveness of FOs for paediatric flexible pes planus. Despite a number of methodological limitations, FOs show potential as a treatment method for children with flexible pes planus.PROSPERO registration numberCRD42017057310.

Evaluation of anatomical structures after calcaneal Evans- or Hintermann osteotomy

Category:HindfootIntroduction/Purpose:Both Evans- and Hintermann-osteotomies are commonly used for the treatment of flexible pes planovalgus deformity. The aim of this study was to examine, which anatomical structures are affected by the performed osteotomy.Methods:Two experienced foot and ankle surgeons performed an Evans- or Hintermann-osteotomy on each of 7 cadaver feet (Science Care, Arizona, USA). There were no defects on the preparations. All cadaver feet were prepared in the same way following predetermined preparation guidelines. All individual anatomical structures were prepared and, in particular, peroneal tendons, nervus suralis as well as articular surfaces evaluated.Results:The mean age of the donors was 80.8 years. Eight left and six right feet were prepared. After Hintermann osteotomy there was no damage of the peroneus longus tendon, after evans-osteotomy in one case (14.3%). The peroneus brevis tendon was once totally damaged after Hintermann osteotomy and once partially damaged after eva...

The Effects of the Foot Types and Structures of the Inner Arch Support Bands on Ground Reaction Force Variables and Sensations during 2nd Vertical Ballet Jump

Objective: The purpose of this research was to establish the differences of ground reaction force variables and sensations according to the foot types and the structures of the inner arch support band during 2nd vertical ballet jump. Method: 12 Female ballet majors in their twenties who have danced for more than 10 years and had no injuries were selected for this research. Independent variables consist of the foot type (pes rectus, pes planus) and the structure of the inner arch support band (no band, x-shaped, linear shaped). Dependent variables consist of ground reaction force variables and relative wearing sensation. Results: The impact decreased the most when x-shaped bands were used on pes rectus and rigid pes planus. When linear-shaped bands were used on flexible pes planus, the impact decreased. Conclusion: The bands also helped reduce the impact on pes rectus. Furthermore, it is clear that according to the foot type, the impact reducing band structures perform differently. The inner arch support bands were necessary for jump training for any foot type.

The Effects of Foot Intrinsic Muscle and Tibialis Posterior Strengthening Exercise on Plantar Pressure and Dynamic Balance in Adults Flexible Pes Planus

The Effects of Foot Intrinsic Muscle and Tibialis Posterior Strengthening Exercise on Plantar Pressure and Dynamic Balance in Adults Flexible Pes Planus

The effects of talus control foot orthosis in children with flexible pes planus

Fourty children were participated in this study who had been diagnosed as flexible pes planus, and had more than two consecutive radiologic studies. The anteroposterior talocalcaneal angles (APTCA) and lateral talocalcaneal angles (LTTCA), the lateral talometatarsal angles (LTTMA) and the calcaneal pitch (CP) of both feet were measured to evaluate foot alignment. Severe flexible pes planus was diagnosed when Beighton hypermobility score was greater than 4 points and when either of the feet had greater than 10 degrees valgus of resting calcaneal stance position angle and indicators showed greater than 55 degrees in APTCA and LTTCA, greater than 10 degrees in LTTMA, lesser than 10 degrees of CP. Twenty children with flexible flat foot were fitted with a pair of RFO and another 20 children were fitted with TCFO. They were recommended to put on orthosis more than 8 hrs a day, to walk with heel strike at initial contact and reciprocal arm swing to normalize gait pattern. The follow up clinical evaluation with radiologic study was done after 12 months. Result With TCFO, all radiologic indicators changed toward corrective direction than with RFO. There were statistically significant improvements in CP and RCSP in both groups. (p < 0.05) In TCFO group, APTCA, RCSP improved significantly compared with RFO group. Conclusion This study showed that TCFO is effective in the treatment of children with severe flexible pes planus than RFO. The evaluation with long term follow up of radiographic study would be necessary to confirm the therapeutic effect of TCFO in children with pes planus.

Talus verticalis

Congenital vertical talus is a rare condition which presents as an isolated deformity or in association with neuromuscular and/or genetic disorders. Pathoanatomically the deformity shows a dislocated talonavicular and subtalar joint. The etiology and pathogenesis are still not finally determined although in some cases a genetic basis has been identified. The clinical picture is that of a flat, convex longitudinal arch with abduction and dorsiflexion of the forefoot and an elevated heel. Clinical diagnosis is confirmed by plain radiographic imaging. Congenital vertical talus should not be confused with other deformities of the foot, such as congenital oblique talus, flexible flat feet or pes calcaneus. The object of treatment of congenital vertical talus is to restore a normal anatomical relationship between the talus, navicular and calcaneus to obtain a pain-free foot. Major reconstructive surgery has been reported to be effective but is associated with substantial complications. Good early results of a modified non-operative treatment using serial manipulation, cast treatment and minimally invasive surgery may change therapeutic concepts.

Central Calcaneal Osteotomy for Correction of Flexible Pes Planovalgus Deformity

Lateral column lengthening procedures have been extensively reported either as primary procedures or adjuncts to combined soft tissue procedures and osteotomies for the correction of the pes planovalgus deformity. There is also considerable debate as to the ideal procedure that is not followed by recurrence and obviates the need for revision surgeries and minimizes complications. We describe a technique and present the clinical results of lateral column lengthening that provides a powerful correction to restore normal foot alignment. We retrospectively reviewed 26 feet in 21 patients with a mean age of 35.4 years (range, 12-75) over an average follow-up period of 71 months (range, 12-147) who underwent reconstructive surgery for flexible pes planovalgus foot. The reconstructive procedures included a central calcaneal osteotomy in all patients, a medial column stabilization procedure, flexor digitorium transfer (FDL), and a gastrocnemius or Achilles tendon lengthening. Clinical evaluation was carried out with the AOFAS ankle-hindfoot scores. Standard weight-bearing anterior posterior (AP) and lateral radiographs before surgery and at follow-up were analyzed for radiographic parameters of correction. The median AOFAS score increased from 50 to 90. Two patients reported dissatisfaction with the result. There were no nonunions nor complications related to hardware. Radiographic improvement of the talonavicular coverage angle was a 74% change from baseline value. All radiographic parameters improved (P < .001) except the lateral talocalcaneal angle (P = .48). No secondary subsidence of the arch was observed within the follow-up time. Correction of flexible pes planovalgus deformity with a central calcaneal osteotomy was an effective, reproducible method to restore normal foot alignment and good function. Level IV, retrospective case series.

A Delphi consensus: prescribing functional foot orthoses for the symptomatic pes planus adult

Background Symptomatic (flexible) pes planus is a difficult entity to classify with no universally accepted aetiology. Foot orthoses are a commonly used intervention for pes planus, however, evidence to support their use is limited. Currently there are no clinical guidelines for the prescription of foot orthoses for pes planus. The aim of this study was to seek expert consensus and agreement on prescription paradigms for foot orthoses in the adult symptomatic pes planus population.

Systematic review on the use of foot orthosis in symptomatic pes planus

Background Physiologic (flexible) pes planus (flatfoot) is a descriptive term for feet that have a visually lowered medial longitudinal arch often in association with rearfoot eversion [1]. Reported to affect approximately 15% of the adult population [2] physiologic pes planus can be categorised as either symptomatic (painful, non-functional) or nonsymptomatic (non-painful, functional) with the literature purporting that flexible non-symptomatic pes planus is a predominantly benign condition with no justification for intervention [3]. When pes planus is symptomatic however, functional foot orthoses are often prescribed and are the most commonly quoted intervention within the literature[4]. Despite some controversy for their use in pes planus, functional foot orthoses remain the cornerstone of podiatric management of this common disorder. The aim of this review is to evaluate the evidence for the use of foot orthoses in adults with symptomatic pes planus.