Flexible Deformity Research Articles

Necessity of posterior osteotomies for mild flexible cervical deformity correction.

Correction of mild flexible cervical deformity (CD) via the posterior approach has been described with and without the use of posterior osteotomies (POs), despite a lack of clarity regarding their necessity or risks. The purpose of this study was to determine whether the use of POs when correcting mild flexible CD leads to improved clinical or radiographic outcomes, as well as defining the relative risks in utilizing them. A prospective multicenter registry of operative CD patients was analyzed. Inclusion criteria were cervical kyphosis > 10°, cervical scoliosis > 10°, cervical sagittal vertical axis (cSVA) > 4 cm, or chin-brow vertical angle > 25°. Mild deformity was defined by a cSVA of 3-5 cm and/or kyphosis < 15°. Flexibility was defined by a C2-7 angular change > 5° on preoperative flexion/extension radiographs. Patients who received a posterior column osteotomy (PCO) (Ames grades 1 and 2) were compared with patients who did not undergo a PCO (noPCO) as well as those who underwent a three-column osteotomy (3CO) (Ames grades 3-6). Ninety-five patients (33 PCO, 49 noPCO, 13 3CO) met the inclusion criteria. Both the number of levels fused (9.2 vs 7.7, p = 0.001) and the estimated blood loss (EBL) (1027 vs 486 mL, p = 0.012) were higher in the PCO cohort. Patients in the noPCO group were more likely to have a cervical apex of kyphosis (71.1%, p = 0.046), while those undergoing 3COs were more likely to have a thoracic apex (58.3%, p = 0.005). Preoperative cSVA (PCO vs noPCO: 45.4 vs 37.9 cm, p = 0.084), T1 slope (32.5° vs 29.6°, p = 0.376), C2-7 lordosis (-8.9° vs -9.2°, p = 0.942), and modified Japanese Orthopaedic Association (mJOA) score (13.4 vs 13.5, p = 0.854) were similar; however, both Neck Disability Index (NDI) (55.6 vs 42, p = 0.002) and numeric rating scale (NRS) neck (7.2 vs 5.8, p = 0.028) scores were higher in the PCO group before surgery. When adjusting for the use of an anterior approach, there was no significant difference in 1-year postoperative cSVA (35.7 and 35.6 cm, respectively; p = 0.969), C2-7 lordosis (13.7° and 10.1°, respectively; p = 0.393), and patient-reported outcome measures (NRS, NDI, and mJOA) between the PCO and noPCO groups. Two-year radiographic outcomes were largely similar, except for C2 slope, which was higher in the PCO group (29.1° vs 18°, p = 0.026). The overall complication rates progressively increased with more complex osteotomy use (noPCO 68.8% vs PCO 71.9% vs 3CO 75%) but did not reach significance (p = 0.063). The use of POs for mild flexible adult CD may not be necessary to achieve desirable radiographic correction. They are associated with greater EBL and fusion burden. Further studies are needed to fully delineate the risks of adverse events for various types of osteotomies.

Hindfoot Alignment in Flexible Cavovarus Deformity Under Orthostatic and Coleman Block Test Positions: A Weightbearing Computed Tomography Study.

Flexible cavovarus deformity is prevalent and the Coleman block test is frequently used to assess the first ray plantarflexion malpositioning in the overall deformity as well as the flexibility of the hindfoot. The objective was to assess and compare the weightbearing computed tomography (WBCT) 3-dimensional (3D) changes in clinical and bone alignment in flexible cavovarus deformity patients when performing the Coleman block test when compared to normal standing position and to controls. Twenty patients (40 feet) with flexible cavovarus deformity and 20 volunteer controls (40 feet) with normal foot alignment underwent WBCT imaging of the foot and ankle. Cavovarus patients were assessed in normal orthostatic and Coleman block test positions. Foot and ankle offset (FAO), hindfoot alignment angle (HAA), talocalcaneal angle (TCA), subtalar vertical angle (SVA) and talonavicular coverage angle (TNCA) and a CT-simulated soft tissue envelope image, WBCT clinical hindfoot alignment angle (WBCT-CHAA), were evaluated by 2 readers. Measurements were compared between cavovarus nonstressed and stressed positions and to controls. P values of .05 or less were considered significant. The intra- and interobserver intraclass correlation coefficient were good or excellent for all WBCT measurements. Cavovarus patients demonstrated significant correction of WBCT-CHAA (9.7 ± 0.4 degrees), FAO (2.6 ± 0.4%), and TNCA (8.8 ± 1.8 degrees) when performing the Coleman block test (all P values <.0001). However, WBCT-CHAA and FAO measurements were still residually deformed and significantly different from controls (P values of .001 and <.0001, respectively). TNCA values corrected to values similar to healthy controls (P = .29). No differences were observed in cavovarus patients during Coleman block test for the coronal measures: HAA, TCA, and SVA measurements. In this study, we observed improvement in the overall 3D WBCT alignment (FAO), axial plane adduction deformity (TNCA), as well as CT simulated clinical hindfoot alignment (WBCT-CHAA) in flexible cavovarus deformity patients when performing a Coleman block test. However, we did not find improvement in measures of coronal alignment of the hindfoot, indicating continued varus positioning of the hindfoot in these patients.

Surgical treatment of mobile planovalgus deformation of feet using calcaneal osteotomy based on preoperative computer modeling in adolescent: a retrospective cohort study

Background: Evans calcaneal osteotomy is one of the recognized surgical techniques for the treatment of flat-valgus foot deformity in children over 12 years of age, which allows simultaneous multiplanar correction. Preoperative planning of the formed diastasis parameters to reduce the number of cases of hypo- and hypercorrection remains an urgent issue. AIM: To evaluate the results of Evans calcaneal osteotomy using the developed method of preoperative planning and fixation with the individual H-shaped reconstructive plate. MATERIALS AND METHODS: This study included 64 children aged 12–17 years with symptomatic planovalgus deformity, who were divided into two groups: in the main group, preoperative planning was used according to the developed method; in the control group for intraoperative control of correction was used only fluoroscopy and visual assessment. To study the effectiveness of the developed method, we used dynamic assessment of radiometric parameters and AOFAS questionnaire results before and after surgery. We also took into account the changes in the Foot Posture Index 6 and the Chippaux-Smirak and Stasheli podometric indices. RESULTS: In comparison with the control group, the main group showed a reduction in the swelling period after surgery, as well as the timing of the onset of full limb support, and a significant decrease in the incomplete correction. Similar dynamics was observed when studying the groups according to the Foot Posture Index 6 scale and podometric indices. CONCLUSION: The use of the developed method of preoperative planning during the Evans operation has shown its effectiveness for the treatment of flexible flatfoot deformity of the feet in adolescence.

Flatfoot Surgery for Flexible Progressive Collapsing Foot Deformity With Inflammatory Joint Diseases: A Report of 3 Cases.

Three cases of inflammatory joint diseases (systemic lupus erythematosus and ongoing juvenile idiopathic arthritis) with painful flexible progressive collapsing foot deformity (PCFD) underwent flatfoot surgery. All cases maintained sufficient radiological correction and achieved good clinical condition at final follow-up. Although the prospect for recurrence of the deformity is not clear, even in inflammatory joint diseases, flat foot surgery such as flexor digitorum longs transfer, spring ligament reconstruction, and lateral column lengthening could have a possibility to be indicated against PCFD, as long as disease activity could be well suppressed by drug therapy, subsequently subtalar and talonavicular joints could be preserved.

Outcomes and Complications Associated with Lateral Column Lengthening Using Porous Titanium Wedges for Flexible Flatfoot Deformity Correction: A Systematic Review

Outcomes and Complications Associated with Lateral Column Lengthening Using Porous Titanium Wedges for Flexible Flatfoot Deformity Correction: A Systematic Review

Innovation of Adjustable Ankle Joint Orthoses for Patients with Flexible Equinus Deformity

The limited dorsiflexion at the ankle joint is characterized by Equinus deformity. It has a large impact on mobility and functionality at all ages. Usually, Achilles tendon stretching and Ankle Foot Orthosis (AFOs) are used as a treatment but have low efficiency and flexibility. Frequently adjustment to AFOs required through dynamic foot positioning makes this treatment very expensive due to repeated molding. An experimental research design was used to measure plantar flexion angles with a goniometer at many follow-ups. This research showed that a decreased plantar flexion angle, this study indicated the effectiveness of locally made adjustable ankle joints. Developing an adjustable ankle joint addresses both the practical and economic challenges of traditional orthotic treatments. This innovation not only provides clinical outcomes but also expands the opportunity to care for patients with equinus deformity. This adjustable joint gives a flexible and cost-effective solution and improves the management of equinus deformity.

FOREFOOT MORPHOTYPES IN CAVOVARUS FEET: A NOVEL CLASSIFICATION

BackgroundThe cavovarus foot is a complex 3-dimensional deformity. Although a multitude of techniques are described for its surgical management, few of these are evidence based or guided by classification systems. Surgical management involves realignment of the hindfoot and soft tissue balancing, followed by forefoot balancing. Our aim was to classify the pattern of residual forefoot deformities once the hindfoot is corrected, to guide forefoot correction.MethodsWe included 20 cavovarus feet from adult patients with Charcot-Marie-Tooth who underwent weightbearing CT (mean age 43.4 years, 14 males). Patients included had flexible deformities, with no previous surgery. Previous work established majority of rotational deformity in cavovarus feet occurs at the talonavicular joint, which is often reduced during surgery. Using specialised software (Bonelogic 2.1, Disior) a 3-dimensional, virtual model was created. Using data from normal feet as a guide, the talonavicular joint of the cavovarus feet was digitally reduced to a ‘normal’ position. Models of the corrected position were exported and geometrically analysed using Blender 3.6 to identify anatomical trends.ResultsWe identified 3 types of cavovarus forefoot morphotypes. Type 1 was seen in 13 cases (65%) and was defined as a foot where only the first metatarsal was relatively plantarflexed to the rest of the foot, with no significant residual adduction after talonavicular correction. Type 2 was seen in 4 cases (20%) and was defined as a foot where the second and first metatarsals were progressively plantarflexed, with no significant adduction. Type 3 was seen in 3 cases (15%) and was defined as a foot where the metatarsals were still adducted after talonavicular de-rotation.ConclusionWe classify 3 forefoot morphotypes in cavovarus feet. It is important to recognise and anticipate the residual forefoot deformities after hindfoot correction as different treatment strategies may be required for different morphotypes to achieve balanced correction.

Treating symptomatic flexible flatfoot deformities. a novel technique: comparison of uc berkeley laboratory foot orthosis with and without kinesio taping in juvenil athletes

PurposeSymptomatic flexible pes planus (SFPP) can cause pain and discomfort when walking or engaging in sportive activities in children and adolescents. SFPP can be treated conservatively with foot orthoses, such as the University of California Berkeley Laboratory (UCBL) foot orthosis, which can improve foot function and reduce pain. Kinesio Tape (KT) has also been used as an adjunct to foot orthoses in the treatment of pes planus. This study aims to compare the effectiveness of the UCBL foot orthosis with and without KT in the treatment of SFPP among amateur juvenile and adolescent athletes.MethodsFifty patients with SFPP were included in the study. In 27 patients UCBL foot orthosis with KT (group 1) was used whereas in 23 UCBL (group 2) was preferred only. The patients were evaluated with AOFAS and radiological measurements.ResultsThe mean follow-up period was 28.6 ± 4.3(26) months. At the final follow-up AOFAS of group 1 was significantly higher than group 2. In group 2, 12 patients (%52,17) had pressure sores that caused superficial dermabrasion. Lateral TFMAs and talocalcaneal angle in group 1 was significantly better than group 2.ConclusionsThis study attempted to determine if using KT with the UCBL foot orthosis was beneficial to the treatment of SFPP compared to simply wearing the orthosis. Our results suggest that KT is effective in reducing pronation and improving the AOFAS score. The use of UCBL with KT seems to be preferable in children and adolescents with SFPP since it is associated with a lower rate of complication, a higher degree of patient compliance and faster improvement in the radiological and clinical findings, compared to the use of the UCBL orthosis alone.

Effect of Body Mass Index on Pedobarographic and Patient-Reported Outcome Measures in Adolescent Flexible Flat Feet.

Although adolescent flexible flatfoot deformity (FFD) is common, little is known regarding the effect of weight on associated symptomatology. This study uses pedobarography and patient-reported outcome measures (PROs) to determine if overweight adolescents with FFD have more severe alterations in dynamic plantar pressures than normal body mass index percentiles (wnBMI) with FFD and if such alterations correlate with pain and activity. A retrospective review of patients aged 10 to 18 years with nonsyndromic symptomatic FFD was performed. Overweight (BMI percentile ≥ 85%) patients were compared with wnBMI patients with regard to dynamic plantar pressure measures and PRO scores. Pedobarographic data were subdivided into regions: medial/lateral hindfoot and midfoot, and first, second, and third to fifth metatarsals. Plantar pressure variables were normalized to account for differences in foot size, body weight, and walking speed. Contact area (CA%), maximum force by body weight (MF%), and contact time as a percentage of the rollover process (CT%) were calculated. Two foot-specific PROs were assessed, including the Foot and Ankle Outcome Score and the Oxford Ankle Foot Measure for Children. Of the 48 adolescents studied, 27 (56%) were overweight and 21 (44%) were wnBMI. After normalization of the data, overweight patients had significantly greater medial midfoot MF%, whereas CT% was increased across the medial and lateral midfoot and hindfoot regions. Correlations showed positive trends: as BMI percentile increases, so will CA and MF in the medial midfoot, as well as CT in the medial and lateral midfoot and hindfoot. Significant differences were seen between groups, with the overweight group reporting lower sports and recreation subscores than the wnBMI group. No significant differences were seen in the pain and disability subscores. Although overweight adolescents with FFD exhibit greater forces and more time spent during the rollover process in the medial midfoot than normal-weight patients, they did not report worse pain or disability associated with their flat foot deformity. Therapeutic level 3.

Forefoot Morphotypes in Cavovarus Feet: A Novel Assessment of Deformity.

The cavovarus foot is a complex 3-dimensional deformity. Although a multitude of techniques are described for its surgical management, few of these are evidence based or guided by classification systems. Surgical management involves realignment of the hindfoot and soft tissue balancing, followed by forefoot balancing. Our aim was to analyze the pattern of residual forefoot deformities once the hindfoot is corrected, to guide forefoot correction. We included 20 cavovarus feet from 16 adult patients with Charcot-Marie-Tooth who underwent weightbearing CT (mean age 43.4 years, range: 22-78 years, 14 males). Patients included had flexible deformities, with no previous surgery. Using specialized software (Bonelogic 2.1, Disior) a 3-dimensional, virtual model was created. Using morphologic data captured from normal feet in patients without pathology as a guide, the talonavicular joint of the cavovarus foot was digitally reduced to a "normal" position to simulate the correction that would be achieved during surgical correction. Models of the corrected position were exported and geometrically analyzed using Blender 3.64 to identify anatomical trends. We identified 4 types of cavovarus forefoot morphotypes. Type 0 was defined as a balanced forefoot (2 cases, 10%). Type 1 was defined as a forefoot where the first metatarsal was relatively plantarflexed to the rest of the foot, with no significant residual adduction after talonavicular joint correction (12 cases, 60%). Type 2 was defined as a forefoot where the second and first metatarsals were progressively plantarflexed, with no significant adduction (4 cases, 20%). Type 3 was defined as a forefoot where the metatarsals were adducted after talonavicular derotation (2 cases, 10%). In this relatively small cohort, we identified 4 forefoot morphotypes in cavovarus feet that might help surgeons to recognize and anticipate the residual forefoot deformities after hindfoot correction. Different treatment strategies may be required for different morphotypes to achieve balanced correction. Level IV, retrospective case series.

Efficacy of hinged and carbon fiber ankle-foot orthoses in children with unilateral spastic cerebral palsy and drop-foot gait pattern.

In children with unilateral spastic cerebral palsy (USCP), ankle-foot orthoses (AFOs) are widely used to correct common gait deviations such as a drop-foot pattern. Most studies on this topic have investigated specific time points while omitting other parts of the gait cycle. This study investigated the separate effects of prefabricated carbon fiber AFOs and custom-made hinged AFOs compared with barefoot walking in children with USCP with a drop-foot gait pattern using statistical parametric mapping. Retrospective, cross-sectional, repeated measures study. Twenty ambulatory children (9.9 ± 2.5 years) with USCP and a drop-foot gait pattern were included. Kinematics, kinetics, and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking. Statistical parametric mapping was used to compare joint angles and moment waveforms. Kinematics, kinetics and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking for each AFO type but not between the 2 AFO types. Compared with barefoot walking, there was a steeper sole angle at initial contact, corresponding to a heel strike pattern, and an increased ankle dorsiflexion in swing with the use of both AFOs. The ankle plantar flexion moment during loading response increased. Ankle power generation during pre-swing decreased in the carbon fiber AFO group when walking with AFOs. Both AFOs were beneficial for improving a drop-foot gait pattern in these small patient groups and can, therefore, be recommended to treat this gait deviation in patients with unilateral cerebral palsy. However, the reduction in ankle power generation during push-off and additional goals targeted by AFOs, such as correction of structural or flexible foot deformities, should be considered for prescription.

Congruency of the TN Joint and Subtalar Joint Middle Facet Under With and Without Weightbearing: A Preliminary Report

Introduction/Purpose: Peritalar subluxation is a key feature of both flatfoot and cavovarus deformities. Our preliminary studies have found that on WBCT there is 20% subluxation of the middle facet of the subtalar joint in normal controls, and &gt;35% in patients with flexible flatfoot deformities; In the spherical talonavicular joint there is physiological uncovering of the talar head regardless of whether the joint is bearing weight or not, since the articular area of the talar head is 1.2 times of the navicular. We hypothesize that there may be a tendency to overestimate the pathological peritalar subluxation on both XR and WBCT. This study aimed to investigate the congruency of each peritalar joint using a weightbearing 3D CT scan remodeling technique. Methods: Five below-knee-amputated fresh frozen cadaveric feet were used (no history of surgery, trauma, arthritis, and deformities). Each specimen was CT scanned using both non-weightbearing and weightbearing protocols. Segmentation on Materialise Mimics software was used to remodel each peritalar bone three dimensionally. Congruency of the restored talonavicular joint and subtalar middle facet was evaluated in the GeoMagic. The total articular surface area for each bone was reconstructed, calculated and recorded. The articulation of each joint with or without weightbearing was restored for analyzing joint uncoverage. Paired t-test (P value ≤0.05) was used to compare the coverage % differences. Results: In the anterior and middle facets of the subtalar joint, There was 16.40% uncoverage of the calcaneus under non- weightbearing, and 30.68% of uncoverage under weightbearing; 17.94% uncoverage of the talus under non-weightbearing, and 24.89% of uncoverage under weightbearing. In the posterior facet of the subtalar joint, the total articular surface on the talus side (683.96±112.07 mm2) was 1.13 times larger than the calcaneus side (606.78±107.23 mm2). In the talonavicular joint, the total articular surface on the talus side (714.18±124.97 mm2) was 1.28 times larger than the navicular side (556.76±97.65 mm2). Conclusion: Our preliminary study in this group of normal cadaver feet has found that in both the talonavicular and middle facet of the subtalar joints, there is physiological uncovering or subluxation regardless of whether the joint is bearing weight or not. Further investigation with a larger sample size is in process.

Classification of the Os Calcis Subtalar Morphology in Symptomatic Flexible Pediatric Pes Planus Deformity Using Weightbearing CT and Distance Mapping

Introduction/Purpose: The etiology of symptomatic pediatric pes planus (PP) deformity is unclear. Reduced os calcis subtalar joint (OCST) anterior facet morphology has been suggested to result in less support to the talar head and a higher propensity to develop PP deformity. Weightbearing computed tomography (WBCT) and distance mapping (DM) offer new opportunities to investigate PP deformity in general and the OCST specifically. The purpose of this study is to investigate the OCST morphology using DM and to classify PP subtalar subtypes with DM using Bruckner's A-D classification system. Methods: Forty feet in 25 patients in a national referral center were evaluated for symptomatic PP deformity that failed nonoperative treatment. A WBCT scan was performed as part of the preoperative evaluation. Visualization of the distance distribution between the articulating surfaces of the subtalar joint was based on a DM technique. Intra- and interobserver agreement of the subtalar morphology was assessed using Bruckner’s classification system. Results: The mean age was 10.7 ± 1.4 years. The following mean ± SD and median ± ranges were semiautomatically measured for this group: Meary angle −21 ± 8, calcaneal inclination 15 ± 4 degrees, talar coverage angle 39 (range 32.6-49) degrees, and hindfoot moment-arm 16 ± 5 mm. Classifying subtalar morphology using DM yielded an excellent intra- and interobserver agreement. The individual percentages of each individual subtype were calculated: type A 5%, type B 48%, type C 4%, and type D in 44%. Conclusion: This study demonstrated excellent intraobserver and interobserver agreement in classifying the OCST using DM. A higher prevalence of types B and D was observed compared to types A and C in this PP cohort Distance mapping representation of 4 types of os calcis according to Buckner’s Classification System. (A) Type A, demonstrated in the axial view (right foot). (B) Type B, demonstrated in the axial view (right foot). (C) Type C, demonstrated in the axial view (right foot). (D) Type D, demonstrated in the axial view (left foot)

Peroneus Brevis to Longus Tendon Transfer in the Treatment of Flexible Progressive Collapsing Foot Deformity: A Cadaveric Study.

Although operative treatment of the flexible progressive collapsing foot deformity (PCFD) remains controversial, correction of residual forefoot varus and stabilization of the medial column are important components of reconstruction. A peroneus brevis (PB) to peroneus longus (PL) tendon transfer has been proposed to address these deformities. The aim of our study was to determine the effect of an isolated PB-to-PL transfer on medial column kinematics and plantar pressures in a simulated PCFD (sPCFD) cadaveric model. The stance phase of level walking was simulated in 10 midtibia cadaveric specimens using a validated 6-degree of freedom robot. Bone motions and plantar pressure were collected in 3 conditions: intact, sPCFD, and after PB-to-PL transfer. The PB-to-PL transfer was performed by transecting the PB and advancing the proximal stump 1 cm into the PL. Outcome measures included the change in joint rotation of the talonavicular, first naviculocuneiform, and first tarsometatarsal joints between conditions. Plantar pressure outcome measures included the maximum force, peak pressure under the first metatarsal, and the lateral-to-medial forefoot average pressure ratio. Compared to the sPCFD condition, the PB-to-PL transfer resulted in significant increases in talonavicular plantarflexion and adduction of 68% and 72%, respectively, during simulated late stance phase. Talonavicular eversion also decreased in simulated late stance by 53%. Relative to the sPCFD condition, the PB-to-PL transfer also resulted in a 17% increase (P = .045) in maximum force and a 45-kPa increase (P = .038) in peak pressure under the first metatarsal, along with a medial shift in forefoot pressure. The results from this cadaver-based simulation suggest that the addition of a PB-to-PL transfer as part of the surgical management of the flexible PCFD may aid in correction of deformity and increase the plantarflexion force under the first metatarsal. This study provides biomechanical evidence to support the addition of a PB-to-PL tendon transfer in the surgical treatment of flexible PCFD.

Equino-plano-valgus foot in cerebral palsy – clinical principles and surgical techniques review (world perspective). Report from the 5th edition of the Transatlantic Orthopedic Surgery Webinar 2023

Introduction. The fifth edition of the Transatlantic Orthopedic Surgery Webinar 2023 occurred on December 4, 2023. The webinar’s main topic was treating equino-plano-valgus foot in children with cerebral palsy (CP). The event included speakers from Austria, Australia, China, India, Canada, Germany, Poland, Sweden, Turkey, the USA and the UK. Results. The first general session presented epidemiology, biomechanics, muscle function, equinoplano- valgus foot prevention options, and the Silverskiöld test in clinical assessment. It also discussed the principles of deformation treatment, options for orthotic treatment, and pathology treatment in adults suffering from CP. The surgical sessions presented comprehensive surgical techniques for the treatment of clubfoot equinus: sliding calcaneal osteotomy, lateral column lengthening with talonavicular arthrodesis, use of an expandable cage for the lateral column lengthening, double arthrodesis with the transfer of the peroneal muscles, percutaneous soft tissue release with/without arthroereisis, lateral column lengthening with arthroereisis, Grice procedure with talonavicular arthrodesis, lateral column lengthening with medial cuneiform bone plantarflexion osteotomy, lateral column lengthening with duplication of the talonavicular capsule, talonavicular and calcaneocuboid arthrodesis, transfer of the tibialis anterior muscle to the peroneal tertius muscle. The second general session presented methods of assessing the results of clubfoot treatment and postoperative rehabilitation protocols involving upright positioning and walking. Conclusion. The most important conclusions from the event are: clinical assessment and understanding the pathophysiology of the defect is crucial for its proper treatment; non-surgical treatment is recommended under the age of 6; between the ages of 6 and 14, surgical methods that preserve joint function predominate; after the age of 14 a large percentage of patients require performing joint arthrodesis. Nevertheless, arthrodesis should be avoided to correct flexible deformities and to treat patients with high functional requirements. The webinar audience included 583 people from 50 countries. Most participants came from Poland, Spain, Turkey, and Great Britain.

Retrospective analysis of factors associated with umbilical diseases in foals

In neonatal foals, umbilical remnants can be affected by infectious and non-infectious diseases. This study aimed to retrospectively evaluate historical, management and clinical factors that may be related to the occurrence of umbilical remnant diseases. Clinical reports of foals born or hospitalized within 24 h of life during the 2017–2021 foaling seasons were reviewed. Forty/183 foals (21.9 %) developed umbilical remnant diseases (URD group), while 143/183 foals (78.1 %) had normal umbilical remnants (NUR group). In the URD group, 24/40 (60 %) had a patent urachus, 16/40 (40 %) omphalo-arteritis, 4/40 (10 %) omphalo-phlebitis, 10/40 (25 %) urachitis, 9/40 (22.5 %) abscess, 3/40 (7.5 %) periumbilical hematoma and 12/40 (30 %) more than one condition. URD frequency was higher in foals hospitalized after birth than in those born at the hospital (17/46 vs 23/137; P = 0.0068), lower in those that had access to the paddock before three days of life (p = 0.0426) and higher in recumbent foals (P = 0.0001). URD occurred more frequently after dystocia (P = 0.0068), prolonged stage II parturition (19±20.51 min vs 13±6.41 in NUR group; P = 0.0279), traction at parturition (P = 0.0005), and in foals with lower APGAR scores (8±1.72 vs 9±0.86 in NUR; P = 0.0063). Sepsis (P = 0.0245), neonatal encephalopathy (P = 0.0014), meconium retention (P = 0.0241) and congenital flexural limb deformities (P = 0.0049) were the most common associated diseases. Umbilical cord (UC) coiling, abnormal UC rupture, umbilical hemorrhage and increased umbilical stump volume occurred more frequently in URD than in NUR group (P = 0.0329, P = 0.0191, P = 0.0007 and P < 0.00001, respectively). Recognition of the identified predisposing historical, management and clinical factors should prompt careful umbilical remnant monitoring in neonatal foals.

Defining and Differentiating Congenital Vertical Talus and Congenital Oblique Talus: It's Not Primarily About the Talus.

Congenital vertical talus (CVT) and congenital oblique talus (COT) are rocker-bottom foot deformities that have similar names and no objective definitions. This has led to confusion for practitioners, as well as scientific challenges for researchers. Our goal was to provide objective radiographic criteria to define and differentiate CVT and COT. We evaluated 62 pairs of maximum dorsiflexion and plantar flexion lateral radiographs of infant feet that had been clinically diagnosed with CVT. The dorsiflexion tibiotalar angle, the plantar flexion talus-first metatarsal angle, and the plantar flexion foot center of rotation of angulation (foot-CORA) were measured using transparent overlay tools. Freehand measurements were made on a subset of 10 pairs of radiographs to confirm clinical applicability. Nine contralateral pairs of radiographs of normal feet were measured for comparison. Specific values for the radiographic measurements were identified that, together, reliably differentiated the shapes of rocker-bottom feet with CVT, COT, and flexible flatfoot with a short tendo-Achilles (FFF-STA), as well as the shape of the normal foot. More severe and rigid rocker-bottom foot deformities were diagnosed with CVT. Less severe and more flexible deformities were diagnosed with COT. CVT, COT, FFF-STA, and normal feet can be reliably differentiated using 2 angular measurements and 1 bone position measurement on dorsiflexion and plantar flexion lateral radiographs. Our data indicated that the differentiation of CVT and COT is based primarily on the rigidity of the navicular dislocation rather than the verticality of the talus. The data further supported the proposition that COT is a foot deformity along a spectrum of valgus/eversion deformities of the hindfoot that requires early treatment. Application of these diagnostic criteria should lead to clinical studies that identify a specific treatment, treatment outcome, and prognosis for each deformity. Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Fratura in uterus de metacarpo em neonato bovino

Long bone fractures are common in juvenile cattle, however, cases of fractures occurring in the intrauterine environment during pregnancy are rare. The objective of this report is to present a case of an open consolidated fracture of the metacarpal that occurred in uterus, in a newborn calf, in which the surgical approach used was successful. A 48-hour-old female bovine was treated at the Veterinary Hospital of Paranaense University, who presented a complete, open and poorly consolidated transverse diaphyseal fracture in uterus during the gestational period on clinical and radiographic examination. As a therapeutic approach, open reduction was chosen, with ostectomy followed by stabilization with type IA external skeletal fixator. Four 4mm transcortical pins were positioned proximally and distally to the newly formed fracture line, followed by two more pins in the proximal phalanges region, seeking to stabilize the metacarpophalangeal joint, since flexural deformity of that joint was observed after the realignment of the longitudinal axis of the metacarpal, even after the section of the superficial and deep digital flexor tendons and suspensory ligament. The ESF was removed after 32 days, when radiographic signs of neoproliferation and bone consolidation were observed. In a last evaluation 15 months after the surgical correction, a complete and satisfactory recovery was observed regarding the development and well-being of the animal.

An Emphasis on the Role of Peroneus Brevis to Peroneus Longus Transfer in Progressive Collapsing Flatfoot Deformity

The role of the peroneal tendons in progressive collapsing flatfoot deformity (PCFD), also traditionally known as posterior tibial tendon dysfunction, is likely overlooked and almost certainly understudied. We explored the impact of peroneus brevis (PB) to peroneus longus (PL) transfer in the adult population with flexible PCFD deformities class A1 (flexible hindfoot valgus), B1 (flexible midfoot abduction), and C1 (flexible forefoot varus) as an augmentative measure combined with various bony procedures with proper assessment functionally, clinically, and radiologically. PB to PL tendon transfer poses a simple procedure dealing with muscle imbalance between the medial and lateral columns of the foot. It deals with the new understanding of the PCFD complex as a three-dimensional deformity. It works mainly on the axial plane to limit midfoot abduction and strongly augments the PL acting on the sagittal plane to address the forefoot varus. Finally, to a lesser extent, it deals with the coronal plane of hindfoot valgus, eliminating the primary evertor of the foot (PB) while simultaneously strengthening the PL, which contributes to the medial longitudinal and transverse arches of the foot, therefore decreasing the possibility of lateral column overload commonly caused by the Evans osteotomy through reducing pressure across the calcaneocuboid joint. This procedure is preferably indicated for flexible PCFD deformities class (A1, B1, and C1), yet is contraindicated in neuromuscular deformities with peroneal nerve palsy. Level of Evidence: Level IV.

In Vitro Characterisation of 3D Printable Filaments Subjected to Edible Liquids: An Analysis of Fused Deposition Modelling for Intraoral Applicability.

To evaluate the influence of edible liquids on the characteristic properties of 3D printable materials compared to conventionally used dental resin acrylic. Dental polymethyl methacrylate (PMMA) specimens were fabricated from preformed molds while polylactic acid (PLA) and polyethylene terephthalate glycol (PETG) specimens were 3D printed using fused deposition modelling at 0.1 mm layer thickness. All specimen forms adhered to ISO 37:2017 and ISO 604:2002 specifications. Specimens underwent controlled immersion for 180 hr into different media (no immersion (control), oil, soda, milk, and caffeine). Changes in mass (g), plastic deformity (N/mm2), ultimate tensile stress (N), flexural deformity (N/mm2), and break force (N) were evaluated using analysis of variance. There was an increase in mass for all specimens following immersion with significant interactions between immersion media and the materials. The materials exhibited significant differences in plastic deformity (F (df) = 156.632(2), P < 0.001), ultimate tensile stress (F (df) = 109.521(2), P < 0.001), and break force (F (df) = 319.785 (2), P < 0.001) with no significant interactions with immersion media (P > 0.05) on both accounts. Materials showed no significant differences in flexural deformity (F (df) = 2.693(2), P = 0.074) but with significant interactions (F (df) = 4.984(8), P < 0.001) between acrylic and immersion media. Commercially available 3D printable PLA and PETG filaments printed at 0.1 mm thickness possess approximately half the mechanical resilience as dental PMMA with comparable flexural deformity after exposure to edible liquids.