Medial Arch Research Articles

Medial longitudinal arch biomechanics evaluation during gait in subjects with flexible flatfoot.

Medial longitudinal arch (MLA) strengthening has been considered an important part of successful flatfoot treatment. But, to date, the biomechanical loading behavior of the medial arch in flatfoot has not been evaluated. This study aimed to evaluate the MLA moment, MLA deformation angle, foot kinematics and ground reaction forces (GRF) in both normal foot and flatfoot groups. Each participant's foot was classified according to arch type using foot prints and radiographs. Twenty-eight non-obese adults (13 flatfeet and 15 normal feet) were involved. The biomechanics data were collected in a 3D motion analysis laboratory. The MLA biomechanics were calculated. Hindfoot and forefoot kinematics were also analyzed. The flatfoot group had a significantly greater peak eversion MLA moment (p = 0.005) and a smaller peak MLA deformation angle (p < 0.05) during specific subphases. The peak of hindfoot plantarflexion (p < 0.05) and internal rotation (p < 0.05) and the peak of forefoot abduction ( p < 0.05) in the specific subphases were greater in the flatfoot group. The flatfoot group also had significantly smaller peak vertical GRF ( p < 0.05) during late stance and larger peak medial GRF (p < 0.05) during mid stance. This study found a significantly greater eversion deforming force acting at the MLA structure, greater hindfoot and forefoot motion, less MLA flexibility and abnormal GRF in a flatfoot group during walking, which reflected the deficit of foot function in a flatfoot group.

Does Medial Arch Height Differs from Barefoot Runners to Shod Runners? – an Analytical Study

Abstract Introduction and background: The integrity of foot arch plays a vital role in providing shock absorption in lower limb activities. Barefoot running is presumed to help retraining intrinsic foot muscle and causing a well developed medial arch of foot compared shod runners as reported by researchers and allowing proper stretch and recoiling effect on foot arch, thereby preventing injuries in runners. Thus this study was intended to analyze variation in medial arch height of foot among long, middle distance shod and barefoot runners. Study design: cross sectional study.Sampling method: convenient stratified sampling.Methodology: For this purpose, 60 samples were selected. Namely 20 from barefoot runners, 20 from shod runners and 20 from controls in analysing their medial arch height with validated tool named normalized navicular height truncated (NNH) to see if there is real difference exist in arch height static weight bearing posture among these groups.Results: ANOVA test was used to analyze significance of difference among three groups NNH and resulted in p=0.88 for right foot and p=0.34 on left foot.Conclusion: The current study revealed no significant difference between these three groups in the evaluation of navicular height normalized.Keywords: Normalized navicular height, runners, BMICorresponding author :Watson Arulsingh E-mail: watsonarulsingh@yahoo.in. Contact Number +91 9945892843much recent study, Lieberman et. al.

Cavovarus deformity in Charcot-Marie-Tooth disease: is there a hindfoot equinus deformity that needs treatment?

BackgroundCharcot-Marie-Tooth disease (CMT), one of the most common hereditary neurologic disorders, often results in debilitating cavovarus foot deformities. The deformities are still not fully understood, and the treatment recommendations are consequently heterogeneous, often including calf muscle or Achilles tendon lengthening.MethodsWe examined 40 patients (80 feet) with CMT and bilateral cavovarus deformities (19 men and 21 women, mean age 33.6 ± 14.6 years) and the feet of a healthy control population of 13 individuals (7 men and 6 women, mean age 43.9 ± 10.8 years). In all cases 3D instrumented gait analysis results with both conventional Plug-in-Gait analysis and the Heidelberg Foot Measurement Method (HFMM) were used to determine the sagittal plane kinematics, dorsi-plantar flexion (DPF), tibio-talar dorsiflexion (TTDF), and medial arch angle (MAA), and the results of patients and the control group were compared using the 2 methods. Decreased and increased dorsiflexion using TTDF was defined as 1 standard deviation below or above the mean of the control. Comparisons were done using descriptive statistics, the Pearson correlation coefficient and ANOVA.ResultsThe TTDF was found to be decreased in 18 of the 80 feet examined (22.5 %), normal in 31 feet (38.75 %), and increased in 31 feet (38.75 %). The Pearson coefficient showed a positive correlation with R = 0.765, p < 0.001 between decreased TTDF values found by HFMM and decreased DPF values found with conventional Plug-in-Gait analysis, but a very weak correlation in patients with normal TTDF (R = -0.118) and increased TTDF (R = 0.078). Also, in patients with decreased TTDF values, there was a weak to moderate correlation with the MAA (R = 0.335), but no correlation between the MAA and DPF (R = 0.023).ConclusionsThe HFMM, unlike the conventional Plug-in-Gait analysis, distinguishes between the segments of the foot in foot deformities and facilitates evaluation of the hindfoot equinus component in patients with CMT and cavovarus deformity. Although there is a significant correlation between decreased TTDF with HFMM and decreased DPF with conventional Plug-in-Gait analysis, this correlation was not seen in patients with normal or increased TTDF values. Conventional Plug-in-Gait analysis alone does not indicate if an increased plantar flexion deformity is the result of either a cavus deformity or hindfoot equinus deformity, which limits its usefulness in assisting in treatment decision making.

Acquired Flat Foot due to Tibialis Posterior Rupture, a Known Yet Missed Cause

AbstractRupture of tibialis posterior tendon is a known cause of acquired flat foot but the diagnosis is missed or delayed in most of the cases. It may lead to significant morbidity. We present a case of 13 years old boy with history of blunt trauma to his left foot one year back and presented with pain medial aspect of right foot and difficulty in prolonged walking and running. Clinically he had a flat and hyperpronated foot. His x-rays were normal and MRI revealed partial tear of posterior tibial tendon. He was recommended medial arch support, shoe modification, NSAIDs and referred to orthopedic surgeon for repair. Posterior tibialis tendon dysfunction is one of the concealed injuries that require earliest diagnosis and immediate attention, failing which the outcomes can have debilitating effects on patient's quality of life. This is important to prevent foot deformities and long term disability.

Correlation between hindfoot joint three-dimensional kinematics and the changes of the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot

BackgroundThe aim of this study was to explore the correlation between the kinematics of the hindfoot joint and the medial arch angle change in stage II posterior tibial tendon dysfunction flatfoot three-dimensionally under loading. MethodsComputed tomography (CT) scans of 12 healthy feet and 12 feet with stage II posterior tibial tendon dysfunction flatfoot were taken both in non- and full-body-weight-bearing condition. The CT images of the hindfoot bones were reconstructed into three-dimensional models with Mimics and Geomagic reverse engineering software. The three-dimensional changes of the hindfoot joint were calculated to determine their correlation to the medial longitudinal arch angle. FindingsThe medial arch angle change was larger in stage II posterior tibial tendon dysfunction flatfoot compared to that in healthy foot under loading. The rotation and translation of the talocalcaneal joint, the talonavicular joint and the calcanocuboid joint had little influence on the change of the medial arch angle in healthy foot. However, the eversion of the talocalcaneal joint, the proximal translation of the calcaneus relative to the talus and the dorsiflexion of talonavicular joint could increase the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot under loading. InterpretationJoint instability occurred in patients with stage II posterior tibial tendon dysfunction flatfoot under loading. Limitation of over movement of the talocalcaneal joint and the talonavicular joint may help correct the medial longitudinal arch in stage II posterior tibial tendon dysfunction flatfoot.

High-Intensity Running and Plantar-Flexor Fatigability and Plantar-Pressure Distribution in Adolescent Runners

Fatigue-induced alterations in foot mechanics may lead to structural overload and injury. To investigate how a high-intensity running exercise to exhaustion modifies ankle plantar-flexor and dorsiflexor strength and fatigability, as well as plantar-pressure distribution in adolescent runners. Controlled laboratory study. Academy research laboratory. Eleven male adolescent distance runners (age = 16.9 ± 2.0 years, height = 170.6 ± 10.9 cm, mass = 54.6 ± 8.6 kg) were tested. All participants performed an exhausting run on a treadmill. An isokinetic plantar-flexor and dorsiflexor maximal-strength test and a fatigue test were performed before and after the exhausting run. Plantar-pressure distribution was assessed at the beginning and end of the exhausting run. We recorded plantar-flexor and dorsiflexor peak torques and calculated the fatigue index. Plantar-pressure measurements were recorded 1 minute after the start of the run and before exhaustion. Plantar variables (ie, mean area, contact time, mean pressure, relative load) were determined for 9 selected regions. Isokinetic peak torques were similar before and after the run in both muscle groups, whereas the fatigue index increased in plantar flexion (28.1%; P = .01) but not in dorsiflexion. For the whole foot, mean pressure decreased from 1 minute to the end (-3.4%; P = .003); however, mean area (9.5%; P = .005) and relative load (7.2%; P = .009) increased under the medial midfoot, and contact time increased under the central forefoot (8.3%; P = .01) and the lesser toes (8.9%; P = .008). Fatigue resistance in the plantar flexors declined after a high-intensity running bout performed by adolescent male distance runners. This phenomenon was associated with increased loading under the medial arch in the fatigued state but without any excessive pronation.

A STUDY OF FOOTPRINTS OF TREE-CLIMBING COMMUNITIES OF SOUTH INDIA

AbstractThe paper details the morphological adaptations of the foot shape and its arches to sustained professional tree climbing activity. Foot inversion, as required by climbers on a long term and regular basis reshapes the bony architecture of the foot and the medial longitudinal arch over a period of time. These changes can be observed and measured, noninvasively through study of footprints.This community study on the progressive adaptation of the arch to the rigors of climbing was recorded through footprints collected from the climbers with varied experience in the profession. The collation of observations show that the medial arch continues to shrink with sustained inversion, raising the dome of the instep.The progressive compensatory rise in arch height however, is arrested abruptly after a phase, with failure of the arch to accommodate further to more stress – leading to slipping and falls from heights. The article discusses the bio-mechanisms and kinetics of foot adaptation to the rigors of climbers and analysis the cause of accidental falls, even though most of the accidental fall victims have had a number of years of climbing experience.

Reconstruction of the Medial Talonavicular Joint in Simulated Flatfoot Deformity

Reconstructing the ligamentous constraints of the medial arch associated with adult acquired flatfoot deformity remains a challenge. The purpose of this study was to test the efficacy of several reconstruction techniques of the medial arch. We hypothesized that an anatomic reconstruction of the spring ligament complex would correct the deformity better than other techniques tested. Three reconstructions of the medial support structures were performed on each specimen to recreate the different lines of action and insertions of the medial ligamentous complex in 12 specimens with a simulated flatfoot deformity. Talonavicular and tibiocalcaneal (hindfoot) orientations were measured in the axial, sagittal, and coronal planes in the intact, flatfoot, and reconstructed conditions. While each reconstruction technique corrected the deformity (P < .05), proximal fixation of the graft corrected the greatest amount of talonavicular deformity while also correcting hindfoot valgus (P < .05). The fixation points and lines of action of a medial arch reconstruction have important implications on deformity correction in a flatfoot model. Despite its fidelity to the native structure, the anatomic spring ligament reconstruction provided the least amount of correction. These findings suggest that other ligamentous structures of the medial arch are critical in supporting the midfoot. Reconstruction of the ligamentous supports of the medial arch might be able to correct substantial amounts of deformity without osseous procedures like calcaneal osteotomies or midfoot fusions.

Assessing plantar pressure distribution in children with flatfoot arch: application of the Clarke angle.

Flatfoot, or pes planus, is one of the most common foot posture problems in children that may lead to lower-extremity pain owing to a potential increase in plantar pressure. First, we compared plantar pressure distribution between children with and without flatfoot. Second, we examined the reliability and accuracy of a simple metric for characterization of foot posture: the Clarke angle. Third, we proposed a mathematical model to predict plantar pressure magnitude under the medial arch using body mass and the Clarke angle. Sixty children with flatfoot and 33 aged-matched controls were recruited. Measurements included in-shoe plantar pressure distribution, ground reaction force, Clarke angle, and radiography assessment. The measured Clarke angle was compared with radiographic measurements, and its test-retest reliability was determined. A mathematical model was fitted to predict plantar pressure distribution under the medial arch using easy-to-measure variables (body mass and the Clarke angle). A high correlation was observed between the Clarke angle and radiography measurements (r > 0.9; P < 10(-6)). Excellent between- and within-day test-retest reliability for Clarke angle measurement (intraclass correlation coefficient, >0.9) was observed. Results also suggest that pressure magnitude under the medial arch can be estimated using the Clarke angle and body mass (R(2) = 0.95; error, <0.04 N/cm(2) [2%]). This study suggests that the Clarke angle is a practical, reliable, and sensitive metric for quantification of medial arch height in children and could be recommended for research and clinical applications. It can also be used to estimate plantar pressure under the medial arch, which, in turn, may assist in the timely intervention and prognosis of prospective problems associated with flatfoot posture.

Ganglion Cyst Contiguity of the Flexor Hallusis Longus Tendon in a National Swimmer

Objectives:Tendinopathy of the flexor hallusis longus tendon is common in the athletes. This case is intended to be reported diagnose and treatment ganglion cyst contiguity of the flexor hallucis longus tendon that located atypical region and adversely affect the athlete's training program.Methods:25-year-old male national swimmer was assessed with a left ankle pain. He had an intensive training program in the pool using pallets at the everyday. Pain in the left ankle was localized posterior and distal of the medial malleolus . Ankle range of motion and muscle strength was full. Neurovascular examination was normal. Radiography with anterior posterior, lateral and oblique analysis was not any unusual finding. In the evaluation with magnetic resonance imaging, thickening of the tendon sheath and effusion around the flexor hallucis longus was revealed and tendon integrity was exact.Results:Conservative treatment was planned. It was applied non-steroidal anti-inflammatory medicine, modification of the training (without or low weight pallet), platelet rich plasma (two weeks, two times peer weeks). During the six-month follow-up the patient's symptoms improved, but with the increased intensity of training at follow-up complaints started again. Professional athletes who did not respond adequately to conservative treatment surgical exposure were planned. Patient is approached the flexor hallucis longus musculotendinous junction from the posteromedial ankle at the level of the posterior talar tubercles. During the tendon exposure cyst was found at the level of talocalcaneal joint. Excision of the cyst was achieved; its size was 5x5 mm, looking transparent, well defined and soft consistency. Tenolysis is accomplished from superior to inferior to the level of the superior calcaneus. A histopathologic examination result of the cyst consistent with ganglion cyst was detected. Sport-specific training program started at the 6 weeks. There was no recurrence during the 6 months follow-up.Conclusion:Tendon associated ganglion cyst is not usual although flexor hallucis longus tendinopathy is common in athletes. External pressure causes in addition to the overuse injuries should be remembered in the differential diagnosis of posterior ankle and medial arch pain. Clinical suspicion and magnetic resonance imaging are valuable in establishing the diagnosis. Tenolysis and excision of the associated mass has proven to be a relatively safe and successful procedure especially in highly demanded elite athletes.

Functionally Optimized Orthoses for Early Rheumatoid Arthritis Foot Disease: A Study of Mechanisms and Patient Experience

To investigate the mode-of-action and patient experience of functionally optimized foot orthoses in patients with early rheumatoid arthritis (RA). We conducted an investigation of 2 functionally optimized foot orthoses (selective laser sintering [SLS] and fused deposition modelling [FDM]) in 15 patients with RA of <2 years duration. The novel devices were optimized for 3 biomechanistic targets exploiting computer-aided design and additive manufacturing. A third standard device was used as the comparator (standard foot orthosis [SFO]). Foot and ankle biomechanical effects were compared. Adverse reactions, orthotic fit and comfort, and short-term symptom benefits were also monitored. Both FDM (P = 0.028) and SLS (P < 0.0001) orthoses significantly reduced peak rearfoot motion in comparison to shod. The average ankle internal moment was significantly decreased in the SFO (P = 0.010) and approached significance in the SLS (P = 0.052) orthosis. SFO, FDM, and SLS orthoses significantly increased the peak height of the medial foot arch between 3.6 to 4.4 mm (P < 0.001). Peak pressures in the medial (P = 0.018) and lateral forefoot (P = 0.022) regions of interest were significantly reduced for the SLS orthosis. SFO, FDM, and SLS orthoses significantly increased midfoot contact area (P < 0.001 for all conditions). In comparison to SFO, SLS and FDM orthoses provided equivalent or better patient experience. No adverse reactions were reported. Functional optimization is a feasible approach for orthoses prescription in early RA and has the potential to provide superior mode-of-action responses for biomechanical therapeutic targets compared to standard devices.

Effects of weight loss on foot structure and function in obese adults: A pilot randomized controlled trial

ObjectiveTo investigate the effects of weight reduction on foot structure, gait, and dynamic plantar loading in obese adults. DesignIn a 3-month randomized-controlled trial, participants were randomized to receive either a weight loss intervention based on portion-controlled meals or a delayed-treatment control. Participants41 adults (32 F, 9 M) with a mean±SD age of 56.2±4.7 years and a BMI of 35.9±4.2kg/m2. MeasurementsArch Height Index (AHI), Malleolar Valgus Index (MVI), spatial and temporal gait parameters, plantar peak pressure (PP) and weight were measured at baseline, 3, and 6 months. ResultsThe intervention group experienced significantly greater weight loss than did the control group (5.9±4.0kg versus 1.9±3.2kg, p=0.001) after 3 months. There were no differences between the groups in anatomical foot structure or gait. However, the treatment group showed a significantly reduced PP than the control group beneath the lateral arch and the metatarsals 4 (all p values<.05) at 3 months. The change in PP correlated significantly with the change in weight at the metatarsal 2 (r=0.57, p=0.0219), metatarsal 3 (r=0.56, p=0.0064) and the medial arch (r=0.26, p<0.0001) at 6 months. ConclusionThis was the first RCT designed to assess the effects of weight loss on foot structure, gait, and plantar loading in obese adults. Even a modest weight loss significantly reduced the dynamic plantar loading in obese adults. However, weight loss appeared to have no effects on foot structure and gait.

Pes planovalgus deformity in children with cerebral palsy: review article.

Pes planovalgus deformity is common in children with cerebral palsy. In planovalgus foot, the talus subluxates medially, the calcaneus is in valgus, and the forefoot is in supination and external rotation related to the midfoot. In young children, mild planovalgus feet can be managed with orthotics. Surgery is indicated if the deformity is not reducible or if the patient cannot tolerate orthotics during functional activities. The surgery can be calcaneal lengthening or subtalar fusion to restore a stable plantigrade foot and achieve hindfoot correction. Medial column fusion is important to reconstruct the medial arch in severe planovalgus feet.

Gender and age related differences in foot morphology

ObjectiveThis study has assessed age-related changes of foot morphology for developing appropriate footwear with particular reference to the elderly. MethodsAnatomical parameters such as foot length, circumference and height and ankle length, circumference and height were assessed in a sample of males (n=577) and females (n=528) divided into three age groups. The groups included young-adult, aged between 20 and 25 years; adult, aged between 35 and 55 years; and old, aged between 65 and 70 years individuals. ResultsIn terms of gender differences, in young-adult individuals the sex-related morphological differences observed, are just related to a significantly lower length of foot in females. In adult subjects morphological parameters investigated were significantly lower in females even after normalization for foot length. In old individuals, no differences of the parameters were found after normalization for foot length. Comparative analysis of morphometric data between young-adult and adult individuals revealed that the instep length was smaller in adults. The opposite was observed for the great toe and medial foot arch height. Length of ankle was higher in adult than in young-adult individuals, whereas ankle circumference and height were smaller. In old vs adult individuals foot circumference showed the most relevant age-related differences. ConclusionsFeet anatomy presents specific characteristics in different ages of life. The ideal footwear should take into account these characteristics. This is true primarily for the elderly for minimizing the risk of falls or of other problems related to inappropriate footwear.

A finite element model of flatfoot (Pes Planus) for improving surgical plan.

Flatfoot is a foot condition caused by the collapse of the medial arch of the foot, and it can result in problems such as severe pain, swelling, abnormal gait, and difficulty walking. Despite being a very common foot deformity, flatfoot is one of the least understood orthopaedic problems, and the opinions regarding its optimal treatment vary widely. In this paper, an FE model of a flatfoot is proposed that is based on CT measurements. Surface meshes of the bones and soft tissue were generated from CT images and then simplified to reduce the node density. A total of 62 ligaments, 9 tendons, and the plantar fascia were modeled manually. Volume meshes of the different components were generated and combined to form the completed flatfoot model. A dynamic FE formulation was derived, and a balanced standing simulation was performed. The model was validated by comparing stress distribution results from the simulation to experimental data.

Exertional Compartment Syndrome of the Medial Foot Compartment: Diagnosis and Treatment.

Exertional compartment syndrome (ECS) in the foot is rarely reported and often confused with plantar fasciitis as a cause of arch pain in the running athlete. We describe a case involving a 19 year old competitive collegiate runner who developed a chronic case of bilateral medial arch pain during training, which was initially diagnosed as plantar fasciitis but failed to respond to conventional treatment. After symptoms began to suggest exertional compartment syndrome, the diagnosis was confirmed by measuring an elevated resting pressure in the medial compartment of both feet. The patient underwent a bilateral medial compartment fasciotomy, which allowed a full return to activity, and has remained pain free after a one year follow up.

Normalized ground reaction force peaks are reduced in symptomatic flatfoot

s / Gait & Posture 39S (2014) S1–S141 S71 Fig. 1. Tibio-talar dorsiflexion (left) and medial arch (right) group averaged for increased, normal or decreased max. tibio-talar dorsiflexion. Table 1 Classification of 72 feet according to max. tibo-talar dorsiflexion. Tibio-talar dorsiflex Increased Normal Decreased No. of feet 28 31 13 % 39% 43% 18% Mean (SD) 15.8◦ 10.0◦ 2.4◦ Reference group 9.8◦ 9.8◦ 9.8◦ talar flexion) is determined via 3 markers at the calcaneus and one at the navicular. Max. tibio-talar flexion in stance for each leg is determined. Involved legs were classified into 3 groups having increased (>1SD above average reference), normal (within 1SD of average reference) or decreasedmax. tibio-talar dorsiflexion (>1SD below average reference). Results: Of 72 feet, only 13 feet (18%) showed a reduction in tibio-talar dorsiflexion, while 82% feet had a normal or even increased tibio-talar dorsiflexion in stance as compared to normal reference (Fig. 1, left). Feet with reduction in tibio-talar dorsiflexion also showed a stronger cavus (smaller medial arch angle, Fig. 1, right) (Table 1). Discussion and conclusions: The results of our study for the first time reveal by objective data that in CMT patients with cavovarus foot, calf muscle shortness plays only an inferior role and is present only in 18% of the cases. All other cases had normal or increased ankle motion. Conventional gait analysis may pretend equinus due to cavus in those cases. Calf muscle lengthening in those patients who are already weak due to the underlying disease may lead to a severe calcaneal gait and should be avoided at all cost. Treatment focus in those patients is on cavus correction. These results are crucial for the planning of surgical correction of cavovarus deformity in CMT disease.

Plantar Measurements to Determine Success of Surgical Correction of Stage IIb Adult Acquired Flatfoot Deformity

Adult acquired flatfoot deformity is a degenerative disease causing medial arch dysfunction. Surgical correction has typically involved tendon reconstruction with calcaneal osteotomy; however, the postoperative changes have not been fully characterized. The present study assessed the success of surgical correction of Stage IIb adult acquired flatfoot deformity through changes in plantar pressures and patient-generated outcome scores. With Institutional Review Board approval, 6 participants were evaluated before and after surgery using pedobarography, the Foot and Ankle Outcome Score, and the Medical Outcomes Study 36-item short-form questionnaire. The plantar pressures were recorded using a TekScan HRMat® during walking and in a 1- and 2-foot stance. The resulting contour maps were segmented into 9 regions, with the peak pressure, normalized force, and arch index calculated. Surgical effects were analyzed using paired t tests. Postoperatively, the Foot and Ankle Outcome Score and Medical Outcomes Study 36-item short-form questionnaire scores increased significantly from 180 ± 78 to 360 ± 136 (p < .03) and 47 ± 18 to 71 ± 19 (p = .06), respectively. During the 2-foot stance, the normalized force had increased significantly in the lateral midfoot (p < .03), although no significant differences were found in peak pressures. No significant differences were observed in the 1-foot stance. During walking, the normalized force increased significantly in the lateral mid- and forefoot (p < .05). The peak pressure increased significantly in the lateral forefoot (p < .01). The arch index values demonstrated no significant changes. The increased questionnaire scores indicated that surgical correction improved the self-perceived health of the participants. Lateral shifts in the peak pressure and normalized force suggest that forefoot and midfoot loading is altered postoperatively, consistent with the goal of offloading the dysfunctional arch. Thus, the present study has demonstrated that surgical treatment of adult acquired flatfoot deformity can be accurately assessed using patient-reported outcome measures and plantar pressures.

Development of an Adjustable Sinus Tarsi Device for Flatfoot Correction: A Pilot Study in a Sawbones Model1

Development of an Adjustable Sinus Tarsi Device for Flatfoot Correction: A Pilot Study in a Sawbones Model1

Foot Drop Correction: By Active Dorsiflexion or Tenodesis Effect?

In their excellent paper, Dreher et al. attempt to answer the question of whether their previously described total split posterior tibial tendon transfer (“T-SPOTT”) works as an active dorsiflexor of the ankle or merely maintains ankle dorsiflexion through a tenodesis effect. The authors report the results of their T-SPOTT procedure performed in conjunction with other soft-tissue or osseous procedures on fourteen limbs in fourteen patients with a cavovarus foot and foot drop related to Charcot-Marie-Tooth disease. They performed preoperative and postoperative three-dimensional gait analysis using their previously validated foot model with seventeen well-defined osseous markers on the foot and leg to measure tibiotalar motion (actually plantar flexion and dorsiflexion of a line between the calcaneus and the navicular relative to the tibia), foot-tibia motion (plantar flexion and dorsiflexion of a line between the calcaneus and distal aspect of the first metatarsal relative to the tibia), and the medial arch angle (angle between the first metatarsal and a line from the medial aspect of the calcaneus to the navicular). The authors found that, at mean of twenty-nine months postoperatively, mean passive ankle dorsiflexion increased by 13° to 15° while mean passive ankle …