Pedis Research Articles

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

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.

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.

3D AUTOMATED VERSUS MANUAL ASSESSMENT OF ALIGNMENT IN NORMAL AND CAVUS FEET USING WEIGHT-BEARING CT SCANS: DOES IT DIFFER?

BackgroundThe complex deformities in cavovarus feet may be difficult to assess and understand. Weight-bearing CT (WBCT) is increasingly used to evaluate complex deformities. However, the bone axes may be difficult to calculate in the setting of severe deformity. Computer-assisted 3D-axis calculation is a novel approach that may allow for more accurate assessment of foot alignment / deformity. The aim of this study was to assess differences in measurements done manually on 2D slices of WBCT versus 3D computer models in normal and cavus feet.MethodsWe retrospectively analyzed WBCT scans from 16 normal and 16 cavus feet in patients with Charcot-Marie Tooth. Eight measurements were assessed: Talus-1st metatarsal angle (axial plane), Forefoot arch angle (coronal plane), and Meary's angle, calcaneal pitch, cuneiform to floor, cuneiform to skin, navicular to floor and navicular to skin distance (sagittal plane). 2D measurements were performed manually and 3D measurements were performed using specialised software (BoneLogic, DISIOR).ResultsThere was no significant difference in the measured variables (2D manual versus 3D automated) in normal feet. In the cavus group, 3D assessment calculated increased values for the sagittal angles: Meary's 7.3 degrees greater (p = 0.004), calcaneal pitch 2.4 degrees greater (p = 0.011)), and lower values for the axial talus-1st MT angle, 10.6 degrees less (p = 0.001).ConclusionThere were no significant differences in the normal group. This suggests 3D automated techniques can reliably assess the alignment of bony axes. However, the 3D axis calculations suggest there may be greater sagittal and lesser axial deformity in cavus feet than measured by 2D techniques. This discrepancy may be on account of the rotation seen in cavovarus feet, which may not be readily assessed manually. 3D automated measurements may therefore have a role in better assessing and classifying the cavus foot which may ultimately help inform treatment algorithms.

Conceptual study of vatakantaka

Pain is that one feature which can interfere with daily activities such as working, having a social life, taking care of oneself and others. Several problems can cause pain to develop in the back of the heel.Plantar fasciitis is one of the most common causes of heel pain. Plantar fasciitis is estimated to affect 1 in 10 people at some point during their lifetime and most commonly affects people between 40 and 60 years of age.Vatakantaka is a Sanskrit compound consisting of the terms vata and kantaka which means a particular pain in the ankle.Walking in irregular or uneven ground, the structural deformity of foot or excessive strain on foot lead to provocation of vata and brings about severe pain in ankle joint which is referred to as Vatakantaka.Through this article an attempt is made to understand the nidana, samprapti, purvarupa, lakshana of vatakantaka which contributes in its manifestation.Snehana, swedana, virechana, raktamokshana, agnikarma are line of treatment explained in ayurveda.

What word-prosodic typology is missing: Motivating foot structure as an analytical tool for syllable-internal prosodic oppositions

A notoriously contested subarea of phonological typology is word-prosodic typology, which governs suprasegmental structure (such as tone, syllable structure and stress) at the word level. Within word-prosodic typology, it is widely recognized that some languages have so-called stress systems while others have lexical-tone systems. Other languages appear to have intermediate systems, with properties of both stress and lexically contrastive tone. Certain types of such intermediate systems are at the core of ongoing theoretical debates on the nature of word- prosodic systems, viz. language varieties with contrasts between two word tones that are restricted to the main-stressed syllables of a word, a phenomenon that is often descriptively referred to as tonal accent. In this paper, we aim to show that exploring tone-accent systems in detail has the potential to significantly contribute to word-prosodic typology, specifically concerning the foot as a tool for the analysis of syllable-internal prosodic contrasts. The phonology of tonal accent in Franconian (a variety of West Germanic spoken in parts of Belgium, Germany, and the Netherlands) will be the main piece of evidence supporting our claims, with a focus on predictable interactions between segmental structure and accentuation. A central implication of our analysis is that tonal contrasts within syllables can sometimes derive from two types of feet being active in the same prosodic system. We support the Franconian evidence with analogous tone-segment interactions in Estonian and discuss the relevance of our claims in the broader context of word-prosodic typology.

Does the Sagittal Radiographic Morphology of Subtalar Joint Affect the Alignment of Foot?

The etiology of flatfoot and cavus foot is multicausal and controversial. So far, no literature reports the relationship between the sagittal morphology of subtalar joint and the alignment of foot. The purpose of this study was to explore whether the subtalar alignment would influence the configuration of foot. From January 2017 to January 2020, we included 109 feet in the flatfoot group, 95 feet in the cavus group, and 104 feet in the control group in this retrospective comparative study. The Gissane angle and calcaneal posterior articular surface inclination angle represented the sagittal morphology of the subtalar joint. Meary's angle, calcaneal pitch angle, and talar pitch angle reflected the alignment of foot. They were measured in the weightbearing foot X-rays. The angles in different groups were compared via Mann-Whitney U test. We calculated the correlation between the sagittal alignment of subtalar joint and the alignment of foot using Spearman's correlation analysis. Interobserver and intraobserver reliability were calculated. The Gissane angle, calcaneal posterior articular surface inclination angle, Meary's angle, talar pitch angle, and calcaneal pitch angle were significantly different in the three groups. The Gissane angle had an excellent correlation with the Meary's angle (r = 0.850, p < 0.0001), and the talar pitch angle (r = -0.825, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = 0.638, p < 0.0001). The calcaneal posterior articular surface inclination angle had an excellent correlation with the Meary's angle (r = -0.902, p < 0.001), and the talar pitch angle (r = 0.887, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = -0.702, p < 0.0001). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent. A subtalar joint with a larger Gissane angle and a more horizontal calcaneal posterior articular surface angle tended to have a higher foot arch and vice versa. The inspiration from this study was that the deformities of flatfoot and cavus foot may relate to the subtalar deformity.

Innovations in prosthetic foot design enhancing durability, functionality and comfort through PLA composite filament 3D printing

Purpose The number of people with special needs, including citizens and military personnel, has increased as a result of terrorist attacks and challenging conditions in Iraq and other countries. With almost 80% of the world’s amputees having below-the-knee amputations, Iraq has become a global leader in the population of amputees. Important components found in lower limb prostheses include the socket, pylon (shank), prosthetic foot and connections. Design/methodology/approach There are two types of prosthetic feet: articulated and nonarticulated. The solid ankle cushion heel foot is the nonarticulated foot that is most frequently used. The goal of this study is to use a composite filament to create a revolutionary prosthetic foot that will last longer, have better dorsiflexion and be more stable and comfortable for the user. The current study, in addition to pure polylactic acid (PLA) filament, 3D prints test items using a variety of composite filaments, such as PLA/wood, PLA/carbon fiber and PLA/marble, to accomplish this goal. The experimental step entails mechanical testing of the samples, which includes tensile testing and hardness evaluation, and material characterization by scanning electron microscopy-energy dispersive spectrometer analysis. The study also presents a novel design for the nonarticulated foot that was produced with SOLIDWORKS and put through ANSYS analysis. Three types of feet are produced using PLA, PLA/marble and carbon-covered PLA/marble materials. Furthermore, the manufactured prosthetic foot undergoes testing for dorsiflexion and fatigue. Findings The findings reveal that the newly designed prosthetic foot using carbon fiber-covered PLA/marble material surpasses the PLA and PLA/marble foot in terms of performance, cost-effectiveness and weight. Originality/value To the best of the author’s knowledge, this is the first study to use composite filaments not previously used, such as PLA/wood, PLA/carbon fiber and PLA/marble, to design and produce a new prosthetic foot with a longer lifespan, improved dorsiflexion, greater stability and enhanced comfort for the patient. Beside the experimental work, a numerical technique specifically the finite element method, is used to assess the mechanical behavior of the newly designed foot structure.

Clubfoot Correction with Ponseti Technique: Three-Dimensional Alignment Analysis and Residual Adult Deformity Effects on Patient-Reported Outcomes

Introduction/Purpose: Few studies have assessed the long-term outcomes of the Ponseti technique and none have utilized 3- dimensional weightbearing analysis. The goal of this study was to understand how potential residual 3D deformities and abnormalities influence patient reported outcomes (PROs). This was accomplished by assessing anatomical foot and ankle alignment in adult clubfoot patients treated with the Ponseti method using 3D weightbearing CT (WBCT) imaging and then correlating residual foot and ankle malalignment with PROs. Methods: There were 37 consecutive patients (57 feet) included and 14 volunteers healthy controls (28 feet) included in this study. Every participant was evaluated using a WBCT (HiRise©) in a bipedal standing position. From these scans Cavus, Adductus, and Varus components were evaluated using multiple 3D measurements calculated using the semi-automatic segmentation software Bonelogic®. Specific Cavus related measurements included sagittal talus-first metatarsal angle and the calcaneal inclination angle. Varus related measurements included talocalcaneal angle in both the sagittal and axial planes as well as the hindfoot moment arm and the hindfoot alignment angle. Adductus deformity was evaluated using talonavicular coverage angle. These measurements were then correlated with patient reported outcome surveys, which included Visual Acuity Scale for pain, PROMIS general health, PROMIS physical function, PROMIS pain interference, pain catastrophic scale, and European foot and ankle society score. Results: There was no significant overall residual 3D-deformity observed in clubfoot patients when compared to controls, with similar FAO measurements observed between the groups, clubfoot=2.63% (95%CI=1.41%-3.85%) and control=3.2% (CI=1.6%- 4.8%,P=0.58). The sagittal talus-first-metatarsal in the clubfoot-patients had a mean-value of -0.12° compared to the controls, −5.2°. Clubfoot patients also had a decreased calcaneal-inclination-angle relative to the controls, 13.01° and 21.5° respectively. Talocalcaneal-angle for clubfoot patients in both the sagittal-plane,44.28°, and axial-plane, 17.74°, were reduced compared to the controls, 57.51° and 25.78°. Talonavicular-coverage-angle in the clubfoot-group (18.63°) was less than the controls (29.19°). Talus- first-metatarsal-angle in the sagittal-plane was significantly correlated with VAS-scores (RSquare=0.19,P=0.0118) and the EFAS- Score (RSquare=0.27,P=0.0025). Talocalcaneal-angle in the sagittal plane was also significantly correlated with the PROMIS-Pain- Interference-score (P=0.038) and PROMIS-Physical-Function-score (RSquare=0.32,P=0.0007). Conclusion: The Ponseti technique is an effective nonsurgical treatment for the overall three-dimensional foot and ankle alignment of Clubfoot. While mild, but statistically significant residual Varus and Adductus deformities were observed in adult clubfoot patients, the overall 3D alignment (FAO) was found to be similar between clubfoot patients and controls. These findings highlight the efficacy of the Ponseti technique and potentially explain the overall good PROs. The results of this study could potentially provide insight into treatment targets that may be applied to help optimize patient outcomes when treating children with Clubfoot in the future. The Ponseti technique is an effective nonsurgical treatment for Clubfoot's overall three-dimensional foot and ankle alignment. While mild, but statistically significant residual Varus and Adductus deformities were observed in adult clubfoot patients, the overall 3D alignment (FAO) was found to be similar between clubfoot patients and controls. These findings highlight the efficacy of the Ponseti technique and potentially explain the overall good PROs. The results of this study could potentially provide insight into treatment targets that may be applied to help optimize patient outcomes when treating children with Clubfoot in the future.

Multi-segment foot kinematics during gait in children with spastic cerebral palsy

BackgroundFoot deformities (e.g. planovalgus and cavovarus) are very common in children with spastic cerebral palsy (CP), with the midfoot often being involved. Dynamic foot function can be assessed with 3D gait analysis including a multi-segment foot model. Incorporating a midfoot segment in such a model, allows quantification of separate Chopart and Lisfranc joint kinematics. Yet, midfoot kinematics have not previously been reported in CP. Research questionsWhat is the difference in multi-segment kinematics including midfoot joints between common foot deformities in CP and typically-developing feet? Methods103 feet of 57 children with spastic CP and related conditions were retrospectively included and compared with 15 typically-developing children. All children underwent clinical gait analysis with the Amsterdam Foot Model marker set. Multi-segment foot kinematics were calculated for three strides per foot and averaged. A k-means cluster analysis was performed to identify foot deformity groups that were present within CP data. The deformity type represented by each cluster was based on the foot posture index. Kinematic output of the clusters was compared to typically-developing data for a static standing trial and for the range of motion and kinematic waveforms during walking, using regular and SPM independent t-tests respectively. ResultsA neutral, planovalgus and varus cluster were identified. Neutral feet showed mostly similar kinematics as typically-developing data. Planovalgus feet showed increased ankle valgus and Chopart dorsiflexion, eversion and abduction. Varus feet showed increased ankle varus and Chopart inversion and adduction. SignificanceThis study is the first to describe Chopart and Lisfranc joint kinematics in different foot deformities of children with CP. It shows that adding a midfoot segment can provide additional clinical and kinematic information. It highlights joint angles that are more distinctive between deformities, which could be helpful to optimize the use of multi-segment foot kinematics in the clinical decision making process.

3D Analysis of Joint-Sparing Charcot-Marie-Tooth Surgery Effect on Initial Standing Foot Alignment.

The complex deformities in cavovarus feet of Charcot-Marie-Tooth (CMT) disease are difficult to evaluate. The aim of this study was to quantify the initial standing alignment correction achieved after joint-sparing CMT cavovarus reconstruction using pre- and postoperative weightbearing computed tomography (WBCT). Twenty-nine CMT cavovarus reconstructions were retrospectively analyzed. Three-dimensional measurements were performed using semiautomated software (Bonelogic 2.1) to investigate changes in sagittal, axial, and coronal parameters. Pre- and postoperative data were compared, along with normative data. Correlation among the preoperative measurements and the amount of correction in sagittal, axial, and coronal parameters were analyzed. 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 angle (from 14.8 to 0.1 degrees), axial talonavicular angle (TNA, from 3.6 to 19.2 degrees), and coronal hindfoot alignment (from 11.0 to -11.1 degrees) showed significant changes postoperatively (P < .001). Hindfoot, forefoot sagittal, and forefoot axial parameters reached comparable outcomes compared with normative value (P > .05). Regarding amount of correction, Spearman correlation demonstrated that axial Meary angle and TNA were most strongly related to improvement in sagittal Meary angle and coronal hindfoot alignment. Preoperative and postoperative WBCT measurements demonstrated that joint sparing CMT cavovarus reconstruction significantly improved sagittal, axial, and coronal deformities of CMT, and sagittal Meary 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 cavovarus foot correction. Level IV, retrospective case series.