Oxford Ankle Foot Questionnaire For Children Research Articles

Is Kidner procedure necessary during subtalar arthroereisis for pediatric flexible flatfoot that combined with symptomatic type 2 accessory navicular? A retrospective comparative study

BackgroundKidner procedure is thought to be able to eliminate the medial foot pain and contribute to restoring the medial longitudinal foot arch, making it particularly suitable for surgical treatment of pes planus that combined with symptomatic type 2 accessory navicular (AN). However, controversy remains, and the clinical evidence is still lacking. The aim of the current study is to verify the necessity of Kidner procedure during subtalar arthroereisis (STA) for pediatric flexible flatfoot (PFF) that combined with symptomatic type 2 AN. MethodsForty pediatric patients (72 feet) who had undergone STA for flexible flatfoot and were also diagnosed with symptomatic type 2 AN concomitantly were reviewed retrospectively and divided into two groups (STA + Kidner vs STA alone). The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Oxford ankle foot questionnaire for children (OAFQC), and the radiographic parameters that quantifying pes planus were evaluated as primary outcomes. Secondary outcomes included the incidence of complications. ResultsThere were 35 feet in the STA + Kidner group and 37 feet in the STA alone group, with mean follow-up periods of 2.7 years and 2.1 years, respectively. The VAS, AOFAS, OAFQC scores and radiographic parameters presented no significant difference between the two groups both preoperatively and at final follow-up (P > 0.05 for each). The complications of STA surgery occurred equally in both groups, and Kidner procedure could lead to more incision problems (22.9% vs. 2.7%) and a longer time to return to activity. ConclusionKidner procedure may be unnecessary during surgical treatment of PFF that combined with painful type 2 AN. Correcting the PFF while leaving the AN alone has a high possibility of relieving the pain in the AN region, and tibialis posterior tendon (TPT) rerouting hardly aids in reconstruction of the medial foot arch. Level of EvidenceIII.

Comparison of Braces for Treatment of Sever's Disease (Calcaneal Apophysitis) in Barefoot Athletes: A Randomized Clinical Trial.

Sever's disease (calcaneal apophysitis) is a common condition in youth athletes, including those who participate in barefoot sports. Health care professionals often recommend that young athletes with Sever's disease wear heel cups in their shoes while active, but barefoot athletes are unable to use heel cups. To compare the efficacy of 2 braces used by barefoot athletes with Sever's disease. Randomized controlled clinical trial. Pediatric sports medicine clinic. A total of 43 barefoot athletes aged 7 to 14 years were enrolled, and 32 completed the study (age = 10.3 ± 1.6 years; 29 girls, 3 boys). Participants were randomized to the Tuli's Cheetah heel cup (n = 16) or Tuli's The X Brace (n = 16) group for use during barefoot sports over the 3-month study period. Participants completed self-reported assessments after diagnosis (baseline) and 1, 2, and 3 months later. The primary outcome was the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical score (3 months postenrollment). The secondary outcomes were OxAFQ-C school or play and emotional scores and the visual analog scale pain score. The percentage of time wearing the brace during barefoot sports was not different between the Cheetah heel cup and The X Brace groups (82% versus 64% of the time in sports; P = .08). At 3 months, we observed no differences for the OxAFQ-C physical (0.79 versus 0.71; P = .80; Hedges g = 0.06), school or play (0.94 versus 1.00; P = .58; Hedges g = 0.26), or emotional (1.00 versus 1.00; P = .85; Hedges g = 0.21) score. Visual analog scale pain scores during activities of daily living and sports were lower (better) at the 2- and 3-month time points than at baseline (P < .001). Both groups demonstrated improvements in ankle and foot function across time, but no between-groups differences were seen at 3 months. Given these results, barefoot athletes with Sever's disease may consider using either brace with barefoot activity to help improve pain and functional status.

05 Methotrexate improve the foot functional impairment in juvenile idiopathic arthritis

BackgroundFoot involvement in juvenile idiopathic arthritis (JIA) is common and affects about 60% of children [1]. Often overlooked by patients and practitioners, ankle and foot disability has been poorly studied and there are no accepted clinical practice guidelines for the diagnostic approach, as well as for the therapeutic management.ObjectivesOur study aimed to evaluate the effect of medical treatments on functional disability related to foot involvement in JIA.MethodsWe conducted a cross-sectional study including patients with JIA according to the revised ILAR criteria, collected from the rheumatology department of the Kassab National Institute. Sociodemographic and disease data (activity assessed by the Juvenile Arthritis Disease Activity Score 10 (JADAS-10) and therapeutic modalities) were recorded. Ankle and foot involvement were investigated by questioning and physical examination. We used the Oxford ankle foot questionnaire for children (OxAFQ-C); a validated, simple and reproducible score to assess the impact on the quality of life of children with foot problems [2]. This questionnaire encompasses 14 items corresponding to three dimensions: physical, school and play, and emotional. Higher scores represent better functioning. We searched for an association between the different drug treatments for JIA and the OxAFQ-C score.ResultsThe study included 23 patients. The mean age was 13 ± 4 [6–18] years. The sex ratio was 0.42 with a female predominance. The age of the disease was 49 ± 40 months [6–180 months]. The distribution of the different forms of JIA was as follows: oligoarticular (n = 7), enthesitis-related arthritis (n = 6), polyarticular FR + (n = 1), polyarticular FR- (n = 3), psoriatic arthritis (n = 3), systemic (n = 1) and undifferentiated (n = 1). Pain on walking and limitation of the talocrural joint was found in 39% and 30% respectively. The mean JADAS-10 score was 6.72 ± 6.1 [0–20]. Ten patients had high activity. Eighteen patients (78%) were taking level I analgesics and 14 patients (61%) were on non-steroidal anti-inflammatory drugs, 12 of them on demand. Naproxen was the most commonly used drug, followed by diclofenac. Eleven patients (48%) were on a disease-modifying anti-rheumatic drug (csDMARD). Methotrexate (MTX) was prescribed in 30% of cases with a mean dose of 7.91 mg/week [7.5–10]. Only one patient was on sulfasalazine. Four patients (17%) were treated with biologics: Etanercept (n = 3) and Tocilizumab (n = 1). The mean scores of the different domains of (OxAFQ-C) were as follows: 73.52 ± 35.89 [0—100] in the physical domain, 84.2 ± 30 [6.25—100] in the school and play domain, 88.75 ± 24.71 [12.5 – 100] in the emotional domain. There was no statistically significant association between the different domains of the Oxford score and the use of analgesics or NSAIDs (p> 0.05). Similarly, there was no statistically significant association between the different domains of the Oxford score and treatment with biotherapy (p> 0.05). However, patients on MTX had less functional impairment of the feet with a significant improvement in the physical domain (99.26 on MTX vs 62.5 without MTX, p = 0.02, r = 0.6).ConclusionOur work showed that only methotrexate was associated with an improvement in functional foot outcomes in JIA. Further studies are needed to highlight the effect of other therapies, especially biologics.

06 Flat foot impairs physical activity in children with juvenile idiopathic arthritis

BackgroundChildren with juvenile idiopathic arthritis (JIA) are less active compared with the general population due to pain and deformities, mainly of the lower limbs. Indeed, only 23% of children with JIA meet the public health recommendations of one h of moderate to vigorous physical activity daily [1]. In this context, foot involvement in JIA is a considerable limiting cause of physical activity.ObjectivesOur study aimed to investigate the types of static foot disorders that impede physical activity in children with JIA.MethodsWe conducted a cross-sectional study of patients with JIA according to the revised ILAR criteria. Socio-demographic and disease-related data were recorded. All patients underwent podoscope examination for varus or valgus deformity of the hindfoot and plantar footprint abnormality (flat foot or hollow foot). Patients with ankle or foot involvement due to congenital malformation or any other cause besides JIA were excluded. The impact of foot involvement on physical activity was assessed by the Oxford ankle foot questionnaire for children (OxAFQ-C). A higher score represents better functioning. We looked for the effect of foot abnormalities and their impact on physical activity.ResultsA total of 23 patients were collected. The mean age was 12.7 ± 3 [6–18] years and the mean age at diagnosis was 9.3 ± 3 [3–16] years. There was a female predominance with a sex ratio of 0.42. The majority of patients had secondary education (52%). The distribution of the different subtypes was dominated by the oligoarticular form (30%) and the enthesitis-related arthritis form (26%), followed by the polyarticular FR + (n = 1), polyarticular FR- (n = 3), psoriatic arthritis (n = 3), systemic (n = 1) and undifferentiated (n = 1) forms. The mean physical activity score assessed by the Oxford score was 73.52 ± 35.8 [0 – 100]. Plantar footprint abnormalities of the hollow and flat foot were found in 39% and 30% of cases respectively. These abnormalities were unilateral and bilateral in 7 and 9 patients respectively. Eleven patients (48%) had a hindfoot abnormality and 30% of them had a limitation of joint movement range. There was no statistically significant association between the physical domain of the Oxford score and the presence of a limited range of the talocrural joint (p> 0.05). A significant reduction in physical activity was associated with hindfoot pain (5.37 vs 89.56; p< 0.001) but was not associated with the presence of hindfoot abnormalities (p = 0.05). The presence of flat feet was significantly associated with impairment in all domains of the Oxford score, particularly in the physical domain (36.79 for the flat foot group vs 89.2 for the group without flat feet, p = 0.001). However, the presence of a hollow foot did not lead to an alteration of the physical activity of JIA patients (p> 0.05).ConclusionOur study showed that the flat foot was associated with a reduction in physical activity. Early detection of this abnormality and adapted podiatric care could improve the function of young patients with JIA.

Observation Versus Cast Treatment of Toddler's Fractures.

Nondisplaced metaphyseal fractures of the distal tibia, or toddler's fractures, are one of the most common pediatric injuries. Healing typically occurs quickly without sequelae. Treatment ranges from long leg cast immobilization to observation. This study compares short-term clinical and radiographic outcomes of toddler's fractures treated with long leg casting versus observation. Patients with toddler's fractures were offered enrollment and randomization at diagnosis. Because many families opposed randomization, a preference arm was added after one year. All subjects were analyzed as a prospective cohort. Radiographs were obtained at diagnosis and 4 weeks. A modified Oxford Ankle Foot Questionnaire for Children (OAFQ-C) and family satisfaction survey were collected at diagnosis, 4 and 8 weeks. Scores were analyzed using mixed effect models. Family satisfaction surveys were compared using a Wilcoxon rank sum test. Forty-four subjects participated in the study, 34 (77%) in the preference arm and 10 (23%) in the randomized cohort. The median patient age was comparable between the cast and the observation groups, 2.0 versus 1.8 years, respectively. Significant improvement in OAFQ-C scores was observed in both groups over 8 weeks (P<0.01). Patients in the observation group had a higher initial play score than the cast group (P=0.03). The observation group trended toward higher physical scores at all time points (P=0.11). There was no significant difference in emotional scores between groups (P=0.77). No displacement was observed in any patient. Casted patients had significantly more minor complications with 4 patients requiring cast change or removal compared with 0 in the observed group (P=0.01). At 8 weeks, 80% of parents in the cast group were likely or very likely to choose the same treatment compared with 95.6% in the observation group. Family satisfaction scores did not differ between groups (P=0.18). They demonstrated differences in perceived normal walking at 4 weeks, with 50% of casted patients walking normally compared with 92% of observed patients. Over 90% of patients in both groups were reportedly walking normally at week 8. Observation of toddler's fractures results in equivalent clinical and radiographic outcomes, high family satisfaction and fewer complications compared with treatment with a long leg cast. Level II.

Strategy and clinical outcomes of child foot surgery for macrodactyly

BackgroundAmputation of the abnormal segment seems to be the reference standard treatment for the surgical management of macrodactyly of the foot in children. Our objectives here were to detail the surgical strategies according to the cause, anatomical characteristics, and static or progressive nature of the macrodactyly and to evaluate the long-term clinical outcomes. HypothesisConservative treatment can be an option in the management of static macrodactyly of the foot in children. Material and methodsWe retrospectively included 24 feet in 19 patients seen consecutively. There were 12 primary and 12 secondary types. The macrodactyly was static in 9 cases and progressive in 15 cases. The treatment consisted in either conservative procedures or amputation of the segment. All patients completed the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) to evaluate their quality of life, shoe wear issues, and satisfaction with their treatment. ResultsMean age at first surgery was 5.8 years (range, 0.5–11.5) and the mean interval between two procedures was 2.3 years (range, 0.3–5.5). Mean number of procedures per foot was 2.2 par pied (range, 0–7). All 9 static forms were managed conservatively. Amputation was performed in 11 of the 15 progressive forms. The mean number of procedures was significantly higher in the progressive forms (4.1 vs. 1.5/pied; p=0.006). Two patients died during follow-up. The remaining 17 patients, with 22 affected feet (primary and secondary in 11 cases; progressive in 14 cases and static in 8 cases) were re-evaluated. Mean follow-up was 9.4 years (range, 2.7–20.6). The final OxAFQ-C score was 46/60 (range, 18–58). Of the 17 patients, 86% would be willing to repeat the same surgical procedures and 77% were satisfied with their treatment at last follow-up. We found no differences between the groups managed with amputation and with conservative treatment regarding quality of life, satisfaction, or shoe size difference. ConclusionsConservative treatment deserves a place in the treatment of static macrodactyly of the foot in children. Regarding amputation of the segment in progressive forms, it is important to reassure the patients and parents about the expected results but also to inform them about the risk of requiring repeat surgical procedures. Level of evidenceIV, retrospective study.

Clinical and Radiological Outcomes of Subtalar Arthroereisis for Management of Planovalgus Foot in Children With Cerebral Palsy: 3-Year Follow-up

Planovalgus deformity of the foot is common among cerebral palsy (CP) patients. It is an upcoming topic with debate and controversy that require further studies. Many clinical studies involving arthroereisis have shown acceptable results in short- and mid-term follow-up. The aim of this work was to evaluate the outcome of arthroereisis using a conventional screw placed percutaneously across the talocalcaneal articulation for the treatment of moderate planovalgus deformity in children with CP. Between 2015 and 2018, a prospective study was conducted including 23 CP patients with bilateral flexible planovalgus deformity with follow-up period ranging from 24 to 40 months (mean of 36.7 months). The radiological and clinical outcomes were assessed. The patient/parent outcome was evaluated using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). The results showed statistically significant improvement in both radiological and clinical data as well as patient's symptoms and parent's satisfaction. Results obtained from literature from the past decades after arthroereisis for the correction of moderate planovalgus deformity in CP patients are promising. The few studies reported on that procedure shared the same harmony with our study giving a chance to be a good alternative to joint destructive procedures. Our technique is simple, effective, economical, and minimally invasive if used in selected pediatric CP patients. Therapeutic, Level IV.

Pediatric and adolescent Lisfranc injuries — Presentation, treatment and outcomes

PurposeLisfranc fracture dislocations are rare injuries and even more so in the pediatric population. The main purpose of our study is to present a descriptive analysis of Lisfranc injuries in pediatric patients to add to the current sparse literature on this topic. In addition, our secondary outcome was to analyze any differences in patients treated conservatively versus operatively, and those with isolated Lisfranc injuries versus those with associated foot injuries. MethodsCharts of patients with Lisfranc injury treated at a tertiary pediatric hospital from January 2010 to July 2019 were reviewed to analyze their demographics, injury characteristics, management details and rehabilitation protocol. Functional outcome was assessed using the Visual Analogue Scale of Pain (VAS) and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). Results30 patients/cases were included with mean age of 13.6 years and mean follow up of 36 weeks. 20% of the cases were missed on initial presentation. 19 cases were managed operatively while 11 were managed conservatively. The average OxAFQ-C and VAS pain scores were 83% and 1.3, respectively at mean follow-up of 36 weeks. The functional outcomes between conservative and operative cases or between those with isolated Lisfranc injuries and those with associated foot injuries were not statistically significant (p > 0.05). ConclusionLisfranc injury in pediatrics can be easily missed. High index of suspicion, a thorough clinical examination and the use of advanced imaging is warranted. Various modalities like K-wires, screws and suture-buttons can be used for fixation. Early to mid-term functional outcomes are satisfactory provided that adequate reduction is obtained.

Factors Affecting Subjective Symptoms in Children with Pes Planovalgus Deformity

Idiopathic pes planovalgus is one of the most common foot deformities in children and adolescents. However, there is a discrepancy between subjective symptoms and radiographic severity in idiopathic planovalgus deformity, and very few studies have investigated this aspect. Further, the assessment of subjective symptoms in patients with pes planovalgus requires a quantitative scoring system for making meaningful comparisons, such as the Oxford Ankle Foot Questionnaire for Children (OxAFQ-c) and that for parents (OxAFQ-p). Therefore, the purpose of this study was to evaluate the factors affecting the symptoms of idiopathic planovalgus using the OxAFQ. All patients who were ≤18 years of age, had visited our clinic for the evaluation of pes planovalgus deformity, and had completed the OxAFQ were included in this study. The anteroposterior talo-first metatarsal, lateral talo-first metatarsal, and hallux valgus angles were measured on weight-bearing radiographs. The data were analyzed using a multiple regression model, with age, sex, and radiographic indices as explanatory variables. Overall, 123 patients were enrolled in this study, and 246 standing foot radiographs were evaluated along with scores in each domain of the OxAFQ. The factors affecting physical domain scores in the OxAFQ-c were female sex (p = 0.047) and the anteroposterior talo-first metatarsal angle (p = 0.033). Age of ≥10 years was a significant factor (p < 0.05) affecting all domains in both the OxAFQ-c and OxAFQ-p other than the physical domain score. Although pes planovalgus deformity is 3-dimensional, the forefoot abduction component of the deformity should be carefully assessed as it is closely related to subjective symptoms. Further, in female patients with a more severe anteroposterior talo-first metatarsal angle, an aggravation of symptoms with aging should be expected when managing pes planovalgus deformity. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Outcome Tools in Pediatric Foot and Ankle Patients: Comparing Child and Parent Scores.

The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) is validated for assessing the impact of foot and ankle conditions in pediatric patients. The purpose of this cross-sectional study is to assess child-parent concordance and identify patient factors that predict improved agreement. Patients aged 8 to 16 years with foot and ankle conditions and their parents completed the OxAFQ-C during routine clinic visits over a 9-month period. Demographic and medical information was collected by chart reviews. Responses in each domain were compared using a Wilcoxon signed-rank test, and the comparisons of responses by sex were analyzed with Wilcoxon rank-sum tests. Concordance was assessed with intraclass correlation coefficients. There were 87 child-parent dyads with 50 female patients (57.5%) and 37 male patients (42.5%). Most parent responders were mothers (84%). The mean patient age was 12.4 (±2.2) years. The most common diagnosis was pes planus (17%). Child scores were significantly higher than their parents' in the school and play (P = 0.008) and emotional (P = 0.001) domains. When stratified by age, children younger than 13 years had significantly higher scores than their parents across all domains (P = 0.015 physical, 0.002 school and play, 0.001 emotional), although the concordance for the school and play and emotional domains was only moderate (0.73 and 0.58, respectively). Female patients and their parents reported significantly lower scores compared with their male counterparts only in the emotional domain (84.37 vs 93.75, P = 0.025). Concordance is good between child and parent scores of the OxAFQ-C for assessing the impact of foot and ankle conditions. When stratified by age, patients younger than 13 years of age had higher scores than their parents' in all domains with the lowest concordance for the school and play and emotional domains. Female patients and their parents reported significantly lower scores than their male counterparts in the emotional domain. Level IV.

Transcultural adaptation and validation of a Korean version of the Oxford Ankle Foot Questionnaire for children

BackgroundThe purpose of this study was to translate and transculturally adapt the original English version of the Oxford Ankle Foot Questionnaire (OAFQ) into a Korean version, and to evaluate its psychometric properties.MethodsA Korean OAFQ for children was developed according to established guidelines. To test validity, 169 consecutive patients with foot and ankle problems and their caregivers each completed the OAFQ. The children also completed a Korean version of the KIDSCREEN-52 health related quality of life questionnaire (KIDSCREEN-52 HRQOL). To validate the Korean version of the OAFQ, reliability (child–parent agreement and internal consistency), feasibility (floor and ceiling effects), and construct validity were evaluated, and factor analysis was performed.ResultsIn terms of reliability, Cronbach’s α values were > 0.7 in all subscales of the OAFQ (0.765 to 0.901). Child–parent agreement was confirmed by high intraclass correlation coefficients for all subscales (0.791 to 0.863). In terms of construct validity, there were moderate correlations between the subscales of the OAFQ and the subscales of the KIDSCREEN-52 HRQOL. Factor analysis revealed a three-component solution for both the child/adolescent and parent-proxy version, by combining the school and play, and footwear items into one subscale. In terms of feasibility, no floor effects were found for all subscales. However, ceiling effects were observed for the school and play, and emotional subscales for child/adolescent and parent-proxy versions.ConclusionsThe OAFQ was successfully translated and transculturally adapted into the Korean language; the Korean version of the OAFQ represents a reliable and valid instrument for evaluating children’s foot or ankle problems. However, factor analysis suggested the use of a three-subscale questionnaire.

Radiographic and Functional Results following Subtalar Arthroereisis in Pediatric Flexible Flatfoot.

Introduction Flexible flatfoot (FFF) is one of the most common skeletal disorders in children. In symptomatic patients who do not respond to conservative measures, surgery may be an option. Subtalar arthroereisis consists of limiting excessive eversion of the subtalar joint through different types of implants. Materials and Methods We carried out a retrospective study of 16 patients (32 feet) intervened for FFF with a subtalar device (arthroereisis), across the period of 2008-2015 with a minimum follow-up period of one year. Pre- and postoperative measures of the Moreau-Costa-Bartani angle, dorsoplantar (DP) and lateral (L) talocalcaneal angle, talonavicular coverage angle, and naviculocuboid overlap were used to evaluate correction of the deformity. Two expert surgeons from the Pediatric Orthopedics Unit took separate measurements of these angles for subsequent analysis purposes and to obtain the interobserver correlation coefficient for quantitative variables. Pre- and postoperative differences in the measurement of angles were ascertained using Student's t-test for paired samples; and a functional evaluation of the patients intervened was carried out pre- and postoperatively by administering the parent version of the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) during a clinical interview. All statistical analyses were performed using the SPSS v. 19.0 program (SPSS, Chicago, IL), with values being deemed statistically significant at p<0.05. Results A breakdown of the study population showed 81.25% (13 patients) males and 18.75% (3 patients) females, with mean age of 9 years (7-11). The interobserver coefficient for quantitative variables displayed a very high degree of concordance (0.7-0.9), indicating that the validity of the measures was adequate. Pre- and postoperative analysis of differences in the measurement of angles was statistically significant (p<0.005). In terms of functional evaluation, the postoperative results were positive, with statistical significance for the “school and play”, “emotional”, and “footwear” domains of the OxAFQ-C scale and no differences in the “physical” domain. Conclusion Subtalar arthroereisis is a valid option for the treatment of symptomatic pediatric flatfoot, with good postoperative functional and radiographic results.

Long-Term Donor-Site Morbidity After Free, Nonvascularized Toe Phalanx Transfer for Congenital Differences of the Hand

Toe phalanx transplantation is a well-established technique for addressing bony deficiency in the reconstruction of hypoplastic digits in patients with congenital differences of the hand. Prior studies have commented on varying degrees of donor-site morbidity, although assessment of morbidity with validated outcome scores is lacking. This study seeks to evaluate donor-site morbidity after toe phalanx harvest using validated outcome measures. We identified all children who underwent free, nonvascularized toe phalanx transfer to the hand at our institution from 2001 to 2011. We administered the Oxford Ankle Foot Questionnaire for Children (OXAFQ-C) and the Foot and Ankle Ability Measure (FAAM) to all patients, scaling results according to published scoring instructions. Thirty-six patients with 83 toe phalanx transfers were able to be contacted, with a mean follow-up of 5.3 years (range, 18 months-11.2 years). The results of the OXAFQ-C showed mean scores of 99.96% (Physical), 100% (School and Play), and 96.01% (Emotional). The FAAM mean scores were 99.08% (Sports) and 99.17% (Activities of Daily Living). There were no lower extremity complications during the study period. In contrast to varying degrees of donor-site morbidity reported in the current literature, this study demonstrates that toe phalanx harvest causes almost no measurable lower extremity morbidity or dysfunction over the mid- to long-term. Therapeutic IV.

Impact of Orthotic Prescription in Pediatric Partial Foot Amputation: A Case Study

ABSTRACT Introduction There is little information available on outcomes after prosthetic/orthotic management in partial foot amputation (PFA) in children. Methods This case study evaluates walking speed, community activity level, and physical function in a child with bilateral PFA after a change from an orthosis finishing distal to the ankle to one finishing proximal to the ankle. Outcome measures used were walking speed (10-meter walk test), the Gillette Functional Assessment Questionnaire (GFAQ), and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical domain. Results At 3-month review GFAQ level increased by 3, OxAFQ-C physical domain increased 50 percentage points, and self-selected velocity increased 0.25 m/s. Conclusions This case study suggests that improvements in walking speed, community activity level, and physical function are possible in children with bilateral PFA when changing to orthoses, which compensate for mechanical deficits caused by the reduced lever arm of the foot.

Outcomes of the Ponseti Method for Untreated Clubfeet in Nepalese Patients Seen Between the Ages of One and Five Years and Followed for at Least 10 Years.

To our knowledge, there are no reports of the Ponseti method initiated after walking age and with >10 years of follow-up. Our goal was to report the clinical findings and patient-reported outcomes for children with a previously untreated idiopathic clubfoot who were seen when they were between 1 and 5 years old, were treated with the Ponseti method, and had a minimum follow-up of 10 years. A retrospective review of medical records was supplemented by a follow-up evaluation of physical findings (alignment and range of motion) and patient-reported outcomes using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). The initial treatment was graded as successful if a plantigrade foot was achieved without the need for an extensive soft-tissue release and/or osseous procedure. We located 145 (91%) of 159 patients (220 clubfeet). The average age at treatment was 3 years (range, 1 to 5 years), and the average duration of follow-up was 11 years (range, 10 to 12 years). The initial scores according to the systems of Pirani et al. and Diméglio et al. averaged 5 and 17, respectively, and an average of 8 casts were required. Surgical treatment, most commonly a percutaneous Achilles tendon release (197 feet; 90%), was required in 96% of the feet. A plantigrade foot was achieved in 95% of the feet. Complete relapse was rare (3%), although residual deformities were common. Patient-reported outcomes were favorable. A plantigrade foot was achieved in 95% of the feet initially and was maintained in most of the patients, although residual deformities were common. Patient-reported outcomes were satisfactory, and longer-term follow-up with age-appropriate outcome measures will be required to evaluate function in adulthood. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Innovative treatment for pes cavovarus: a pilot study of 13 children

Background and purpose — Pes cavovarus (PCV) is a complex deformity, frequently related to neurological conditions and associated with foot pain, callosities, and walking instability. The deformity has the tendency to increase during growth. Orthotic treatment is ineffective and surgery may be troublesome. We present the preliminary results of a new mini-invasive surgical technique for correction of this foot deformity.Patients and methods — We operated on 13 children (24 feet), age 7–13 years. In 7 children the deformity was neurological in origin. The surgical technique included a dorsal hemiepiphysiodesis of the 1st metatarsal, and a plantar fascia release. The clinical deformity, hindfoot flexibility, and foot callosities, together with a radiological assessment (Meary angle, calcaneal pitch, and talo-calcaneal angle), was done pre- and postoperatively. At final check-up, after a median of 28 months (12–40), the Oxford Ankle Foot Questionnaire for children (OXAFQ-C) was used to assess patient satisfaction. The primary outcome was the hindfoot varus correction.Results — All the operated feet improved clinically and radiologically. Heel varus improved from a mean 6° preoperatively to 5° valgus postoperatively. In those children where treatment was initiated at a younger age, full correction was achieved. Footwear always improved.Interpretation — This treatment may offer a less aggressive alternative in the treatment of PCV in young children and may eventually reduce the amount of surgery needed in the future.

Health related quality of life of children with calcaneal apophysitis: child & parent perceptions.

BackgroundChildren with a clinical diagnosis of calcaneal apophysitis reportedly experience impaired physical ability. Patient reported outcome assessments measure the level of conditional specific interference in everyday life. The aim of this study was to assess and compare the child and parent perceptions of health related quality of life (QOL) associated with calcaneal apophysitis.MethodsThis is a longitudinal repeated measure study nested within a randomized comparative effectiveness trial. Children who had symptoms of calcaneal apophysitis were recruited from local advertising and from the caseload of podiatrists within the health setting (Australia). The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) was completed at baseline, 1, 2, 6 and 12 month time points by both child and parent.ResultsA total of 133 children were recruited and 124 participated in the study with 101 completing the OxAFQ-C at all five time points. The inter-rater reliability between the child and parent for the physical domain ranged between poor (0.06) to good (0.77) agreement, and the footwear domain ranged between poor (0.09) to good (0.66) across the time points. Both the school and emotional domains had moderate (0.46) to good (0.77) agreement.ConclusionChildren with calcaneal apophysitis have differing perceptions of health related QOL impact compared to their parents. Parents initially reported greater impact than their child however there was convergence of agreement over the follow-up period. These findings suggest understanding the impact from both child and parent perspective is imperative during treatment.Trial registrationTrial Number: ACTRN12609000696291.

Ray amputation for the treatment of foot macrodactyly in children.

Macrodactyly of the foot is a rare but disabling condition. We present the results of surgery on 18 feet of 16 patients, who underwent ray amputation and were followed-up for more than two years at a mean of 80 months (25 to 198). We radiologically measured the intermetatarsal width and forefoot area pre-operatively and at six weeks and two years after surgery. We also evaluated the clinical results using the Oxford Ankle Foot Questionnaire for children (OxAFQ-C) and the Questionnaire for Foot Macrodactyly. The intermetatarsal width and forefoot area ratios were significantly decreased after surgery. The mean OxAFQ-C score was 42 (16 to 57) pre-operatively, improving to 47 (5 to 60) at two years post-operatively (p = 0.021). The mean questionnaire for Foot Macrodactyly score two years after surgery was 8 (6 to 10). Ray amputation gave a measurable reduction in foot size with excellent functional results. For patients with metatarsal involvement, a motionless toe, or involvement of multiple digits, ray amputation is a clinically effective option which is acceptable to patients.

Patient perceptions of foot disability in Juvenile Idiopathic Arthritis: a comparison of the juvenile arthritis foot disability index and the Oxford ankle foot questionnaire for children.

BackgroundThe Juvenile Arthritis Foot Disability Index (JAFI) and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) are two region-specific paediatric outcome tools that measure the impact on well-being in children with foot pathology. The aim of this study was to establish the level of agreement between the JAFI and the OxAFQ-C in a group of children diagnosed with Juvenile Idiopathic Arthritis (JIA).MethodsChildren with JIA accessed the questionnaire via a website. The OxAFQ-C questionnaire and the JAFI questionnaire were combined into one document consisting of 42 statements with Likert-scale responses. A further question regarding duration of disease was added. On completion, the web-linked questionnaire was returned by e-mail.ResultsThirty five participants were included. Individual domain and composite score analysis was undertaken. The JAFI participation domain was compared to the OxAFQ-C school domain and showed no significant difference between the median scores of each participant (z = -1.33, p = 0.181). The JAFI activity and the OxAFQ-C physical domains were compared and showed that a significant difference between the median scores existed (z = -4.29, p < 0.001). Agreement between the two PROMs was tested using Bland Altman Levels of Agreement based upon the percentage summed composite scores. Levels of agreement between the scores were considered to be poor based on the Bland Altman plot, despite a low mean difference in scores (mean difference = -3.88, SD of difference = 9.93, p = 0.027). Pearson correlation was undertaken to measure the relationship between the summed composite score and disease duration. No relationship was found (JAFI: r = -0.08, p = 0.672; OxAFQ-C: r = 0.037, p = 0.871).ConclusionsThis study has shown that despite some agreement between the individual domains, overall there is poor agreement between the OxAFQ-C and the JAFI percentage summed composite scores. The study is not able to determine if one score is superior to the other but both scores could be of value when used in this population.

The association of foot structure and footwear fit with disability in children and adolescents with Down syndrome.

BackgroundFoot deformity, flat feet, and the use of ill-fitting footwear are common in children and adolescents with Down syndrome (DS). The aim of this study was to determine whether these observations are associated with foot-specific disability in this group.MethodsA cross-sectional study design. Foot structure (foot posture determined using the Arch Index, presence of hallux valgus and lesser toe deformities) and footwear fit (determined by length and width percentage differences between the participant’s foot and footwear) were assessed in 50 participants with DS (22 females, 28 males) aged five to 18 with a mean (SD) age of 10.6 (3.9) years. Foot-specific disability was determined using the parent-reported Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). Associations between foot structure and footwear fit with the four domains (Physical, School and play, Emotional and Footwear) of the OxAFQ-C were determined using multivariate regression modelling.ResultsThe mean (SD) Arch Index was 0.29 (0.08), and the prevalence of flat feet, hallux valgus and lesser toe deformities was 76%, 10% and 12% respectively. Few participants wore footwear that was too short (10%), but the use of footwear that was too narrow was common (58%). The presence of hallux valgus was significantly associated with increased disability for the OxAFQ-C School and play domain scores. The use of narrow-fitting footwear was significantly associated with increased levels of disability for the OxAFQ-C Physical, School and play, and Emotional domains. However, these variables only explained between 10% to 14% of the variance in the OxAFQ-C domain scores. There were no significant associations between foot structure and footwear fit with the OxAFQ-C Footwear domain scores.ConclusionsFlatter feet and lesser toe deformities are not associated with foot-specific disability in children and adolescents with DS. Hallux valgus is associated with foot-specific disability during school and play activities. Ill-fitting footwear (too narrow) is common and is associated with foot-specific disability. Further research is required to identify if the relationship between narrow-fitting footwear and foot-specific disability is causal, and to identify other factors associated with foot-specific disability in children and adolescents with DS.