Planovalgus Foot Research Articles

Structure and function of the foot in the context of Achilles tendon rupture – cause-effect analysis

Introduction and objective: Achilles tendon rupture is the most common sports injury. The aim of the study was to analyse the cause-effect correlation between the occurrence of foot dysfunction and Achilles tendon rupture in male athletes. Materials and methods: The study included 41 men who were treated for Achilles tendon rupture, and a control group of 40 men who met the same criteria, but had no history of Achilles tendon rupture. Each participant underwent the following examinations: orthopaedic examination, plain standing foot radiographs, and foot examination on the gait platform. The final stage was an experimental study in the field of biomechanics of the musculoskeletal system of the lower limbs, with an assessment of forces arising in the Achilles tendon and statistical analyses of all obtained results. Results: Plain foot radiographs and examination on the gait platform showed that the feet in the study group had significantly more abnormalities compared to the control group. Planovalgus foot deformity was far more frequent in the study group on plain radiographs. The forefoot was overloaded much more often in the study group, and the foot was placed in excessive abduction, which is characteristic of planovalgus foot. The experimental study shows that the force in the Achilles tendon increases with increasing load on the forefoot. Conclusions: Planovalgus foot deformity in male athletes with a history of ruptured Achilles tendon is the most common foot pathology, significantly increasing the forces transmitted by the Achilles tendon.

Surgical management of severe planovalgus foot deformity in children with generalised joint hypermobility

BackgroundThis study aimed to evaluate the outcomes of calcaneal lengthening osteotomy (CLO) and double arthrodesis of the talonavicular and calcaneocuboid joints (DA) for correcting planovalgus foot deformity exclusively in patients with generalised joint hypermobility. MethodsWe retrospectively reviewed 29 feet in 17 consecutive patients who underwent either CLO or DA. The mean age at surgery was 11.3 ± 2.3 years, and the mean follow-up duration was 7.7 ± 3.2 years. Preoperative and final follow-up radiographs and dynamic foot-pressure measurements were analysed. ResultsBoth operations significantly improved the radiographic parameters, except for the lateral talocalcaneal angle in the CLO group. Pedobarographic study demonstrated an elevation of the medial longitudinal arch and an improved foot-pressure distribution after both surgeries. The plantar pressure in the lateral forefoot significantly increased only in the DA group, while the pressures exerted on the medial forefoot and hindfoot and the arch index improved only in the CLO group. ConclusionsBoth CLO and DA effectively improve the foot alignments of the deformity in patients with generalised joint hypermobility. However, differences were observed in the changes in the lateral talocalcaneal angle and plantar pressure distribution between the two procedures. Level of evidenceTherapeutic Level III.

New Insight into the Effects of Different Types of Midfoot and Hindfoot Deformities on the Functional Outcomes of Rheumatoid Arthritis Patients

In advanced stages of rheumatoid arthritis (RA), the pattern of joint involvement leads to varied types of foot deformities such as forefoot, midfoot, and hindfoot deformities. We aim to evaluate midfoot and hindfoot deformities and their effect on functional outcomes in RA patients. In this prospective cross-sectional study clinical and radiological evaluations of 100 adult RA patients were studied for midfoot and hindfoot deformities. The RA disease activity, functional disability level, specific foot and ankle assessments, gait speed, and balance tests were assessed. Radiological examinations of the weight-bearing feet in a standing position were done. We found that the most frequent deformity type was the planovalgus foot (24%). There were statistically significant differences between the types of foot deformities and disease duration, disease activity, falls, Tinetti and Berg balance Test, and health assessment questionnaire-disability index. The multivariate regression analysis of independent correlates of falling detected that patients with equinovarus deformity were 2.5 times more liable for falling with 63.5% predictive power. According to the predictive criteria of deformity type for falling, the equinocavovarus type had accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 84.5%, 98.5%, 99%, and 84%, respectively. We found in RA patients, midfoot and hindfoot deformities cause a significant reduction of functional ability and quality of life. The early detection of foot deformities requires a good awareness of the clinical and radiographic diagnosis of different types of deformities thus reducing the possible functional disabilities via early management by combined orthotic, physiotherapy, and surgical treatments.

Planovalgus Foot Deformity in Patients Undergoing Total Hip Arthroplasty Is Associated With Increased Risk of Falls, Implant-Related Complications, and Revisions: A Case-Control Analysis

BackgroundPes planus occurs due to the loss of the longitudinal arch of the foot, resulting in altered gait mechanics. This may lead to increased complications following total hip arthroplasty (THA). Thus, the aim of this study was to assess the effects that pes planus has on rates of falls, implant complications, fall-related injuries, and times to revision among THA patients. MethodsA retrospective review of a private insurance claims database was conducted from 2010 to 2021. Patients who had a diagnosis of congenital or acquired pes planus and cases of THA were identified. Patients undergoing THA with a diagnosis of pes planus were matched to control patients 1:5 based on age, sex, and comorbidity profiles. Logistic regression was utilized to assess for differences in complication rates. ResultsA total of 3,622 pes planus patients were matched to 18,094 control patients. The pes planus group had significantly higher rates of falls than the control group (6.93 versus 2.97%, OR [odds ratio]: 2.43; CI [confidence interval]: 2.09 to 2.84; P < .001). Pes planus patients also had significantly greater odds of dislocation (OR: 1.89; CI: 1.58 to 2.27; P < .001), mechanical loosening (OR: 2.43; CI: 2.09 to 2.84; P = .019), and periprosthetic fracture (OR: 2.43; CI: 2.09 to 2.84; P < .001). The pes planus group had significantly greater rates of proximal humerus fractures (P = .008), but no difference was seen in distal radius fractures (P = .102). The time to revision was significantly shorter in the pes planus group (190 versus 554 days, P < .001). ConclusionsPes planus in patients undergoing THA is associated with increased risk of complications and faster time to revision. These findings may allow orthopaedic surgeons to identify those patients at risk and allow for more educated patient counseling and operative planning.

Hindfoot flexibility assessment of cavovarus and planovalgus feet by modified Shriners Hospitals for Children – Greenville (mSHCG) foot model

BackgroundMulti-segment foot models have been used to quantify foot kinematics during walking. However, walking kinematics is not sufficient to assess hindfoot flexibility (available range of hindfoot varus-valgus motion). The modified Shriners Hospitals for Children – Greenville (mSHCG) foot model has been used to quantify hindfoot flexibility with Coleman block test (peak hindfoot valgus) and Root test (peak hindfoot varus). Sensitivity of mSHCG foot model to detect clinically relevant difference in hindfoot flexibility measures for planovalgus (PV) and cavovarus (CV) feet has not been demonstrated. Research questionCan mSHCG foot model detect statistically significant difference in hindfoot flexibility measures between PV, CV and typically developing (TD) feet? MethodsHindfoot flexibility assessment was completed for 32 PV (37 feet), 27 CV (37 feet) and 20 TD (40 feet) individuals. Hindfoot position relative to tibia in coronal plane was measured in three postures: standing, heel raise and Coleman block test. Radiographic measures in standing position were also completed for PV and CV individuals and their correlation with hindfoot flexibility measures were evaluated. ResultsStatistically significant (p<0.001) differences were observed between three groups (TD, PV, CV) in all three hindfoot flexibility measures- (i) Hindfoot varus in standing position (ii) Peak hindfoot varus in heel raise and (iii) Peak hindfoot valgus in Coleman block test. There was relatively stronger correlation (R2=0.407–0.854) between three radiographic measures and hindfoot varus in standing position. Correlation between hindfoot range of motion towards valgus from standing to Coleman block test and the three radiographic measures was weaker (R2=0.2329–0.3042). SignificanceHindfoot flexibility assessment can detect statistically significant difference between PV, CV and TD feet and provides additional information about available dynamic range of motion of hindfoot in the coronal plane that cannot be predicted from radiographic measures. Therefore, hindfoot flexibility assessment may assist in treatment planning of foot deformities.

Tarsal coalition and painful plano-valgus foot. Deformity correction as alternative to resection

Aim. The study aimed to evaluate a group of patients who underwent consecutive surgeries between 2007 and 2020 due to a painful coalition of the tarsal bones, focusing exclusively on correcting valgus foot deformity. Materials and methods. A retrospective clinical and radiographic analysis was conducted on 11 adolescents (13 feet) who underwent surgery for talonavicular or talocalcaneal coalition combined with valgus deformity. Age at surgery ranged from 12 to 21 years. In each patient, the procedure involved performing opening wedge osteotomy of the anterior part of the calcaneus along with gastrocnemius muscle lengthening, with no coalition removal. The calcaneal osteotomy, using an autograft from the lateral malleolus, did not require stabilization. Two patients were operated on bilaterally. Before the surgeries, all the patients had painful valgus and abduction deformity and/or flatfoot with restriction of subtalar motion. Follow-up ranged from 2 to 14 years (mean 6). Results. Pain relief and foot shape improvement were achieved in all patients who underwent the procedure. Conclusion. In adolescents and young adults, deformity correction and improvement in foot shape without coalition resection alleviates the pain associated with the defect.

Simultaneous subtalar arthroeresis, midfoot soft tissue release, and talo-navicular arthrodesis in children with planovalgus neurologic foot.

Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA). A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6years (6-17). Mean follow-up was 7 ± 2.9years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01. Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108feet (4.6%) and 2feet (3.3%) had delayed medial wound healing. SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications. IV.

НАСЛЕДСТВЕННАЯ ТУБУЛОПАТИЯ: ФОСФАТ-ДИАБЕТ (Два клинических наблюдения)

Introduction. Phosphate diabetes is a representative of a group of diseases known as tubulopathies. It is more often of a hereditary nature. The disease manifests at an early age with symptoms similar to alimentary rickets, which creates problems for diagnosing and prescribing an adequate therapy. In this case, the current situation leads to the development of bone deformities and disability, delayed physical development, and the need for surgical treatment, which reduces the quality of life of the patients for a long time. Aim: To consider two clinical cases of phosphate diabetes with typical symptoms, demonstrate the diagnosing challenges, and analyze the treatment effects. Materials and Methods. Two clinical cases of phosphate diabetes are presented. The first patient: 16 years old, observed from the age of 2, and takes vitamin D and inorganic phosphates from the diagnosis date. The geneticist found the autosomal dominant of the pathology. The girl underwent two surgeries for her leg deformity. The second patient, 10 years old, was diagnosed at the age of 4 years. DNA diagnostics detected a mutation in the COL9A3 gene. They refused the complete DNA exome sequencing. From the diagnosis date, the patient is treated with the active vitamin D metabolite and inorganic phosphates. Results and Discussion. Clinician-observed: Patient 1 had leg deformities, painful legs, and disharmonious physical development caused by her growth retardation. Blood concentrations of calcium and phosphorus are within normal, there is hypocalciuria typical of phosphate diabetes in the urine, while phosphates are within normal. The patient’s kidney function is not impaired. Clinician-observed: Patient 2 is physically retarded, there are varus foot deformities and pes planovalgus feet. Kidney function is not impaired, the level of alkaline phosphatase is increased, the total blood calcium levels are decreased with phosphorus indicating normal values, and the urine phosphaturia and hypocalciuria are within normal ranges. Due to the COL9A3 mutation detected, Stickler syndrome was excluded. Orthopedic surgeon recommended surgical treatment of her leg deformities. Conclusions. The examination showed that the therapy allows keeping phosphate diabetes under control and avoiding the side effects of taking vitamin D.

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

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

Treatment for plano-valgus foot in children with subtalar arthroereisis. A review

Plano-valgus foot is a common problem among children and adolescents. The problem is most often noticed in early childhood, as this is the period when the arches of the foot should achieve a normal structure through the disappearance of the fat pad that is present from birth. During this period, the child's skeletal system is very malleable and its remodelling can be considerably influenced by additional factors. This is due to the high amount of cartilage tissue present in a child's skeletal system. Plano-valgus foot can be treated with non-operative methods, such as physiotherapy or the use of orthopaedic supplies, such as suitable orthopaedic insoles. Unfortunately, non-operative treatment is not always sufficient. If physiotherapy does not achieve the expected results, a physician may opt for surgical treatment to restore a correct foot alignment. The most commonly performed plano-valgus foot procedure is subtalar arthroereisis. It is a minimally invasive procedure that takes approximately 10–30 minutes to perform. During the procedure, appropriate implants of various types and sizes are inserted into the tarsal sinus to reduce excessive foot pronation. Studies have shown that the procedure is beneficial to the patient, as it positions the foot correctly and children can return to performing physical activities without experiencing pain and/or rapid muscle fatigue in the foot area. The most commonly used measurements to assess the effects of plantar arthrodesis are those calculated from X-rays, such as Meary's angle, calcaneal inclination pitch angle (CP), talocalcaneal angle (Kite's angle), and surveys using The American Orthopaedic Foot and Ankle Society’s (AOFAS’s) ankle and hindfoot scoring system.

Telehealth during the COVID-19 pandemic regarding children with plano-valgus foot after subtalar arthroereisis

Introduction: The COVID-19 pandemic brought about numerous changes. Access to health services was limited, and restrictions were imposed to prevent the spread of the disease. Consequently physical activity of children was limited due to their increased time at home, which could result in reduced physical performance and abnormal development. Aim: This study aimed to assess the access to physiotherapy and the use of telemedicine regarding children after subtalar arthroereisis surgery during the COVID-19 pandemic. Material and methods: Seventy-nine parents/guardians of children who underwent subtalar arthroereisis surgery at Chorzow Municipal Hospital Complex between May 2019 and May 2021 participated in the study. A self-administered questionnaire designed for the study was used as the research method. Results: The results showed that some respondents perceived the wait times at the National Health Service and the cost of private services as problems during the COVID-19 pandemic. However, increased problems associated with general access or course of treatment were not confirmed. Sixty-seven percent of respondents confirmed decreased physical activity in children due to the COVID-19 pandemic. One-third of parents noticed weight gain and muscle weakness in their children, while for 56% of respondents, the weight gain was not noticeable. In addition, more than 70% of the children had no complaints of pain. The results also showed that only 36.8% of respondents used telemedicine during the pandemic. Conclusions: The constraints imposed by the COVID-19 pandemic caused a decline in children’s physical activity; one-third of parents reported weight gain in their children. In addition, waiting times for physiotherapy reimbursed by the National Health Fund were long, and the cost of private physiotherapy was higher; it could not be confirmed whether more patients subsequently used telemedicine.

Medial Column Soft Tissue Imbrication with Internal brace Augmentation Following Lateral Column Lengthening in the Ambulatory Pediatric CP with Pes Planovalgus Foot Deformities: A Novel Indication

Category: Midfoot/Forefoot; Other Introduction/Purpose: Pes planovalgus foot deformity is common in children with cerebral palsy (CP), and with failed bracing or painful progression, surgery is often needed. This study examines the effect of flatfoot reconstruction utilizing a novel approach to address the redundant medial soft tissue on these measures when compared to matched cohort undergoing the traditionally described soft tissue plication (STP) (Figure 1). Methods: An IRB approved, retrospective review of ambulatory pediatric CP, GMFCS I-III, patients with pes planovalgus foot deformities was conducted. Patients underwent a lateral column lengthening (LCL) along with medial column STP, with/without internal brace (IB) augmentation at a single tertiary institution by the same surgeon from 2017 to 2020. Patients were divided into two groups: without IB, and with IB augmentation. Radiographic indices on orthogonal weightbearing (WB) x-rays were measured at multiple timepoints: Preoperative, immediate postoperative and at the 3/6/12/24 months postoperative follow-up periods. Variables measured included AP and lateral talus-first metatarsal angles (TFMA), talonavicular coverage angle (TCA) and calcaneal pitch (CP). Means and standard deviation for continuous radiographic variables were calculated, followed by one-sided t-tests to compare the values between the two groups at all intervals. Results: 58 patients were identified, 31 without IB and 27 with IB augmentation. Both groups were well matched with respect to age, CP type, GMFCS level and gender. Preoperative WB radiographs showed no statistical difference between the two groups: Mean AP TFMA (26° vs. 28°, p=0.073), lateral TFMA (27° vs. 30°, p=0.067), TCA (34° vs. 30°, p=0.059) and CP (4° vs. 2°, p=0.069)(Table 1). Both cohorts maintained improved radiographic indices at the final 2-year timepoint. However, radiographs showed that the IB group had less midfoot collapse, maintaining a statistically significant difference in all radiographic parameters at final 2-year follow-up: Mean AP TFMA (13° vs. 5°, p&lt; 0.001), lateral TFMA (11° vs. 2°,p &lt; 0.001), TCA (15° vs. 6°,p &lt; 0.001) and CP (10° vs. 19°,p &lt; 0.001) Table 2). Conclusion: Internal brace augmentation is an innovative surgical technique that provides additional stability to the medial column soft tissues following LCL. This procedure will help prevent mid-foot collapse and better maintain long-term foot shape when WB. Utilizing this novel technique helps maintain proper biomechanical orientation of foot following reconstruction of pes planovalgus deformities in the ambulatory pediatric CP population.

Early Outcomes after Minimally Invasive Percutaneous Calcaneal Osteotomy in the Treatment of Cavovarus and Planovalgus Foot Deformities

Category: Hindfoot; Other Introduction/Purpose: A calcaneal osteotomy is often included as part of the treatment in planovalgus and cavovarus foot deformities. Often this is done through an open approach where complications of wound infection and sural nerve injury are common. More recently, this strategy has been modified using minimally invasive techniques. A percutaneous approach, in comparison to the standard open calcaneal osteotomy, allows for reduced postoperative complication and decreased pain compared to an open procedure. This retrospective chart review aims to evaluate the postoperative outcomes of patients undergoing calcaneal osteotomy via a minimally invasive percutaneous approach in foot reconstructive surgery to assess early functional outcomes, complication rate and revision rates. Methods: One fellowship-trained foot and ankle orthopaedic surgeon at one academic institution performed minimally invasive calcaneal osteotomy on 20 patients. All cases were completed between March 2021 and March 2023. Patient charts were reviewed for outcome data including complication rate, union rate, revision rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Results: Participants included 15 females and 5 males, 4 of whom were smokers. Average age was 42.2 years. Average BMI was 32.3, and average follow up was 130.4 days. Complications included 1/20 patients had a postoperative wound breakdown of the screw site requiring incision and debridement with closure and 2/20 cases of sural neuritis. One resolved 6 months after treatment and the other was present but became less symptomatic. All participants achieved union, and there were no revisions. All shifts corrected hindfoot deformity either via medializing or lateralizing osteotomy. Average preoperative PROMIS scores in the domains of physical function, pain interference, and mobility were 36.8 (28.6-46), 67.1 (54.3-78), and 34.6 (25-40), respectively. Average postoperative PROMIS scores were 35.7 (21-76), 62.3 (39-76), and 33.4 (16-75), respectively. Conclusion: Minimally invasive calcaneal osteotomy appears to be an efficacious and safe treatment option for the correction of cavovarus and planovalgus hindfoot deformities with the ability to obtain appropriate hindfoot correction with low complication rates and high union rates. Early outcome measures show a favorable pain interference PROMIS score as well as a trend in improvements in PROMIS physical function scores. Longer term data will need to be done to assess long term functional outcome and revision rates.

Higher revision rates in patients with preoperative contralateral pes planovalgus deformity following total knee arthroplasty.

The purpose of this study was to compare the incidence of revision in those with pes planovalgus deformity to those without using a large national database. Given the reciprocal changes in lower extremity alignment associated with planovalgus foot deformity, it has been suggested that patients with this deformity has worse outcomes following total knee arthroplasty (TKA). A retrospective cohort analysis of patients undergoing elective TKA was conducted using the PearlDiver database. Patients were stratified into three cohorts: those without pes planovalgus, patients with ipsilateral or bilateral pes planovalgus relative to the TKA, and patients with contralateral pes planovalgus. Patients with prior foot reconstructive surgery were excluded. The cohorts were each matched to those without pes planovalgus. Bivariate analysis was performed comparing 90-day medical complications and 2- and 4-year revisions following TKA. An adjusted number needed to be exposed for one additional person to be harmed (NNEH) was calculated using the adjusted odds ratio (OR) and unexposed event rate. Following matched analysis, those with contralateral pes planovalgus had similar odds (OR 3.41; 95% CI 0.93-12.54; p = n.s.) for aseptic revision within 2 years but significantly higher odds (OR 3.35; 95% CI 1.08-10.41; p = 0.03) within 4 years when compared to those without a pes planovalgus deformity. Within 4 years, there was no significant difference in the incidence of aseptic revision (p = n.s.) in patients with ipsilateral/bilateral pes planovalgus. No patients in any cohort underwent septic revision within 4 years of TKA. This study found that patients with contralateral pes planovalgus deformity had higher odds of aseptic revision within 4 years following primary TKA in a national database, suggesting that the change in gait kinematics associated with this deformity could possibly be associated with increased revision rates. Level III.

Risk Factors for Failure of Calcaneal Lengthening Osteotomy in Children and Adolescents With Planovalgus Foot Deformity: A Retrospective Study.

The calcaneal lengthening procedure (CLP) is a well-known surgical technique used for the correction of symptomatic planovalgus foot deformities. Literature shows a significant rate of relapse and undercorrection of the foot post-operatively. Factors determining the failure or success of CLP are still not well understood. The purpose of this retrospective study was to assess the most significant factors related to the failure of this procedure. A case-control retrospective study was conducted on 50 patients (80 feet) aged 12.4±2.5 years who underwent CLP. A clinical (demographic parameters, etiology, Gross Motor Function Classification System (GMFCS) level) and radiological evaluation were assessed preoperatively and repeated postoperatively at 56.5±32.5 months. Two methods of osteotomy bone fixation were studied: K-wires vs. eight-plate. Standing anteroposterior (AP) and lateral (L) radiographs were done, and the following radiographic parameters were measured: calcaneocuboid (CC) joint subluxation classified into normal, moderate, and severe (L); AP and L talo-first metatarsal (T1MT) angle; AP talonavicular (TN) coverage angle; AP and L talocalcaneal (TC) angle; calcaneal pitch (CP) angle; and L talo-horizontal (TH) angle. Mosca's criteria were used for clinical and radiological assessments. The association between demographic data, clinical and radiological results, and the variation between preoperative and postoperative angles were studied. The main risk factors affecting clinical results and CC joint subluxation were investigated (logistic regression and analysis of covariance (ANCOVA)). Satisfactory clinical results were associated with satisfactory radiological ones on Mosca's criteria (p<0.001). The use of an eight-platefor osteotomy fixation gave better results than K-wires (79% vs. 59%). Radiological angles were improved in both techniques postoperatively (increase of CP and L-TC and decrease of AP-T1MT, AP-TC, AP-TN, and L-T1MT, all p<0.05). Non-satisfactory clinical results were associated with a high GMFCS level, a low preoperative AP-TN coverage angle, and a low preoperative CP angle (R2=0.45). Both a young age and a low CP angle preoperatively were associated with CC subluxation (R2=0.31). The neurological status and the severity of the planovalgus foot deformity preoperatively were the main risk factors affecting clinical outcomes after CLP. However, young age and the severity of the deformity preoperatively were the main risk factors behind CC joint subluxation affecting CLP outcomes.

Deltoid ligament injury and repair.

The deltoid ligament is the primary stabilizer of the medial side of the ankle joint. It is a complex structure with an origin at the medial malleolus from where it spreads fan shaped distally with an insertion into the medial side of the talus, calcaneus and navicular bone. This chapter gives an overview of the anatomy, function, and pathology of the deltoid ligament.The deltoid ligament can become insufficient as a result of an ankle injury or prolonged strain. In the acute setting, deltoid insufficiency often coincides with multi ligament injury the ankle joint; syndesmosis injury, or ankle fractures. Management in the acute phase remains a subject of debate. Some orthopedic surgeons have a tendency towards repair, whereas most trauma surgeons often treat the deltoid nonoperatively. In the chronic setting the ligament complex is often elongated as a result of prolonged strain. It often coexists with a hindfoot valgus, as is the case in planovalgus feet. In such a case a realignment procedure should be combined with the deltoid repair.

Analysis of the results of the surgical treatment of plano-valgus foot deformity in children and adolescent

Background: Plano-valgus deformity of the feet is a common reason for contacting an orthopedist. Pediatric orthopedics uses technologies, in particular, subtalar arthroeresis, that do not violate the physiological growth of the patient. Aim: to choose the optimal methods for the correction of foot deformity in children and adolescents. Analysis of the results of the surgical treatment. Methods: In the period from 2013 to 2022, 482 patients were operated on for flat-foot deformity. Subtalar arthroeresis surgery was performed in 405 cases in various combinations. Results: The 9-year-long observation of the patients after the surgical treatment showed that in most cases there was a persistent positive effect, namely: no complaints of pain syndrome, no clinical and radiological pictures of a plano-valgus foot, patients led an active lifestyle, including sports. On average, after 17.7 months, 66 cases (16.1%) required replacement of the subtalar implant due to the physiological growth of patients. In 125 cases (31.2%) the implant was removed on average 31.2 months after placement. Unsatisfactory results were noted in 14 patients (3.4%). Conclusions: The technique of subtalar arthroeresis, as a low-traumatic one, does not interfere with the physiological growth of the foot skeleton, does not limit physiological loads after the surgical treatment, and is actively used in the childhood and adolescence. The peculiarity of the subtalar arthroeresis in a patient with the physiological growth of the foot skeleton is a high probability of the subtalar implant replacement.

Comparison of foot kinematics of planovalgus feet using calculations of midfoot joint center based on anatomical landmarks, regression equations and functional calibration algorithms

Comparison of foot kinematics of planovalgus feet using calculations of midfoot joint center based on anatomical landmarks, regression equations and functional calibration algorithms

Improved Gait and Radiological Measurements After injection of Botulinum Toxin Into Peroneus Longus in Young Children With USCP and Equinovalgus Gait

BackgroundChildren with cerebral palsy develop foot deformities due to a combination of factors including muscle shortening, hypertonia, weakness, and cocontraction of muscles acting at the ankle joint resulting in an altered gait pattern. We hypothesized these factors affect the peroneus longus (PL) and tibialis anterior (TA) muscles couple in children who develop equinovalgus gait first followed by planovalgus foot deformities. Our aim was to evaluate the effects of abobotulinum toxin A injection to the PL muscle, in a cohort of children with unilateral spastic cerebral palsy and equinovalgus gait. MethodsThis was a prospective cohort study. The children were examined within 12 months before and after injection to their PL muscle. Twenty-five children of mean age 3.4 (S.D.: 1.1) years were recruited. ResultsWe found significant improvement in foot radiology measures. Passive extensibility of the triceps surae did not change, whereas active dorsiflexion increased significantly. Nondimensional walking speed increased by 0.1 (95% confidence interval [CI], [0.07, 0.16]; P < 0.001), and the Edinburgh visual gait score improved by 2.8 (95% CI, [-4.06, -1.46]; P < 0.001). Electromyography showed increased recruitment for gastrocnemius medialis (GM) and TA but not for PL during the reference exercises (standing on tip toes for GM/PL, active dorsiflexion for TA) and decreased activation percentages for PL/GM and TA across sub-phases of gait. ConclusionsOne key advantage of treating the PL muscle only might be to address foot deformities without interfering with the main plantar flexors that are instrumental to support body weight during gait.

Long-term Impact of Planovalgus Foot on Activities of Daily Living in Patients With Down Syndrome.

Planovalgus foot (PVF) is the most common orthopaedic abnormality in children with Down syndrome (DS), and as a result these patients rarely develop an adequate plantar arch in adulthood. The present study aims to evaluate the impact of PVF on activities of daily living and participation in sports among young adults with DS and determine whether this impact is related to the degree of foot deformity based on clinical and imaging studies. Observational analytical study examining a database of 649 patients with DS from a pediatric referral center, identifying those individuals over age 20 years at the time of the study with a childhood diagnosis of PVF. Finally, 51 patients (102 feet) were evaluated based on clinical and imaging studies, and function was assessed using the The Foot and Ankle Outcome Score (FAOS) and the Visual Analogue Scale (VAS) pain scale. A correlation analysis was performed to determine the clinical and radiographic variables associated with functional outcomes. Linear regression models were obtained to quantify the impact of these variables on function. Patients had a mean age of 26.14±3.88 years and body mass index of 24.51±4.57. Clinically, 63.65% presented grade 3 or 4 PVF, and most were flexible. Radiographically, midfoot flattening was mild-moderate in 92.16%, 58.82% had medial talo-navicular uncoverage, and 30.39% had an increased hallux valgus (HV) angle. Mean scores for all FAOS subscales were between 65 and 71% and the mean VAS score was 1.45±1.96. An association analysis revealed a tendency toward lower scores on all FAOS subscales and greater pain according to the VAS scale in more severe PVF and in cases of moderate HV with asymmetry between feet. Linear regression models showed that major contributors to functional scores were radiographic evidence of hindfoot valgus, midfoot abduction, and flattening, and HV. Young adults with DS who are diagnosed with PVF in childhood have acceptable functional scores and low pain. Alteration of radiographic parameters toward flatter, more valgus and abducted feet and greater and asymmetric HV tend to be associated with worse long-term functional scores in activities of daily living and sports participation and increased pain. Therefore, non-operative management of these patients is justified, although individualized treatment is recommended. Level IV, Case series.