Foot Progression Angle Research Articles

The anatomy of the pelvis in the exstrophy complex.

We compared computerized tomography scans of the pelvis of twenty-four patients who had exstrophy of the bladder with scans of age-matched controls in order to analyze the pelvic deformity that accompanies the variably severe manifestations of this condition. The patients who had classic exstrophy of the bladder were found to have a mean of 12 degrees of external rotation of the posterior aspect of the pelvis on each side, retroversion of the acetabula, a mean additional 18 degrees of external rotation and 30 per cent shortening of the pubic rami, and progressive diastasis of the symphysis pubis. The foot-progression angle demonstrated 20 to 30 degrees of external rotation beyond the normal limits seen in early childhood, but this improved with age. The patients who had exstrophy of the cloaca and the bladder not only had all of these pelvic deformities to a greater degree but also had asymmetry of measured parameters between the right and left sides of the pelvis, malformation of the sacro-iliac joints, and occasional dislocation of the hip. An understanding of the pelvic anatomy that accompanies exstrophy is essential when corrective approaches are planned. Such an understanding will improve the rate of success of both closure of the bladder and control of urinary continence postoperatively.

Cause of toe-in gait after posteromedial release for congenital clubfoot.

Eighteen children with 24 congenital clubfeet were examined for their foot-progression angle and radiographic angles before and after Turco's posteromedial release. The foot-progression angle was -12.9 degrees before surgery and 1.6 degrees after surgery. The ratio of correction of the foot-progression angle was 58%. Using multiple regression analysis, this ratio was mostly related to the ratio of correction of the anteroposterior talo-first metatarsal and lateral talocalcaneal angles. These results suggest that it is important in correction of toe-in gait of congenital clubfoot to correct adduction deformity of the forefoot and equinus deformity of the hindfoot.

Slipped capital femoral epiphysis. A quantitative analysis of motion, gait, and femoral remodeling after in situ fixation.

A prospective clinical study was done for quantitative examination of motion of the hip, gait, and proximal femoral remodeling after in situ fixation of a slipped capital femoral epiphysis. In situ fixation was performed in forty-five consecutively treated patients (fifty-six hips). Thirty-nine (87 per cent) of the patients returned for examination two years after treatment. The greatest percentage of motion of the hip returned within six months after treatment. Despite loss of internal rotation of the hip, the mean foot-progression angle was 10.8 degrees. Radiography and computerized tomographic scanning revealed minimum change in the relationship of the femoral head to the femoral shaft and no change in the neck-shaft angle. Motion returned despite minimum osseous remodeling. The early return of motion (in the first three months) may have been due to relief of pain, spasm, and synovitis, while soft-tissue stretching and resorption of bone in the anterolateral part of the femoral neck may have accounted for the remainder of the increase in internal rotation.

Foot-Progression Angle in Clubfeet

Foot-progression angle was determined using the Shutrack carbon paper system for 52 feet treated by clubfoot release without wide subtalar release and 43 age-matched controls. Mean foot progression angle was -5 degrees for the clubfeet. This represented 13 degrees of inturning from the normal mean of 8 degrees. Forty-eight percent of the clubfeet had inturning greater than 2 SD from the normal mean. The causes of inturning included adductus (p = 0.005) and, in some cases, internal tibial torsion or internal femoral torsion. Varus of the foot was usually associated with inturning, but inturning was not always associated with varus.