Forefoot Adduction Research Articles

Combined Cuboid-Cuneiform Osteotomy For Correction Of Residual Forefoot Adduction Deformity In Idiopathic Clubfoot

Combined Cuboid-Cuneiform Osteotomy For Correction Of Residual Forefoot Adduction Deformity In Idiopathic Clubfoot

Assessment of the Outcomes of Double Column Osteotomy in Treatment of Residual Forefoot Adduction in Clubfoot

Assessment of the Outcomes of Double Column Osteotomy in Treatment of Residual Forefoot Adduction in Clubfoot

Improving Prenatal Diagnosis Precision for Congenital Clubfoot by Using Three-Dimensional Ultrasonography.

Prenatal diagnosis of clubfoot traditionally relied on two-dimensional ultrasonography. To enhance diagnosis and predict postnatal outcomes, we examined the parameters that differentiate pathological clubfoot using three-dimensional ultrasonography. In our retrospective study, we examined the findings of prenatal ultrasound and the postnatal outcomes of pregnancies with suspected congenital clubfoot between 2018 and 2021. Based on the three-dimensional perspective, we measured the angles of varus, equinus, calcaneopedal block, and forefoot adduction and compared the sonographic variables between the postnatal treated and non-treated groups. We evaluated 31 pregnancies (47 feet) with suspected clubfoot using three-dimensional ultrasonography. After delivery, a total of 37 feet (78.7%) underwent treatment involving serial casting only or additional Achilles tenotomy. The treated group showed significantly greater hindfoot varus deviation (60.5° vs. 46.6°, p = 0.026) and calcaneopedal block deviation (65.6° vs. 26.6°, p < 0.05) compared to the non-treated group. The calcaneopedal block had an area under the curve of 0.98 with a diagnostic threshold of 46.2 degrees (sensitivity of 97%, specificity of 90%, positive predictive value of 97%, and negative predictive value of 90%). During prenatal evaluation of clubfoot using three-dimensional ultrasonography, the calcaneopedal block deviation has the potential to predict postnatal treatment.

Characteristic 3D foot motion patterns during gait of patients with Charcot-Marie-Tooth identified by cluster analysis

BackgroundCMT is a clinically and genetically heterogenous disease with varying degrees of progression. Different foot deformities, gait and movement patterns are observed. In order to achieve an improved, targeted treatment strategy, the participants are divided into characteristic groups using a mathematical cluster analysis based on the data from the three-dimensional foot kinematics during walking. MethodsOutpatients from age 5–64 years (N = 33 participants, 62 feet) with a proven CMT type 1 (N = 16, 31 feet) or CMT without any further type assignment (N = 17, 31 feet) were retrospectively analyzed. After a standard clinical examination, participants underwent 3D gait analysis using the Oxford Foot Model. To classify the movement patterns, a k-means cluster analysis was calculated based on the principal component analysis (PCA) of the foot kinematics data. Gait parameters, clinical parameters and X-ray data were statistically tested. ResultsThe cluster analysis divided the gait data of the participants into two groups. Cluster 1 (N = 21 participants, 34 feet) showed increased dorsiflexion of the hindfoot and increased plantarflexion of the forefoot with cavus position in the sagittal plane, a hindfoot inversion and forefoot pronation with hindfoot varus in the frontal plane and in the transversal plane a forefoot adduction. Cluster 2 (N = 17 participants, 28 feet) deviated significantly from the norm mainly in the frontal plane and were characterized by a strong eversion of the hindfoot with a supination in the forefoot. DiscussionBased on the findings, the resultant clusters can be interpreted as cavovarus feet (cluster 1) and pes valgus (cluster 2). The most reliable variables in the 3D gait analysis to classify CMT feet with regard to significance are the ones in the frontal plane.This subdivision of participants goes hand in hand with the various necessary guidelines for orthopedic treatment.

Management of complex idiopathic clubfoot using modified Ponseti method

Clubfeet with rigid equinus, severe plantarflexion of all the metatarsals, a transverse crease in the sole of the foot, short and hyperextended great toe, forefoot adduction and supination and a deep posterior crease are categorized under the heading of complex clubfeet, which do not respond to the conventional Ponseti technique. Rather treatment of such feet with conventional Ponseti method results in the development of secondary deformities and thus failure of treatment. Hence modification of the technique is warranted for optimal correction of these feet as described by Ponseti. The aim of our study was to evaluate effectiveness of Modified Ponseti technique in the management of complex clubfoot. Thirty two complex clubfeet in 19 patients were managed by Modified Ponseti technique through the study period. Four patients with 7 complex clubfeet were lost to follow-up. At the end of study 15 patients with 25 complex clubfeet were available for final follow up assessment and evaluation. Pirani and Dimeglio score was allotted to each foot at every visit. There after each foot was manipulated and casted as per the Modified Ponseti technique at an interval of one week. Average number of casts required for deformity correction was 7.68. Tendo-achilles tenotomy was obligatory in 23 (93.33 %) feet. The mean follow-up duration was 12.35 months (Range 8-21 months). The mean pre-treatment Pirani score (initial PS) was 5.60±0.54 and mean post-treatment Pirani score (PS at SFAB) was 0.70±0.38. The change in mean score post intervention was found to be statistically significant. The mean pre-treatment Dimeglio score (initial DS) was 15.80±2.02 and mean post-treatment Dimeglio score (DS at SFAB) was 3.68±1.35. The change in mean score post intervention was found to be statistically significant. Relapse rate was 4% (n=1), which responded to re-casting with modified Ponseti technique and re-tenotomy of the tendo-achilles. Based on our study results and existing literature we recommend modified Ponseti technique as the first line initial treatment for these complex feet. However such feet require higher number of plaster casts with higher rate of tendo-achilles tenotomy, with high relapse rate than their classical idiopathic counterparts, nonetheless the eventual outcome is reasonable correction of deformity, negating the necessity of multifaceted operating procedures.

Outcomes of Eight-Plate Epiphysiodesis for Residual Clubfoot Deformities.

The outcome of congenital clubfoot treatment is still challenging if the feet deformities are not completely corrected. Here we explore a minimal invasive procedure with an eight-plate implant to correct the residual forefoot adduction deformity after treatment of neglected or relapsed clubfoot. We retrospectively reviewed patients with residual forefoot adduction deformity after clubfoot treatment between January 2013 and June 2016. The patients underwent temporary epiphysiodesis of the lateral column of the mid-foot, which in detail, an eight-plate was placed on each side of the calcaneocuboid joint. The foot deformities were recorded according to the weight-bearing radiographic measurements including talo-first metatarsal angle, calcaneo-fifth metatarsal angle and medial-to-lateral column length. A total of 13 patients (20 feet) with an average age of 7.8 years old were located with an average duration of 40.8 months follow-up (range, 28 to 54months). The average talo-first metatarsal angle improved from 28.3° (range, 19° to 47°) preoperatively to 8.3° (range, 3° to 18°) and the calcaneo-fifth metatarsal angle improved from 29.1° (range, 19° to 40°) preoperatively to 8.4° (range, 0° to 21°) at final follow-up. The mean ratio of the medial-to-lateral column length improved from 1.14 ± 0.06 to 1.55 ± 0.09 with statistical significance (t=3.566; P < 0.001). Eight-plate epiphysiodesis is an easy and effective method for the correction of residual forefoot adduction deformity after clubfoot treatment in growing children without the need of osteotomy.

Effect of Different Ankle-Foot Immobility on Lateral Gait Stability in the Stance Phase.

Background This study aimed to investigate the effect of limited foot and ankle mobility on the lateral stability of gait through the observation of the mediolateral margin of stability and related kinematic parameters. Methods Thirty young, healthy participants walked at a fixed gait velocity on a level surface. Participants achieved different degrees of restricted mobility by wearing soft-soled shoes (S), an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion activity only (A), and an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion and adjustable horizontal rotation of the foot (OU/OR). Furthermore, the spatiotemporal parameters, mediolateral margin of stability, center of pressure, angle of the fore and hind foot relative to the tibia, and correlation coefficients of the factors were analyzed. Regression analysis was also performed. Results At right heel strike, group A had a significantly lower mediolateral margin of stability than group S and group OU. Meanwhile, forefoot adduction (0.2 < |r| <0.4) and plantarflexion (0.2 < |r| <0.4), as well as hindfoot internal rotation (0.2 < |r| <0.6) and inversion (0.2 < |r| <0.4), correlated negatively with lateral stability. Regression analysis revealed forefoot dorsiflexion and supination were the main independent variables for group A. At right heel off, groups OU and OR had a significantly lower mediolateral margin of stability than those in groups A and S. Forefoot adduction (0.2 < |r| <0.4) and dorsiflexion (0.4 < |r| <0.6) were correlated with lateral stability, as were hindfoot dorsiflexion (0.2 < |r| <0.4) and inversion (0.2 < |r| <0.4). Regression analysis revealed forefoot abduction and plantarflexion were the main independent variables for groups OU and OR. Conclusions The present study verified from gait data that forefoot dorsiflexion and supination at the initial contact of the stance phase were relevant factors for the differences in lateral gait stability, whereas abduction and plantar flexion of the forefoot at the terminal stance phase were the main influencing factors of lateral gait stability.

FACTORS ASSOCIATED WITH RECURRENCE CLUBFOOT

Background: Clubfoot is an intricate deformity of ankle and foot involving bony mal-alignment, adduction of forefoot, and hind-foot Varus, cavus, and equines caused by contracture of soft tissues. The many factor contribute to relapse of clubfoot, are neglected when advise the Proper pan of care. Objective: To find the association of clubfoot recurrence with no proper exercise and improper fitting of Denis Browne splint shoe. Materials &amp; Methods: A cross sectional study was conducted at PIPOS Rehabilitation Service Program (PRSP), Peshawar. The data was collected from a sample of n=300 patients in Pakistan Institute of Prosthetic and Orthotic Science. The non-probability convenient sampling technique was used for data collection. The duration of the study was 6 months (April 2019 to October 2019). The male and female recurrent clubfoot children whose are either infant or till the age of 6 and registered in PRSP. The data collection was done through an international club foot registry form and self structured questionnaire. The results are presented in term of descriptive statistics and Chi-Square test was also performed to assess club foot and other variable association with each other. Results: The result showed n=110(37.3%) participants reported they had no proper fitting of Denis Browne Splint shoe (DBS) and n=97(32.3%) showed they underwent no proper exercise follow up. There was significant association of club foot recurrence with improper fitting of DBS (p&lt;0.001) and no proper exercises (p=0.02). Conclusion: The study indicated that without proper exercises and in appropriate fitting of DBS may lead to recurrence of club foot. Keywords: Congenital Talipes Equinovarus, Clubfoot, Denis Browne Splint, Ponseti method

Standard and accelerated ponseti technique in management of idiopathic congenital talipes equinovarus: A comparative study

Introduction: Congenital talipes equinovarus (CTEV) is one of the most common deformities of foot and ankle. Incidence of CTEV is around 1 in every 1000 live births. Males are affected twice as often as females. Bilateral deformities occur in 50% of cases and in unilateral cases, right foot has predominance. Components of Congenital talipes equinovarus are cavus, forefoot adduction, hindfoot varus, ankle equinus. Goal of clubfoot management is to produce and maintain a painless, functional, mobile and callosity free, normal shoeable foot. In an accelerated ponseti technique, cast is applied twice weekly on fixed days instead of one week. This study compares the results of Standard Ponseti technique with Accelerated Ponseti technique in management of idiopathic CTEV. Materials and Methods: A hospital based prospective randomized comparative study was conducted in the Dept. of Orthopaedics of Silchar Medical College,Silchar, Assam from 1stJune 2020 to 31st may 2021. Total of 50 cases were selected randomly, randomization was done, 25 were treated by Standard Ponseti and 25 were treated by Accelerated Ponseti technique. Results: Mean Pirani score at presentation in standard Ponseti group was 5.25±0.76, and in accelerated Ponseti group it was 5.37±0.65, with p-value indicating that two groups did not have significant difference. In standard Ponseti group, the treatment time in plaster ranged from 28-56 days, and in accelerated Ponseti group it ranged from 14-31 days. Discussion: Modification in frequency of casting has shown that the efficacy remains unchanged but correction of deformity occurs in a shorter span of time. Reduction in duration of treatment will help to improve compliance among parents. Conclusion: Ponseti method has shown good results in idiopathic as well as syndromic CTEV. This Study shows that Accelerated Ponseti method is equally effective as Standard Ponseti method in treatment of idiopathic CTEV with the benefit of reduction in treatment time.

Understanding the role of foot biomechanics on regional foot orthosis deformation in flatfoot individuals during walking

BackgroundFoot orthoses (FOs) are one of the most common interventions to restore normal foot mechanics in flatfoot individuals. New technologies have made it possible to deliver customized FOs with complex designs for potentially better functionalities. However, translating the individuals’ biomechanical needs into the design of customized FOs is not yet fully understood. Research questionOur objective was to identify whether the deformation of customized FOs is related to foot kinematics and plantar pressure during walking. MethodsThe kinematics of multi-segment foot and FOs contour were recorded together with plantar pressure in 17 flatfoot individuals while walking with customized FOs. The deformation of FOs surface was predicted from its contour kinematics using an artificial neural network. Plantar pressure map and deformation were divided into five anatomically based regions defined by the corresponding foot segments. Forward stepwise linear mixed models were built for each of the four gait phases to determine the feet-FOs interaction. ResultsIt was observed that some associations existed between foot kinematics and pressure with regional FOs deformation. From heel-strike to foot-flat, longitudinal arch angle was associated with FOs deformation in forefoot. From foot-flat to midstance, rearfoot eversion accounted for variation in the deformation of medial FOs regions, and forefoot abduction for the lateral regions. From midstance to heel-off, rearfoot eversion, longitudinal arch angle, and plantar pressure played significant role in deformation. Finally, from heel-off to toe-off, forefoot adduction affected the deformation of forefoot and midfoot. SignificanceThis study provides guidelines for designing customized FOs. Flatfoot individuals with excessive rearfoot eversion or very flexible medial arches require more support on medial FOs regions, while the ones with excessive forefoot abduction need the support on lateral regions. However, a compromise should be made between the level of support and the level of increase in plantar pressure to avoid stress on foot structures.

Forefoot adduction and forefoot supination as kinematic indicators of relapse clubfoot.

Understanding the kinematic characteristics of relapse clubfoot compared to successfully treated clubfoot could aid early identification of a relapse and improve treatment planning. The usage of a multi segment foot model is essential in order to grasp the full complexity of the multi-planar and multi-joint deformity of the clubfoot. The purpose of this study was to identify differences in foot kinematics, using a multi-segment foot model, during gait between patients with Ponseti treated clubfoot with and without a relapse and age-matched healthy controls. A cross-sectional study was carried out including 11 patients with relapse clubfoot, 11 patients with clubfoot and 15 controls. Gait analysis was performed using an extended Helen Hayes model combined with the Oxford Foot Model. Statistical analysis included statistical parametric mapping and discrete analysis of kinematic gait parameters of the pelvis, hip, knee, ankle, hindfoot and forefoot in the sagittal, frontal and transversal plane. The relapse group showed significantly increased forefoot adduction in relation with the hindfoot and the tibia. Furthermore, this group showed increased forefoot supination in relation with the tibia during stance, whereas during swing increased forefoot supination in relation with the hindfoot was found in patients with relapse clubfoot compared with non-relapse clubfoot. Forefoot adduction and forefoot supination could be kinematic indicators of relapse clubfoot, which might be useful in early identification of a relapse clubfoot. Subsequently, this could aid the optimization of clinical decision making and treatment planning for children with clubfoot.

Novel device for nonsurgical correction of rigid forefoot adduction in children.

Forefoot adduction deformity (FAD) (commonly called metatarsus adductus) is reported as the most common congenital foot deformity in newborns. Early diagnosis and treatment are important in rigid cases, as better outcomes have been reported if treatment was initiated before 9 months of age. While casting and splinting is the current standard of care for nonsurgical management of rigid FAD (RFAD), several orthoses have demonstrated equal benefit. The Universal Neonatal Foot Orthotic (UNFO) brace is below ankle orthosis that provides continuous pressure, thereby correcting the deformity without casting. To the best of our knowledge, UNFO is the first brace that operates below the ankle. The aim of this study was to compare the effectiveness of UNFO shoe to standard serial casting in the treatment of RFAD in infants. Between the years 2012 and 2019 we treated 147 feet (94 patients): 52 using the UNFO shoes and 95 by standard casting and splinting protocol. The treatment groups were compared based on treatment duration, complications, and recurrence of deformity. Mean full-time treatment duration was significantly shorter in the UNFO group, while no significant difference in the total duration of treatment was observed. Similar complication and recurrence rates were demonstrated. In conclusion, treatment with UNFO is equally effective to serial casting. The use of UNFO increases convenience and diminishes social burden, thus providing a distinct advantage over other treatment modalities.

English

BACKGROUND Though the Ponseti method has become the popular and standard of care for clubfoot correction, relapse of clubfoot deformity following correction is not uncommon. The relapsed feet can progress from flexible to rigid if left untreated and can become as severe as the initial deformity. The purpose of this study was to analyse the relapse pattern in clubfeet that have undergone treatment with the Ponseti method. METHODS Between 2015 and 2017, 78 children (134 feet), 58 boys and 20 girls were included in this study. It was a prospective observational study of relapse patterns in idiopathic clubfoot after one year of completion of the Ponseti method of treatment. Pirani scoring system was used to identify the relapse. RESULTS Dynamic, fixed, and complete relapse patterns were observed in this study. Patients were categorised into two groups - bilateral and unilateral. In the bilateral group, 18 children (36 feet i.e. 23 %) had decreased ankle dorsiflexion, 5 had (10 feet i.e. 6 %) rigid equinus, 22 had (44 feet i.e., 29 %) dynamic forefoot adduction or supination and 5 had (10 feet i.e. 6 %) fixed adduction in forefoot and midfoot. Six children from the bilateral group showed complete relapse. Among the unilateral group, 8 children (8 feet i.e. 36 %) presented with decreased ankle dorsiflexion, 4 had (4 feet i.e. 18 %) rigid equinus relapse, 6 had (6 feet i.e. 27 %) dynamic forefoot adduction or supination and 4 had (4 feet i.e. 18 %) showed fixed forefoot adduction. CONCLUSIONS Dynamic forefoot adduction or supination pattern is common to relapse pattern in the bilateral group and dynamic hind-foot relapse was common in the unilateral group. Age at initial presentation, initial Pirani score, and the number of casts required were not significantly related to the incidence of relapse. KEYWORDS Club Foot, CTEV, Ponseti Method, Relapse Pattern

Universal neonatal foot orthotics-a novel treatment of infantile metatarsus adductus.

Approximately one in 100 babies has metatarsus adductus) MTA(. Although most deformities may resolve spontaneously, moderate and severe deformities might cause future discomfort and are therefore often treated. Common treatment alternatives include stretching, serial casting, and orthoses. Surgery is reserved for severe cases that are unresponsive to conservative management. The purpose of this study was to present our experience with a novel orthosis designed to correct and maintain correction of MTA in infants. Seventy-three children between the ages of 4 and 11.5 months with moderate to severe MTA were treated using the Universal Neonatal Foot Orthosis (UNFO). Treatment was started in cases of rigid deformity when the child was first seen in the clinic, or after the age of 5 months in children with moderate or severe but flexible deformity that failed to improve spontaneously. The orthosis was applied for 23 h daily. Weaning was started after a complete correction of the deformity was achieved. Follow-up was continued at least until walking age. Results were assessed utilizing the heel bisector line (HBL) as a measure of foot deformity before, during, and after treatment completion, and at the end of follow-up. Seventy-one patients (114 feet (were followed from the time of diagnosis to at least walking age. There were 102 severe (HBL at, or lateral to, the 4TH toe) and 12 moderate MTA (HBL between 3rd and 4th toes). Average age at the beginning of treatment was 6.58 months (range 4-11.5). Of the study population, 56 patients (98 feet) improved significantly by the end of the follow-up. In 11 children (11 feet), no change was noted, and in 3 children (3 feet), worsening of the deformity was observed at the end of follow-up. In one child who discontinued treatment after 6 weeks, there was no change in one foot and worsening in the other. Minor side effects were observed in 11 patients, all resolved uneventfully.Conclusion: UNFO is an effective treatment for moderate and severe MTA in children younger than10 months, with only infrequent minor side effects. What is Known: • Debate exists as to which patient warrants treatment since spontaneous improvement is the rule. However, some deformities persist to adulthood and may be esthetically unpleasing. • Treatment modalities available vary from benign neglect, special shoe ware that are either static or need special tools, and knowledge to adjust or casting by an orthopedic surgeon What is New: • This is a description of the results of treatment with a new orthotics which may be applied by pediatricians to treat this very common neonatal deformity. The orthotics provides an excellent, short duration solution, easy for the baby and caregiver with results comparable to those of more elaborate orthotics and casting • The use of digital pictures to assess forefoot adduction deformity severity instead of radiographs is a reliable measurement method.

Effect of Modified Ankle Foot Orthoses (AFO) along with Goal-Oriented Physiotherapy in a Child with Spastic Diplegic Cerebral Palsy–An Interesting Case Report

Cerebral Palsy (CP) is considered as a neurological condition caused by a non-progressive damage ormalformation of the brain that occurs during the developmental process. Body movement and musclesynchronization are mainly impaired in children with Cerebral Palsy. Each cerebral palsy case is uniqueto the person. One person may have complete paralysis and need continuous treatment, while another mayhave mild movement tremors with partial paralysis but require little assistance. The form and the timing ofthe injury to the developing brain are the main reasons for such impairments. Orthoses are primarily used totreat the secondary musculoskeletal problems of muscle contracture and bony deformity. In the Present Casereport a modified Ankle Foot Orthoses (AFO) is used bilaterally by using an extra malleolar orthosis, medialblock to prevent forefoot adduction and an extra strap to prevent navicular drop for a 7-year-old SpasticDiplegic girl child who was in Gross Motor Functional Classification System (GMFCS) grade III. After a3-month goal-oriented physiotherapy treatment program primarily focusing on gait, we observed decreasedNavicular drop, increased ankle stability (Twisting was not seen), improvement in Gait Parameters such asIncreased stride length, Cadence and improved gait velocity.

Evaluation of effectiveness of Ponseti's method in the clubfoot management under 1-year children: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Congenital talipes equino Varus is common congenital orthopedic foot deformity in children characterized by hindfootequinus, hind foot varus, midfoot cavus, and forefoot adduction deformities. There is a necessity to analyze the number of casts employed in the treatment, compliance of bracing, relapse pattern and percentages of surgical referral under 1 year of age for clear understanding and better practice to achieve successful outcomes. This study aimed to judge the effectiveness of Ponseti in the treatment of clubfoot under 1-year old children. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The patients were selected in the OPD and evaluated for virgin idiopathic clubfoot under 1-year age. Serial casting done weekly by Ponseti method after assessing Pirani and Demeglio score before every cast.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study all 29 clubfeet that were treated by Ponseti method showed complete correction. Minimum cast being 5 and maximum being 10 casts. Corrected feet were supple, plantigrade and painless of which 1 foot had relapse&amp;lt;3weeks due to ill-fitting shoes. Which was subsequently corrected with repeat tenotomy and cast application.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The Ponseti method is a safe, effective, cheap and reproducible method for correction of CTEV which significantly reduces the rate of extensive corrective surgeries for correction of clubfoot under 1-year age. For successful outcome and to prevent relapse, this technique must be applied strictly in accordance to the protocol and parents must be taught the importance of full compliance with bracing. Our series has a short follow up. Longer follow-up is needed for further evaluation of effectiveness of Ponseti method. &lt;/p&gt;

Correlation between clinical and radiographic parameters of the feet in children with flatfoot

Background. Flatfoot in children is one of the most common reasons for visiting an orthopedic specialist. The main criteria in determining various types of flatfoot are clinical (severity of arch flattening, hindfoot valgus, and degree of the foot dorsiflexion) and radiographic (angular values calculated from lateral and anteroposterior radiographs). The primary assessment of the degree of flatfoot is based on the clinical criteria. Detection of changes in the foot shape is the reason for the radiographic assessment.&#x0D; Aim. This study aimed to determine and analyze the relationship between clinical and radiological parameters of the feet in children with flatfoot.&#x0D; Materials and methods. The study group included patients with flatfoot observed in the outpatient clinic of H. Turner National Medical Research Center within the period from 2018 to 2020. The study population consisted of 30 children (53 feet) with flexible flatfoot and 65 children (111 feet) with flatfoot and short Achilles tendon. The patients were 10 (8.3; 12) years old. Clinical parameters (valgus value, longitudinal arch angle, and degree of foot dorsiflexion) and radiographic data (Kites angle, Mearys angle, calcaneal pitch, talotibial angle, longitudinal arch angle, talonavicular coverage angle, and forefoot adduction angle) were analyzed. Statistical differences were determined between groups of patients with flexible flatfoot and patients flatfoot and short Achilles tendon, and correlations between the studied parameters were identified.&#x0D; Results. Strong correlations were revealed in the following pairs of criteria: lateral Kites angle and lateral Mearys angle; talotibial angle and lateral Mearys angle; radiographic longitudinal arch angle and lateral Mearys angle; talotibial angle and lateral Kites angle; foot dorsiflexion and foot dorsiflexion with great toe extension; and radiographic longitudinal arch angle and calcaneal pitch. Only moderate and weak correlations were found between clinical and radiographic parameters of the feet.&#x0D; Conclusion. The relationship between clinical and radiographic parameters of the feet in patients with flatfoot is characterized by a moderate and weak correlation. Results suggest that the assessment of the clinical parameters of the feet in this population does not provide complete information about the degree of flatfoot.

Clinical outcome of tibiotalocalcaneal fusion using cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach

To evaluate the clinical outcome of tibiotalocalcaneal fusion using cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach. From June 2015 to December 2018, 15 patients underwent a tibiotalocalcaneal fusion operation using cannulated screw and inverted proximal humerus locking plate through a transfibular approach. There were 10 males and 5 females with the age ranging from 45 to 72 (58.9±6.1) years, and the course of disease ranged from 2 to 35 (11.9±7.9)years. Preoperative diagnosis included 8 cases of post traumatic arthritis, 2 cases of Charcot arthritis, 2 cases of Charcot-Marie -Tooth (CMT), 1 case of ankle tuberculosis, 1 case of talar necrosis, and 1 case of pigmented villonnodular synovitis. Among them, 8 patients were combined with simple varus deformity, 4 patients with simple valgus deformity, 2 patients with equinovarus deformity, 1 patient with equinovarus deformity, 2 patients with adduction and internal rotation of middle and forefoot. American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and the visual analogue scale (VAS) score were used to evaluate the clinical outcome at the last follow up. One lost follow up and remaining fourteen patients were followed up. The follow up time ranged from 10 to 25(16.6±4.3) months. All the 15 patients had primary healing. Fusion time ranged from 15 to 24 (16.8 ± 2.4) weeks after operation. One patient with diabetes experienced delayed union and was successfully treated with secondary bone grafting combined with Platelet-Rich Plasma (PRP) injection. The AOFAS score increased from 38.7±3.3 to 84.5±2.6 (P<0.05), and the VAS score decreased from 7.5±1.6 to 1.9±0.3(P<0.05). Tibiotalocalcaneal fusion used cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach has the advantages of relatively simple technique, high fusion rate, especially for patients with posterior foot deformity, which has satisfactory short term effects.

Clinical and Radiological Evaluation of Results of Surgical Correction of Forefoot Adduction by Cuneiform and Cuboid Osteotomy Using Radiological Forefoot Measurements.

Forefoot adduction is a relatively common problem. It is usually mild or it can be effectively managed conservatively. Severe deformities may require surgical treatment. The aim of the study was to perform a clinical and radiologic evaluation of forefoot adduction correction using medial cuboid and cuneiform osteotomy with a transposed wedge. This is a retrospective study involving 16 patients who underwent 20 procedures. Mean age at surgery was 6 years (3-13). Clinical evaluation was based on measurements of forefoot deviation and patients'/care-givers' subjective opinion. The radiologic parameters assessed comprised the first ray angle, talar-first metatarsal angle, calcaneal-fifth metatarsal angle, talocalcaneal angle, metatarsus adductus angle, and Kilmartin's angle. Results were then compared in children below and above 6 years of age. The mean duration of follow-up was 4.6 years (2-9). The clinical and subjective outcome was rated as good in 16 procedures and satisfactory in 4. The talar-first metatarsal angle, calcaneal-fifth metatarsal angle, metatarsus adductus angle, and Kilmartin's angle were significantly reduced, while the talocalcaneal and first ray angle remained unchanged. A significantly better correction of metatarsus adductus and talar-first metatarsal angle was achieved In children below 6 years of age compared to older patients. 1. Medial cuneiform and cuboid osteotomy with a transposed wedge improves both clinical and radiological parameters, especially in children under the age of 6. 2. Besides the metatarsus adductus angle, the talar-first meta-tarsal, calcaneal-fifth metatarsal and Kilmartin's angles appear to be good radiologic indicators of correction.

RECURRENCE OF DEFORMITY IN IDIOPATHIC CTEV TREATED BY PONSETI TECHNIQUE

Congenital talipes equinovarus (CTEV) or clubfoot, is one of the commonest congenital deformity . At present ,Ponseti method is most commonly used successful reliable , essentially conservative technique for correction of CTEV deformity and successful in upto 98% of feets. However there is a chance of the relapse or recurrence . A prospective and observational study after getting institutional ethical clearance was conducted in the department of Orthopedics, at COM and JNM Hospital, Kalyani, Nadai, WB, between August 2018 to July , 2020 including baby with club foot . Total study sample size was 20 according to inclusion and exclusion criteria. The mean age of presentation was 4 ± 2.51 week . The male to female ratio was 1.86:1. Bilateral feet involvement was 50% . In unilateral involvement , right side was affected 70%, left side was affected in 30 % cases. Family history of CTEV was seen in 20% cases. Mean body weight of babies was 2.49 ± 0.17kg . At presentation , mean pirani score was 5 ± 0.48. Tenotomy was done 75% cases . Relapse rate was 15 %, mean age of relapse was 7 ± 1.73205 month , occurred in most common in left side (66%). There was history of non-adherence of abduction brace for &gt;2 month in all three patients adduction score was 0.5 in all child . Most common deformity relapse was adduction of forefoot. Ponseti method is cost effective especially in developing country . Strict adherence to brace protocol and good communication between heath care persons and parents reduces incidence of relapse. Relapse is relatively common even in Ponseti method and most of cases , it manageable by conservative treatment like cast.