Pedis Research Articles

Enhanced bearing capacity prediction using hybrid tree-based ensemble learning with advanced meta-heuristic optimization

Abstract The accurate prediction of soil bearing capacity remains a critical challenge in geotechnical engineering, particularly given the complex non-linear relationships between soil properties and foundation performance. Traditional analytical methods often struggle to capture these complexities, leading to potential overestimation or underestimation of bearing capacity across different footing types. This study investigates the application of machine learning techniques for predicting soil bearing capacity across different footing types. The research utilized 200 datasets, comprising 175 institutional sources and 25 laboratory Direct Shear Test experiments, with an 80-20 split ratio for model development and validation. A Hybrid Tree-Based Ensemble Learning (HTBEL) methodology was developed and compared against conventional models (M5P, CatBoost, AdaBoost, SVR, and Decision Tree) and Terzaghi analytical equation. The HTBEL model demonstrated superior predictive accuracy with R² values exceeding 0.96 across all footing types, maintaining errors below 5% throughout the sample range. Square footings showed the highest bearing capacity (median ~3,400 kN/m²) due to favorable area-to-depth ratio, followed by circular footings (~3,200 kN/m²) benefiting from symmetrical stress transmission, while strip footings (~2,000 kN/m²) showed lower performance due to concentrated stress distribution along their length. Clustering analysis identified optimal configurations at 3 clusters (Silhouette Score: 0.5236) and 10 clusters (0.5315). This research establishes HTBEL as a robust methodology for bearing capacity prediction in geotechnical engineering applications.

Network Analysis of Legg–Calve–Perthes Disease and Its Comorbidities

Background/Objectives: Legg–Calvé–Perthes disease (LCPD) is characterized by idiopathic avascular necrosis of the femoral head in children. There are several hypotheses regarding the cause of LCPD; however, the exact cause remains unclear. Studies on comorbidities can provide better insight into the disease. We aimed to perform a network analysis to identify the associations between LCPD and comorbidities. Methods: We analyzed patients aged ≤ 12 years with LCPD as defined by ICD-10 codes M91.1, M91.8, and M91.9 registered in the National Health Insurance Service cohort database from 2002 to 2015. A control group was designed using propensity score matching. Comorbidities were identified and network analysis was performed. The identified comorbidities were reclassified into clinical disease groups considering their clinical relevance, and a network map was created using odds ratios. Results: In total, 23 significant disease clusters were identified. Injury-related disease clusters with ICD-10 codes starting with “S” were the most frequent. They were reclassified into 11 disease groups based on clinical relevance. Among these, congenital deformities of hip (Q65) had the highest odds ratio. Congenital deformities of feet (Q66) and other anemia (D64) had a single association with LCPD in the comorbidity network analysis. Conclusions: We confirmed the association between LCPD and comorbidities using a network analysis. The LCPD comorbidity network identified in this study is expected to serve as the basis for future research on LCPD.

Effects of a long-term triceps surae stretching program on the pennation angle of triceps surae heads in children with hypermobile flat foot and Achilles tendon shortening

BACKGROUND: Triceps surae retraction plays a key role in the pathogenesis of flat feet in children. This is a pennate muscle. The pennation angle is defined as the angle between triceps surae fascicles and aponeurosis. AIM: The aim of the study was to evaluate the effect of a long-term triceps surae stretching program on the pennation angle of the triceps surae head in children with flat feet and Achilles tendon shortening. MATERIALS AND METHODS: The study included a total of 82 children with hypermobile flat feet and Achilles tendon shortening. The pennation angle was measured by ultrasound. Triceps surae stretching was recommended for 6 months as a basic exercise. SPSS v.26.0 was used for statistical analysis of data. RESULTS: The study group included 63 children who performed stretching exercises and the control group included 19 children who did not perform stretching exercises at the required intensity. The study group showed a significant improvement in the Foot Posture Index (FPI)-6, while the control group showed no change. The baseline foot dorsiflexion was 4.84° ± 0.10° in the study group and 4.81° ± 0.17° in the control group. After 6 months of stretching, dorsiflexion was 11.34° ± 0.24° in the study group and 4.85° ± 0.19° in the control group (p 0.01). The pennation angle of the triceps surae heads showed a significant increase in the medial head of the gastrocnemius and soleus muscles. CONCLUSIONS: A long-term stretching program in children with flat feet resulted in a significant increase in foot dorsiflexion. These changes were associated with morphological and functional muscle restructuring, manifested by a significant increase in the pennation angle of the medial head of the gastrocnemius and soleus muscles. Further research will identify the mechanisms underlying anatomical and functional muscle restructuring and their effects on anatomical foot parameters in flat feet.

FABRIKASI DAN PENGUJIAN TELAPAK KAKI PALSU JENIS SINGLE AXIS

Along with the increasing number of persons with disabilities, the need for prosthetic foot has also increased. However, the irony is that some of the products circulating in Indonesia are still imported from abroad, while the domestic product is quite limited and possesses some drawbacks. This study aims to study the production process of the single axis type of the right-side prosthetic foot as well as to evaluate the performance of this product. The prosthetic foot in this research was made from thermoplastic polyurethane (TPU) resin and prepared with casting by pouring it into a pre-fabricated mold. A single-axis type of right prosthetic product could have been successfully made in this study with men's shoe sizes EU 42 and a mass of 654 g. The result of evaluation of the material and foot prosthetic product showed an average Shore hardness value of 54.3 HA. According to the result of compression test, this prosthetic product was also able withstand the highest compressive load up to 259.76 kgf. Finally, the result of fatigue test showed no damage on the foot prosthetic product until 90.000 cycle.

Revisiting the radiological signs for the first metatarsal pronation assessment.

The first metatarsal pronation deformity of hallux valgus feet is widely recognized. However, its assessment relies mostly on 3D standing CT scans. Two radiological signs, the first metatarsal round head (RH) and inferior tuberosity position (ITP), have been described, but are seldom used to aid in diagnosis. This study was undertaken to determine the reliability and validity of these two signs for a more convenient and affordable preoperative assessment and postoperative comparison. A total of 200 feet were randomly selected from the radiograph archives of a foot and ankle clinic. An anteroposterior view of both feet was taken while standing on the same x-ray platform. The intermetatarsal angle (IMA), metatarsophalangeal angle (MPA), medial sesamoid position, RH, and ITP signs were assessed for statistical analysis. There were 127 feet with an IMA > 9°. Both RH and ITP severities correlated significantly with IMA severity. RH and ITP were also significantly associated with each other, and the pronation deformities of these feet are probably related to extrinsic factors. There were also feet with discrepancies between their RH and ITP severities, possibly due to intrinsic torsion of the first metatarsal. Both RH and ITP are reliable first metatarsal pronation signs correlating to the metatarsus primus varus deformity of hallux valgus feet. They should be used more for preoperative and postoperative assessment.

Differences in Walking Speed of SACH Foot And Single Axis Foot in Transtibial Prosthesis User

Background: Lower limb amputation causes disruption of limb function, one of which is the ability to walk. One of the walking aids that can be used is a transtibial prosthesis. A transtibial prosthesis consists of a socket, shank and foot components. The choice of foot type and the use of a transtibial prosthesis is one of the factors that influence walking speed. SACH foot and single axis foot are the types of foot that are often used by prosthesis users Aims: To determine the difference in walking speed of SACH Foot and Single Axis Foot in transtibial prosthesis users. Method and Subjects: Using quantitative research, observational method with cross sectional design. The subjects of this research were users of transtibial prosthesis type SACH foot and single axis foot. The sample for this study consisted of 28 people. The measuring instruments used in this research are 10 MWT (Meter Walk Test). Results: Based on statistical tests, the results showed that there were differences in walking speed between SACH foot and single axis foot type transtibial prosthesis users. Where the p value <0.05 is 0.000 with an effect size of 0.81, which means it has a high or strong difference effect. Conclusion: There is a difference in walking speed, namely the walking speed of users of single axis foot transtibial prosthesis is faster than SACH foot. So, it is recommended to prefer using a single axis foot in users of transtibial prosthesis, especially at moderate activity levels. The limitations of this research are that there are not many subjects and the foot types are less diverse. Future research can be developed with other types of foot prosthesis and measurement of gait parameters

Arthroscopically Assisted Reduction and Fixation of Acute Tillaux, Pilon, Bosworth, Talar, and Calcaneal Fractures: A Systematic Review.

Increased use of arthroscopically assisted techniques for the treatment of ankle fractures has been reported. Despite their rapid development, there is only one systematic review regarding arthroscopically assisted treatment of ankle fractures, in which, however, only malleolar fracture studies are included. Various other types of ankle fractures have also been treated with arthroscopically assisted procedures. The purpose of this review was to identify and evaluate the existing literature about arthroscopically assisted surgical management of other types of foot and ankle fractures, such as Tillaux, pilon, Bosworth, talar, and calcaneal fractures. A systematic review was conducted until December 2022 using the Arksey and O'Malley framework and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Three databases-PubMed, Elsevier Scopus, and Cochrane Library-were searched for relevant studies. The chosen studies were divided into groups according to the fracture type. Of the 424 initially identified studies, 36 were finally included in the review: 22 case reports or case series and 14 original retrospective cohort studies. Participant demographic characteristics; methods of arthroscopically assisted reduction and fixation; and clinical, radiologic, and patient-reported outcomes were extracted. Arthroscopically assisted techniques for the treatment of Tillaux, pilon, Bosworth, talar, and calcaneal fractures are effective procedures and have already shown satisfactory and promising clinical and radiologic outcomes. There are some limitations in their use though, especially in some specific fracture patterns. Long-term effects and possible superiority of arthroscopically assisted techniques over classic reduction and fixation must be further studied.

UK Foot and Ankle Thromboembolism (UK-FATE).

Venous thromboembolism (VTE) is a potential complication of foot and ankle surgery. There is a lack of agreement on contributing risk factors and chemical prophylaxis requirements. The primary outcome of this study was to analyze the 90-day incidence of symptomatic VTE and VTE-related mortality in patients undergoing foot and ankle surgery and Achilles tendon (TA) rupture. Secondary aims were to assess the variation in the provision of chemical prophylaxis and risk factors for VTE. This was a multicentre, prospective national collaborative audit with data collection over nine months for all patients undergoing foot and ankle surgery in an operating theatre or TA rupture treatment, within participating UK hospitals. The association between VTE and thromboprophylaxis was assessed with a univariable logistic regression model. A multivariable logistic regression model was used to identify key predictors for the risk of VTE. A total of 13,569 patients were included from 68 sites. Overall, 11,363 patients were available for analysis: 44.79% were elective (n = 5,090), 42.16% were trauma excluding TA ruptures (n = 4,791), 3.50% were acute diabetic procedures (n = 398), 2.44% were TA ruptures undergoing surgery (n = 277), and 7.10% were TA ruptures treated nonoperatively (n = 807). In total, 11 chemical anticoagulants were recorded, with the most common agent being low-molecular-weight heparin (n = 6,303; 56.79%). A total of 32.71% received no chemical prophylaxis. There were 99 cases of VTE (incidence 0.87% (95% CI 0.71 to 1.06)). VTE-related mortality was 0.03% (95% CI 0.005 to 0.080). Univariable analysis showed that increased age and American Society of Anesthesiologists (ASA) grade had higher odds of VTE, as did having previous cancer, stroke, or history of VTE. On multivariable analysis, the strongest predictors for VTE were the type of foot and ankle procedure and ASA grade. The 90-day incidence of symptomatic VTE and mortality related to VTE is low in foot and ankle surgery and TA management. There was notable variability in the chemical prophylaxis used. The significant risk factors associated with 90-day symptomatic VTE were TA rupture and high ASA grade.

Effects of the excavation of deep foundation pits on an adjacent double-curved arch bridge

The excavation of deep foundation pits can cause variations in the displacement and stress fields of surrounding soils, which hence induces adverse effects on adjacent structures. This study presents a two-stage method to quantify the impact of the excavation of a deep foundation pit on the adjacent double-curved arch bridge in the historical city of Nanjing, Southeastern China. The entire process of the foundation pit excavation was simulated and the induced deformation of the arch foot was obtained in the first stage by hardening soil model with small-strain stiffness. Then, the obtained deformation of the arch foot was applied to the bridge structure as a displacement boundary in the second stage to calculate the internal forces and deformations of the double-curved arch bridge structure. The tensile strength of concrete is taken as the limit value of the tensile stress of the double-curved arch bridge. The limit values of arch foot displacement under four evaluation conditions are obtained by step loading calculation. The present results provide construction guidance and safety warning for the process of foundation pit excavation adjacent to double-curved arch bridges for historical preservation.

Body Mass Index, Age and Gender Have No Impact on Venous Thromboembolism Rates; An Epidemiologic Study of 1434 Foot and Ankle Surgeries Performed at a Single Academic Medical Center

Category: Other Introduction/Purpose: Despite the large volume of foot and ankle orthopaedic procedures performed annually, there is a paucity of data describing the post-operative complications, including venous thromboembolisms (VTE), and the impact of patient characteristics and comorbidities as they contribute to these observed complications. The wide variety of foot and ankle orthopaedic procedures performed presents a challenge for orthopaedic surgeons when counseling patients on the risk of post-operative complications and identifying patients with relevant comorbidities to mitigate risk. Methods: This was a retrospective study of 1434 foot and ankle surgeries performed at a large urban academic medical center by a single surgeon. Patient demographics, pre-operative comorbidities, and VTEs within 90 days postoperatively, defined as either pulmonary embolism (PE) or deep vein thrombosis (DVT), were analyzed using Chi-square test of independence. All patients were given standard prophylaxis of aspirin; enoxaparin or direct oral anticoagulants (DOACs) were given based on preoperative risk factors, such as prior VTE. Preoperative comorbidities recorded included history of myocardial infarction (MI), congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, rheumatic disease, peptic ulcer disease, mild liver disease, moderate or severe liver disease, diabetes mellitus (DM), hemiplegia/paraplegia, renal disease, malignancy of any kind, metastatic solid tumor of any kind, and human immunodeficiency virus. All patients who smoked were abstinent immediately prior to the procedure. Results: The overall rate of VTE was 1.6% (n=23), with a PE rate of 0.4% (n=6) and DVT rate of 1.3% (n=19); two patients were diagnosed with both. Current smokers had higher rates of PE (1.4% vs 0.0%, p=0.02) than former smokers. Patients who identified as Hispanic had higher rates of DVT than non-Hispanics (4.6% vs 1.2%, p=0.03). Renal disease, MI, and mild liver disease were also associated with higher rates of PE and DVT (p < 0.05). Patients with one or more comorbidities exhibited higher rates of PE than those without comorbidities (0.8% vs 0.1%, p=0.04). Differences in body mass index (BMI), age, DM, gender, race, peri-operative opioid use, and procedure type were not associated with differences in VTE rate. Conclusion: While including both elective and non-elective cases, the results of this study may be used to counsel patients on their anticipated surgical risk based on their demographics and medical comorbidities. Further, these results may help identify areas for targeted mitigation to prevent postoperative VTE. The results of this study indicate that cigarette smoking and preoperative medical comorbidities continue to impact VTE rates while BMI, DM, and age had no significant differences in rate of VTE after foot and ankle surgery. PE and DVT rate by selected patient characteristics Rates of pulmonary embolism (PE) and deep vein thrombosis (DVT) within 90 days of any type of foot and ankle surgery, stratified by age, diabetes (DM) status, smoking status, body mass index (BMI), gender, and self-identified race (AA = African American).

3D Semi-Automated Analysis of Joint Sparing Charcot-Marie-Tooth Cavovarus Reconstruction Using Preoperative and Postoperative Weightbearing Computed Tomography

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Charcot-Marie-Tooth (CMT) disease is the most common cause of cavus foot. The complex deformities in cavovarus feet of CMT disease are difficult to evaluate. The bone axes of CMT may be difficult to calculate by conventional weightbearing computed tomography (WBCT). For this reason, 3D automated measurements have been used to assess complex anatomy. The aim of this study was to quantitatively assess deformity correction following joint sparing CMT cavovarus reconstruction surgery. This is the first study investigating preoperative and postoperative WBCT findings in CMT feet using semi-automated 3D measurements. Methods: The study was approved by our institutional review board and informed consent was obtained from all patients. Joint sparing CMT surgery was performed with multiple soft tissue releases and bony procedures. Among the 170 cases from May 2021 to May 2023, twenty-nine CMT patients who had both pre- and postoperative WBCTs were retrospectively analyzed. 3D measurements of WBCT were performed using semi-automated software (Bonelogic 2.1, Disior) to investigate changes in sagittal, axial, and coronal parameters. Pre- and postoperative data was compared using a Wilcoxon signed-ranks test and these data were also compared with normative data using a Welch's t-test. Correlation among these sagittal, axial, and coronal parameters were analyzed using Spearman’s rank correlation coefficient test. Results: The sagittal, axial, and coronal malalignment of the hindfoot, and the sagittal and axial malalignment of the forefoot was significantly improved after corrective surgery (P < .05). Sagittal Meary’s angle (from 14.8 degrees to 0.1 degrees), axial talonavicular angle (TNA, from 3.6 degrees to 19.2 degrees), and coronal hindfoot alignment (from 11.0 degrees to -11.1 degrees) showed significant changes postoperatively (P < .001). Hindfoot, forefoot sagittal and forefoot axial parameters reached comparable outcomes compared to normative value (P > .05). Regarding amount of correction, Spearman’s correlation demonstrated that axial Meary’s angle and TNA were most strongly related to improvement in sagittal Meary’s angle and coronal hindfoot alignment. Conclusion: Preoperative and postoperative WBCT measurements demonstrated that joint sparing CMT cavovarus reconstruction significantly improved sagittal, axial, and coronal deformities of CMT, and sagittal Meary’s angle was restored toward normative values. Apparent axial plane correction, the majority of which occurred at the talonavicular joint, had the strongest correlation with deformity correction in multiple planes. This suggests that soft tissue releases and correction of the talonavicular joint may be a key component of a CMT cavovarus foot correction. Figure. (A) CMT surgery with soft tissue releases and bony procedures, (B) Pre- and postoperative radiographic results, and gross photos of the operated right foot of a 17-year-old male patient.

Descriptive Study of the Influence of Foot Type on Physical Characteristics, Laxity, Strength and Baropodometry in Children Aged 5 to 10 Years

Background: Foot morphology in children is a crucial factor influencing multiple aspects of their physical development. Between the ages of 5 and 10 years, the critical period of child development is when the movement and stability patterns are consolidated that can affect their long-term physical performance and quality of life. The aim of this study is to analyze how the type of foot influences different physical characteristics, laxity, strength, motor tests, and baropodometric variables in children aged 5 to 10 years. Methods: A cross-sectional study involving 196 children was conducted. Different physical characteristics, laxity, strength, motor tests, and baropodometric variables of the sample were analyzed for age and Foot Posture Index (FPI). Results: Differences in all variables were examined by age and FPI. Statistical analysis showed a moderate to high correlation (r > 0.6, p < 0.01) between FPI and the relaxed calcaneal stance position (RCSP) test. Some significant differences were also found in variables related to foot pronation and supination. These results provide valuable information for understanding differences in motor and functional development during childhood and pre-adolescence. Conclusions: The findings highlight the variability in physical and functional development between age and foot type groups, highlighting the importance of considering these differences in the assessment and management of foot-related conditions and biomechanics in childhood. Foot type significantly influences children’s growth and development.

Simple Exostectomy and Tarsal Tunnel Release for a Rocker Bottom Deformity in a Diabetic Charcot Arthropathy Foot—An Addition to the Eichenholtz Stage Classification of Charcot Arthropathy: A Case Report

Simple Exostectomy and Tarsal Tunnel Release for a Rocker Bottom Deformity in a Diabetic Charcot Arthropathy Foot—An Addition to the Eichenholtz Stage Classification of Charcot Arthropathy: A Case Report

Comparison of spatiotemporal gait parameter measurements across various emulated foot strike patterns between the Tekscan® Strideway™ pressure sensitive walkway and gold-standard marker-based motion capture

Spatiotemporal gait parameters are commonly used to quantify physical functioning including in populations with atypical foot strike patterns. The current gold standard measurement system for gait analysis is marker-based motion capture and floor-mounted force plates, but it can be expensive and cumbersome to set up. Pressure sensitive walkways are more affordable, quicker to set up, and more portable. Currently available walkways have not been compared to marker-based motion capture when measuring atypical foot strike patterns. The recently developed Tekscan® Strideway pressure sensitive walkway system has not been compared to any gold standard. This study compared measurements of step width, step length, and step time from the Strideway™ system against a gold standard marker-based motion capture (Vicon® Vantage™) and floor-mounted force plate (AMTI®) system. Ten typically ambulating adults, free of injury, emulated five different foot strike patterns recording two-hundred footsteps for each. Results indicate that the Strideway™ compares well to the gold standard especially under typical foot strike patterns. The errors were highest for step width and near-zero for step time. However, the user needs to be aware that errors can substantially increase with certain foot strike patterns such as when the heel does not make contact with the walkway. The results of this study will help inform users about potential limitations when using a pressure sensitive walkway like the Strideway™ for testing populations with typical and atypical strike patterns.

Pressure-Relieving Effect of Different Insole Top Covers in People with Diabetes at High Risk of Foot Ulceration.

Pressure-relieving footwear helps prevent foot ulcers in people with diabetes. The footwear design contributes to this effect and includes the insole top cover. We aimed to assess the offloading effect of materials commonly used as insole top cover. We measured 20 participants with diabetes and peripheral neuropathy for in-shoe peak pressures while walking in their prescribed footwear with the insole covered with eight different materials, tested in randomized order. Top covers were a 3 mm or 6 mm thick open or closed-cell foam or a 6 mm thick combination of open- and closed-cell foams. We re-assessed pressures after one month of using the top cover. Peak pressures were assessed per anatomical foot region and a region of interest (i.e., previous ulceration or high barefoot pressure). Walking comfort was assessed using a 10-point Likert scale. Mean peak pressure at the region of interest varied between 167 (SD:56) and 186 (SD:65) kPa across top covers (p < 0.001) and was significantly higher for the 3 mm thick PPT than for four of the seven 6 mm thick top covers. Across 6 mm thick top covers, only two showed a significant peak pressure difference between them. Over time, peak pressures changed non-significantly from -2.7 to +47.8 kPa across top cover conditions. Comfort ratings were 8.0 to 8.4 across top covers (p = 0.863). The 6 mm thick foams provided more pressure relief than the 3 mm thick foam during walking in high-risk people with diabetes. Between the 6 mm thick foams and over time, only small differences exist. The choice of which 6 mm thick insole top cover to use may be determined more by availability, durability, ease of use, costs, or hygienic properties than by superiority in pressure-relief capacity.

PERBEDAAN KECEPATAN BERJALAN PADA PENGGUNA TRANSTIBIAL PROSTHESIS TIPE SACH FOOT DAN SINGLE AXIS FOOT

Background: Amputation can be defined as the act of separating part of the body, part or all of an extremity. Currently, lower limb amputations account for 85-90% of all amputations and transtibial amputation is the most frequently performed type of amputation surgery. One of the problems with transtibial amputation is hyperextension and weakness of the ligaments in the knee. Knee hyperextension is a condition that occurs when the knee joint is extended (straightening the knee) excessively, thus putting pressure on the structure of the knee and the back of the knee joint. Ligament weakness in the knee is weakness in the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. Choosing the right prosthesis components can overcome this. One component that plays an important role is the foot component. Methods: This type of research is observational analytic with a cross-sectional design. The research subjects were 17 transtibial prosthesis users. Data analysis in this study used Spearman Rank Test. Results: Based on the Spearman Rank results, the significance result was 0.653 for the type of foot with hyperextension, while for the type of foot with ligament weakness, the significance result was 0.434. Both variables had variable values &gt; 0.05, meaning there was no correlation between foot type and hyperextension and ligament weakness in transtibial prosthesis users. Conclusion: There is no correlation type of foot to hyperextension and ligament weakness. In future research, it is hoped that research can be carried out with a larger number of samples and a more varied type of foot.

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.

A rare case of Klippel-Trenaunay-Weber syndrome in a child

Klippel-Trenon-Weber syndrome is a rare congenital disorder characterized by polymorphism of clinical manifestations, including vascular malformations, skeletal deformities, facial asymmetry and other developmental anomalies. The study of this syndrome is driven by its rarity, complexity of diagnosis and treatment, and significant impact on the quality of life of patients. Early diagnosis and adequate surgical intervention can significantly improve the prognosis and reduce the risk of serious complications This is a rare congenital disease characterized by a triad of symptoms: angiodysplasia, congenital skeletal anomalies and muscle hypertrophy. This syndrome is caused by a defect in the keratin 13 gene (KRT13), which causes dysfunction of cells of ectodermal origin, including keratinocytes, endothelial cells and ectodermal cells. Clinical symptoms of the syndrome may include hydrocephalus, congenital kidney defects, limb abnormalities, and other pathological changes. Treatment usually depends on the specific symptoms and complications and may include surgery, drug therapy, physiotherapy and rehabilitation. Understanding the genetic mechanisms and factors that cause the syndrome will allow us to develop more effective diagnostic and treatment methods and improve the prognosis for patients. The aim of the study was to demonstrate a clinical case of this extremely rare paediatric pathology, to show the peculiarities of its diagnosis and treatment. The peculiarity of this patient was a deformity (severe thickening) of the right foot at birth. In the process of growth, the deformity of the right foot increased, making it impossible to use standard shoes. The subcutaneous venous network on the right lower limb became stronger. The course of this disease and the treatment performed are described. Keywords: syndactyly, hypertrophy, foot, surgery, limb asymmetry, congenital anomaly.

THE INCIDENCE OF VTE IN FOOT AND ANKLE SURGERY IN THE UK: UK FOOT AND ANKLE THROMBO-EMBOLISM AUDIT (UK-FATE)

IntroductionVTE is a possible complication of foot and ankle surgery, however there is an absence of agreement on contributing risk factors in the development of VTE. The primary outcome of this study was to analyse the 90-day incidence of symptomatic VTE following foot and ankle surgery and to determine which factors may increase the risk of VTE.MethodsThis was a national, multi-centre prospective audit spanning a collection duration of 9 months (2022/2023). Primary outcomes included incidence of symptomatic VTE and VTE related mortality up to 90 days following foot and ankle surgery and Achilles tendon rupture, and analysis of risk factors.ResultsIn total 11,363 patients were available for analysis. 5,090 patients (44.79%) were elective procedures, 4,791 patients (42.16%) were trauma procedures (excluding Achilles ruptures), 398 patients (3.50%) were acute diabetic procedures, 277 patients (2.44%) were Achilles ruptures undergoing surgery and 807 patients (7.10%) were Achilles ruptures treated non-operatively. There were 99 cases of VTE within 90 days of admission across the whole group (Total incidence = 0.87%), with 3 cases of VTE related mortality (0.03%). On univariate analysis, increased age and ASA grade showedhigher odds of 90-day VTE, as did previous cancer, stroke, history of VTE, and type of foot and ankle procedure / injury (p&lt;0.05). However, on multivariate analysis, the only independent predictors for 90-day VTE were found to be the type of foot and ankle procedure (Achilles tendon rupture = Odd's Ratio 11.62, operative to 14.41, non-operative) and ASA grade (grade III/IV = Odd's Ratio 3.64).ConclusionThe incidence of 90-day post procedure VTE in foot and ankle surgery in this national audit was low. Significant, independent risk factors associated with the development of 90-day symptomatic VTE were Achilles tendon rupture management and high ASA grade.

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.