Symptomatic Flatfoot Research Articles

Ultrasound Shear Wave Elastography of the Arch-Supporting Structures in Symptomatic Flatfoot: A Pilot Study.

The posterior tibial tendon (PTT), deltoid ligament, and spring ligament are often torn or attenuated in patients with progressive collapsing foot deformity. The goal of this pilot study was to measure the ultrasound shear wave velocity (SWV) of these arch-supporting structures in feet with varying degrees of deformity to improve our understanding of their role in the progression of deformity. Two observers measured the SWV of the supramalleolar and inframalleolar PTT in long and short axes, in the tibiospring portion of the deltoid ligament, and in the superomedial band of the spring ligament in 8 neutrally aligned feet, 5 asymptomatic flatfeet, and 7 symptomatic flatfeet. Each measurement was repeated 3 times both with and without an applied eversion stress. Average SWV was lower at all locations in the symptomatic flatfeet compared with normal feet, but these differences were statistically significant only for the inframalleolar PTT and the spring ligament. Externally applied stress led to an increase in the SWV of the ligaments but a paradoxical decrease in the SWV in the supramalleolar PTT. The SWV of the PTT was lower along the short axis compared with the long axis. SWV may be useful in evaluating the severity of degenerative disease of arch-supporting structures, but further study is needed before this technique can be applied clinically. Level III, case-control study.

Does severity of the flatfoot deformity affect pain and mobility in adolescents with symptomatic flatfoot.

Level III.

An evaluation of a bespoke modified UCBL foot orthosis on subjects with flat foot using kinetic measurements and user comfort scores: A randomized controlled trial

AimThe purpose of this study was to assess and evaluate the effect of a bespoke Modified UCBL Foot Orthosis (MUFO) using both kinetic parameters (Centre of Pressure (CoP) and the Ground Reaction Force (GRF) pattern) and comfort scores in subjects diagnosed with flat foot. MethodThis study included thirty-four young adults with symptomatic flatfeet. Two Kistler force plates (100 Hz) were used to record the CoP sway and GRF pattern during four conditions; 1) an MUFO and standard-fit shoe; 2) the University of California-Berkley Lab (UCBL) insole and standard-fit shoe; 3) barefoot and 4) standard-fit shoe only. The magnitude of subject comfort with UCBL and MUFO also was measured by a 10 cm Visual Analogue Scale (VAS) during walking. ResultsThe MUFO decreased mean lateral displacement in the initial phase and midstance of gait compared to barefoot walking. During the propulsion phase use of the new MUFO produced more lateral excursion with a mean difference of 3 mm) P < 0.001(compared to barefoot walking and standard shoe wear. No significant difference in comfort rate was found between the MUFO and UCBL (P = 0.165). ConclusionThe MUFO produced effective pronation control and decreased the CoP displacement in all of stance phase.

Is a keystone Bone Anomaly the Main Cause of Flatfoot (Pes Planus)?

Flatfoot (pes planus) is a decrease or loss of longitudinal medial arch height. The cause of symptomatic flatfoot occurring in adolescents is still unclear. In this study, the relationship between adolescent pes planus and foot bone shape was investigated. For this purpose, the volume and superficial area data of the foot bones of adolescent individuals with flatfoot deformity and individuals without any foot deformity were compared. Between September 2022 and June 2023, 30 individuals with adolescent pes planus with a medial arch angle greater than 145 degrees and 30 individuals without any foot deformity were included in the study. Computed tomography (CT) images of the participants' feet were obtained with a General Electric brand IQ model 32 detector CT device with a section thickness of 0.625mm in accordance with the bone protocol. Using the 3D Slicer program on CT images, foot bones were segmented and the volume and surface area ratios of each foot bone were determined. Cuneiforme mediale and cuneiforme intermediale volume ratios in individuals with flatfoot deformity decreased by 14% and 24%, respectively, compared with the control group ( P <0.05). Cuneiforme mediale and cuneiforme intermediale superficial area ratios were found to be 10% and 30% lower in the flatfoot group compared with the control group, respectively ( P <0.05). There was no difference in the volume and superficial area ratios of other foot bones between the groups ( P >0.05). The study results suggest that symptomatic adolescent flatfoot deformity may be associated with developmental anomalies of the os cuneiforme mediale and os cuneiforme intermedium.

Multi-Segment Foot Kinematics during Gait in Adults with Asymptomatic and Symptomatic Flatfoot

PurposeTo investigate the differences in foot kinematics during gait between adults with asymptomatic and symptomatic flatfoot.MethodsThe study included 10 participants (six males and four females, aged 25.7 ± 6.5 years) with symptomatic flatfoot and 10 participants (eight males and two females, aged 21.2 ± 1.0 years) with asymptomatic flatfoot. Multi-segment foot kinematics were captured during barefoot gait analysis using a 3D software. Angles were calculated for the calcaneus with respect to the shank (Sha-Cal), the midfoot with respect to the calcaneus (Cal-Mid), and the metatarsus with respect to the midfoot (Mid-Met) during the stance phase.ResultsSome differences were noted between medium-to-large effect sizes. The symptomatic group had a decreased Mid-Met dorsiflexion angle at the initial contact to 50% of the stance phase compared with the asymptomatic group. The symptomatic group also showed decreased Mid-Met abduction at initial contact, larger Sha-Cal eversion angles at 10% of the stance phase, and larger Cal-Mid eversion angles at 50% and 70% of the stance phase compared to the asymptomatic group. The symptomatic group also had a larger peak Sha-Cal eversion angle than the asymptomatic group.ConclusionAdults with symptomatic flatfoot exhibit significant differences in foot kinematics towards decreased forefoot dorsiflexion at initial contact to mid-stance, decreased forefoot abduction at initial contact, and increased rearfoot eversion during the stance phase compared with those with asymptomatic flatfoot during gait. Pain may impair intersegmental motion.

Does the Presence of Asymptomatic Flatfoot Deformity Impact the Clinical and Radiographic Outcomes of the Minimally Invasive Chevron and Akin Bunionectomy?

Flatfoot deformity is believed to play a role in hallux valgus development and recurrence. While symptomatic flatfoot deformity can be treated with separate procedures at the time of hallux valgus correction, the question remains whether the patient undergoing correction of a symptomatic hallux valgus deformity should have their asymptomatic flatfoot concurrently addressed. We aimed to investigate whether the presence of asymptomatic flatfoot influences patient-reported and radiographic outcomes of the minimally invasive chevron and Akin bunionectomy. A total of 104 patients were included in this study. Forty-two asymptomatic patients met the radiographic criteria for flatfoot while 62 had a normal arch. Patient-reported outcomes were evaluated and compared between the two groups using validated PROMIS measures preoperatively and at a minimum one-year postoperatively. Radiographic outcomes including hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch (CP), and talonavicular coverage angle (TNCA) were measured and compared preoperatively and minimum six-months postoperatively. Both groups demonstrated similar preoperative and postoperative PROMIS scores with significant improvements in physical function, pain interference, pain intensity, and global physical health. Preoperatively, HVA was similar between both groups, however the flatfoot group showed a greater IMA, Meary's angle, TNCA, and lower CP. Postoperatively, HVA and IMA were similar between groups, although patients in the flatfoot group retained a significantly greater Meary's angle, TNCA, and lower CP. Both groups showed significant improvements in HVA, IMA, and TNCA. Our study indicates that the minimally invasive chevron and Akin bunionectomy leads to improved clinical and radiographic hallux valgus outcomes without adversely impacting radiographic flatfoot parameters. Therefore, the MIS bunionectomy may be an effective option for hallux valgus correction in patients with mild, asymptomatic flatfoot. Level III, retrospective cohort.

The effects of foot orthoses on radiological parameters and pain in children with flexible flat feet: a systematic review and meta-analysis.

This study aimed to investigate the impact of foot orthoses on foot radiological parameters and pain in children diagnosed with flexible flatfoot. A comprehensive search was conducted across several databases, including PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO, covering publications from the inception of each database up to 8 June 2024. The study focused on randomized controlled trials investigating the use of foot orthoses for treating flexible flat feet in children. Four researchers independently reviewed the identified literature, extracted relevant data, assessed the quality of the studies, and performed statistical analyses using RevMan 5.4 software. Six studies involving 297 participants were included. The methodological quality of the included literature ranged from moderate to high. Radiological parameters of the foot improved significantly in older children with flexible flat feet following foot orthotic intervention compared to controls, particularly in the lateral talar-first metatarsal angle [mean difference (MD) = -2.76, 95% confidence interval (95% CI) -4.30 to -1.21, p = 0.0005], lateral talo-heel angle (MD = -5.14, 95% CI -7.76 to -2.52, p = 0.0001) and calcaneal pitch angle (MD = 1.79, 95% CI 0.88-2.69, p = 0.0001). These differences were statistically significant. Additionally, foot orthoses significantly improved the ankle internal rotation angle and reduced foot pain in children with symptomatic flexible flatfoot (MD = -2.51, 95% CI -4.94 to -0.07, p = 0.04). The use of foot orthoses positively impacts the improvement of radiological parameters of the foot and reduces pain in older children with flexible flat feet. However, in younger children with flexible flat feet, the improvement from foot orthoses was not significant, likely due to challenges in radiological measurements caused by the underdevelopment of the ossification centers in the foot. Further studies are needed. Consequently, the results of this meta-analysis support the implementation of an early intervention strategy using foot orthoses for the management of symptomatic flat feet in older children. https://www.crd.york.ac.uk/, PROSPERO [CRD42023441229].

Resection of Calcaneonavicular and Talocalcaneal Coalitions With Surgical Correction of the Hindfoot Valgus Deformity in One Step.

Calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions are the most common cause of rigid flatfoot in children. After resection, correction of the most frequent valgus-hindfoot deformity usually requires a second-step surgery. We report results of a retrospective study of patients treated with a one-step correction. Between 2008 and 2019, data were collected on 26 patients (19 male, 7 female) affected by CNC (n = 18) and TCC (n = 13), all with rigid symptomatic flatfeet. Average age at surgery was 12.5 ± 1.1 (SD) years (range, 9.8-15.2). All patients (26/26) underwent resection, 20 of 26 underwent at the same time subtalar extraarticular screw arthroereisis (SESA) for correction of residual hindfoot valgus deformity. Pre- and postoperative talocalcaneal angle according to Costa Bartani and Talar inclination angle in weightbearing were measured. Twenty-five of 26 patients had postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Pre- and postoperative talocalcaneal average angle for CNC was respectively 141.5 ± 7.7 degrees and 130.5 ± 5.2 degrees (P < .0001) and 143.7 ± 7.7 degrees and 129.7 ± 7.0 degrees (P < .0001) for TCC. Talar inclination average angle for CNC was 29.2 ± 5.3 degrees and 19.3 ± 1.6 degrees (P < .0001) and 31.2 ± 6.4 degrees and 21.4 ± 3.4 degrees (P < .0001) for TCC. Average follow-up (FU) was 4.7 ± 3.0 years (range, 6 months-11.9 years, median 4.9 years), with a mean age at FU of 17.2 ± 5.8 (SD) years (min 12.1, max 25.3, median 16.8 years). The mean AOFAS ankle-hindfoot score for CNC and for TCC was 96.6 (range 83-100) for resection and valgus correction as one-step procedure with no statistical difference (P = .5) between CNC and TCC. No patients had additional surgery for complications or recurrence. Symptomatic rigid flatfeet affected by CNC and TCC treated with coalition resection and minimally invasive subtalar arthroereisis (SESA) for residual hindfoot valgus correction in one step in adolescent age achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided. Level IV, retrospective study.

Efficacy of Faradic Foot Baths and Short Foot Exercises in Symptomatic Flatfoot: A Review.

Flatfoot is a common condition among adults, according to orthopedic experts. Flatfoot is defined in this document as a foot condition that occurs after the completion of skeletal growth and is characterized by either partial or complete reduction of the medial longitudinal arch (MLA). The purpose of this study was to evaluate the effects of short foot exercise (SFE) and faradic foot baths on people who have flat feet. This review focused on comprehensive original primary articles written in English. Numerous studies have been conducted in order to determine the effects of both interventions. The search yielded a wide range of papers, including editorials, review articles, freely available full texts, and abstracts. The results showed that both SFE and faradic foot baths effectively improved flat feet.

Nonunion Rate of Evans Osteotomy Without Fixation Pediatric Flatfoot

Category: Hindfoot; Other Introduction/Purpose: The Evans osteotomy is a calcaneal lateral column lengthening procedure commonly used to correct flatfoot deformities. Currently, there is no consensus on whether fixation is needed when performing this osteotomy. Also, large sized grafts have been found to lead to degeneration of the calcaneocuboid joint. The aim of this study was to determine the nonunion rate of an unfixed Evans osteotomy with use of an allograft wedge performed in patients undergoing flexible flatfoot reconstruction and if addition of a medial calcaneal slide osteotomy will help limit graft size. Methods: We retrospectively reviewed 39 pediatric patients with idiopathic symptomatic flatfoot deformity who underwent 46 unfixed Evans osteotomies with allogenic bone graft for flatfoot reconstruction between March 2013 and September 2017, with a mean follow-up of 49 (range 9.9- 243.9) weeks. Hospital record, preoperative, follow-up radiographs and complications were reviewed. Results: Of the 46 feet, 42(91.3%) underwent an associated medial displacement calcaneal osteotomy. Mean graft wedge size was 7.2mm(SD 1.6). Mean time to union was 10.3weeks (range, 6.7-13.9)(Table 1). There were no nonunions. There was significant improvement in all radiographic parameters at final follow-up (Table 2). Postoperative calcaneocuboid subluxation occurred in 70% of feet, with no correlation with wedge size(r=0.01,p=0.53). Magnitude of calcaneocuboid subluxation was small and only significant at 6-months (p=0.02), with regression to no significance by 1-year(p=0.3). Mean change in calcaneocuboid subluxation at final follow-up was 1.07mm(SD 2.18), with postoperative subluxation diminishing over time(Table 3). No correlation was observed between wedge size and change in lateral column length (r=0.01,p=0.45). One patient had persistent sinus tarsi pain requiring arthroscopic debridement of fibrosis and graft prominence. Conclusion: An unfixed Evans osteotomy for symptomatic pediatric flatfoot deformity resulted in a significant improvement in the radiographic alignment and achieved 100% union rate with minimal calcaneocuboid subluxation at final follow-up. Performing adjunctive procedures allowed the Evans procedure to be routinely limited to less than 10 mm of lengthening. Mean graft size in our cohort was smaller than that reported by other studies. While calcaneocuboid subluxation was detectable in 70% of feet, it was small in magnitude and diminished with longer postoperative follow-up.

La pérdida de corrección radiológica a los 2 años de la artrorrisis subastragalina con implante reabsorbible en el pie plano flexible no influye en los resultados funcionales.

Purpose of the study: To analyze the functional, radiological and satisfaction outcomes of the pediatric patient with symptomatic flat foot subjected to subtalar arthroereisis with a resorbable implant, evaluating the evolution of radiological measurements during the postoperative period. Material and methods: Retrospective study of 69 patients, between 8 and 14 years of age, operated on between 2011 and 2020, with 2 years of postoperative follow-up, evaluating functionality (AOFAS scale), degree of satisfaction, and radiological analysis. Results: The mean preoperative score on the AOFAS scale was 75.7. At 2 years, the score was 96.5 (p&lt;0.001). 60 patients were satisfied, and 9 were not satisfied. All angular measurements improved after surgery (p&lt;0.001), although loss of reduction was observed at 2 years compared to the first postoperative month. Conclusions: Subtalar arthroereisis in symptomatic flexible flatfoot presents good outcomes, with loss of radiological correction at the end of follow-up compared to measurements one month after surgery.

Foot Falls – Managing Flatfeet in Children and Adolescents

Flat feet are rarely symptomatic in children. The reason for consultation is usually parental anxiety and peer pressure. Majority of the patients and their parents needs to be treated with assurance. The clinical assessment of the foot must however be performed systematically in order to detect signs of symptomatic flat feet that are detected early and treated within time. Asymptomatic flexible flat feet constitute the majority of these feet and need to be assessed for a tight tendo achilles. Feet with a tight tendo achilles are most likely to become symptomatic and may need some form of treatment. The treatment is primarily conservative however in exceptional circumstances joint sparing osteo tomies of the feet are recommended Evaluation of the foot should detect any signs of a rigid flat foot. The cause of rigidity if established early can be addressed to prevent long term morbidity. Keywords: :Flexible Flatfoot, Rigid Flatfoot Achilles tendon contracture, Foot Osteotomies.

Controversy of subtalar arthroereisis in symptomatic flatfoot

Flatfoot could be divided into flexible flatfoot and rigid flatfoot. Flatfoot with symptoms is called symptomatic flatfoot, surgical treatment is required if conservative treatment is not effective. Subtalar arthroereisis is a minimally invasive procedure which has been used for many years with good results in flexible flatfoot, however, still has many controversial points. Controversial points focus on indications and contraindications, optimal age, subtalar arthroereisis alone or not, efficacy and safety of absorbable material implants, and implant removal. The paper reviewed and summarized the use and controversies of subtalar arthroereisis in symptomatic flatfoot as follows:the best indication for subtalar arthroereisis was pediatric flexible flatfoot syndrome and aged from 10 to 12 years old was optimal age for treatment;tarsal coalitions with flatfoot and adult flatfoot were relative indications. Stiff flatfoot, joint laxity, and subtalar arthritis were contraindications;obesity and neurogenic flexible flatfoot were relative contraindications. The correction ability of subtalar arthroereisis alone was limited, and it's combined with other procedures depending on patient's situation. The safety and efficacy of absorbable material implants had been reported. Routine removal of the implant was not necessary, the main reason of which was tarsal sinus pain.

Identification of the Apex of the Medial Longitudinal Arch Break in Progressive Collapsing Foot Disorder

Category: Midfoot/Forefoot Introduction/Purpose: Progressive Collapsing Foot Disorder (PCFD) is caused by failure of both dynamic and static structures. The aim of this study was to identify the anatomical location of the medial longitudinal arch break in symptomatic flat foot deformity and analyze its relationship with Meary's angle. Methods: We analyzed weight-bearing radiographs of 81 patients [mean age 53.7 years (range, 18-81) with 101 flat feet. The apex of the medial arch break was determined on the lateral foot radiographs as the intersection of the anatomical axis of the talus and the first metatarsal. Therefore, the overall centre of rotation of angulation (CORA) of the medial arch break was documented as the angle at its apex (Meary's angle). Each separate joint angulation was then calculated to determine if the overall CORA was made of separate CORAs. Correlations between the apex location, and the number of apices, with Meary's angle were conducted. Results: There was an isolated apex of deformity in 50.4% (51/101) of cases. These were localised at talonavicular joint (TNJ) in 47% (24/51), the naviculocuneiform joint (NCJ) in 52.9% (27/51) and none at the cuneiform-first metatarsal joint (C-1MTJ). The remaining 49.5% (50/101) had combination apices with the primary deformity being at TNJ in 58% (29/50), the NCJ in 40% (20/50), and 2% (1/50) at the C-1MTJ. The mean Meary's angle was -17.9° for isolated and -18° for combination which was not statistically significant (p=0.92). There was no statistical difference in the talonavicular uncoverage angle between the single and combination apices group (p= 0.99). Conclusion: The apex of the medial arch break occurs distal to the talonavicular joint in the majority of cases, and thereby the main insertion points of the posterior tibial tendon and spring ligament. In 52.9% (27/51) of cases, the deformity occurs solely distal to the TNJ and in 58% (29/50) cases, it involves joints in addition to the TNJ. These will involve pathology of other structures, including the naviculocuneiform ligament. Surgical strategies in successfully correcting Progressive Collapsing Foot Disorder will therefore need to address joints distal to the TNJ in the majority of cases.

The Double Calcaneal Osteotomy for Pediatric Flatfoot

Category: Hindfoot Introduction/Purpose: The double calcaneal osteotomy combines a medial calcaneal sliding osteotomy and lateral column lengthening. Corrective osteotomies, as opposed to arthrodesis and arthroereises, are preferred for foot deformity correction in children and adolescents because they preserve joint mobility, shock absorption, and avoid concerns about adjacent joint degeneration. Individually, both types of osteotomies have demonstrated efficacy in achieving deformity correction and improved functional outcomes for patients. The literature regarding outcomes of this procedure in children is sparse. This retrospective study objectively analyzes outcomes of children who underwent double calcaneal osteotomies at our institution by comparing pre and postoperative radiographs and reporting postoperative complications. To our knowledge, this study contains the largest sample size of symptomatic flatfeet analyzed with regards to double calcaneal osteotomies in children. Methods: Patients who underwent a double calcaneal osteotomy over the past 5 years at our institution were analyzed. Pre and postoperative weightbearing radiographs of the foot were measured (Figure 1). Paired t tests were used to compare pre and postoperative measurements. Statistical significance was set at α &lt; 0.05. Additional factors analyzed for each procedure include total operative time, torniquet time, hardware used for fixation, type of graft, concomitant procedures, and post-operative complications such as infection, nerve injury, nonunion, and reoperation. Results: A total of 20 patients and 26 feet were studied. Significant correction from pre to postoperative radiographic measurement was noted for the talo-first metatarsal angle, talonavicular coverage angle, calcaneal pitch, and tibiocalcaneal angle (p &lt; 0.001). Complications were noted in 3 of the 20 patients, or 3 of 26 feet, and included infection, painful hardware, and hardware failure. Conclusion: The double calcaneal osteotomy was found to be effective in correcting the radiographic parameters associated with flatfoot deformity in children and adolescents with symptomatic flatfeet. The average postoperative radiographic measurements for the 26 feet analyzed were significantly improved from preoperative measurements. Pediatric orthopedists should strongly consider the double calcaneal osteotomy for appropriate surgical candidates.

Rare, But Existing Complications after Calcaneal lengthening osteotomy for the treatment of symptomatic planovalgus deformity in children and Adolescent

Purpose: Description and analysis of the rare, but existing complications from the application of calcaneal lengthening osteotomy for treatment of the symptomatic flatfoot deformity in children and adolescents.&#x0D; Materials and methods: The procedure of calcaneal lengthening osteotomy has been introduced at the University Orthopaedics Hospital „Prof. B. Boichev“in 1999. The study included 64 children or 92 cases, the average age being 11.61±1.90, and the youngest child being 7 years of age. The deformity is more often found in males, making up 44 or 68.75% of the cases. The females make up 20 of the cases, or more precisely 31.25%. We used angle X-ray measurements of the feet in AP and profile positioning, with a mandatory upright position of the pateints, to figure out the severity of the flatfoot deformity. When grading based on the subjective criteria, we used an instrument called Visual-Analogue-Scale Foot and Ankle (VAS FA). To grade the complications, we applied the clinically based Dindo-Clavien classification, used in orthopaedic surgery.&#x0D; Results: The average timing for an overall follow-up for all cases is 18.65± 8.29 months. A correction of the CIA appears in all cases that were operated. The average value of the angles at the time of diagnosis of the deformity, the average value was 13.07°, which has risen to 23.25° by the last follow-up session. When analyzing the changes in the MA (angle of Meary), we observed that the angle has decreased to 7.87° in the last follow-up session. The TNCA has decreased with an average of -8.272±5.27°, taking into consideration the high statistical reliability (p≤0.00). Even though we mark five cases of dorsal subluxation of the distal fragment, we have observed a complication from a degenerative process of the CC (calcaneo-cuboid) joint.

Using a modified nominal group technique to develop complex interventions for a randomised controlled trial in children with symptomatic pes planus

BackgroundChildren with symptomatic flat feet (pes planus) frequently present for care but there remains uncertainty about how best to manage their condition. There is considerable variation in practice between and within professions. We intend to conduct a three-arm trial to evaluate three frequently used interventions for pes planus (exercise and advice, exercise and advice plus prefabricated orthoses, and exercise and advice plus custom made orthoses). Each of these interventions are complex and required developing prior to starting the trial. This paper focusses on the development process undertaken to develop the interventions.MethodsWe used a modified Nominal Group Technique combining an electronic survey with two face-to-face meetings to achieve consensus on the final logic model and menu of options for each intervention. Using the Nominal Group Technique across consecutive meetings in combination with a questionnaire is novel, and enabled us to develop complex interventions that reflect contemporary clinical practice.ResultsIn total 16 healthcare professionals took part in the consensus. These consisted of 11 podiatrists, two orthotists, two physiotherapists, and one orthopaedic surgeon.Both meetings endorsed the logic model with amendments to reflect the wider psychosocial impact of pes planus and its treatment, as well as the increasing use of shared decision making in practice. Short lists of options were agreed for prefabricated and custom made orthoses, structures to target in stretching and strengthening exercises, and elements of health education and advice.ConclusionsOur novel modification of the nominal group technique produced a coherent logic model and shortlist of options for each of the interventions that explicitly enable adaptability. We formed a consensus on the range of what is permissible within each intervention so that their integrity is kept intact and they can be adapted and pragmatically applied. The process of combining survey data with face-to-face meetings has ensured the interventions mirror contemporary practice and may provide a template for other trials.

Are Pedobarographic and Gait Analyses Useful Tools to Evaluate Outcomes of Anterograde Calcaneo-Stop Procedure in Pediatric Symptomatic Flexible Flatfoot?

Background: Flexible flatfoot is a frequent condition in childhood that needs to be treated when symptomatic. The aim of this study was to analyze pedobarographic and gait outcomes of patients with painful flexible flatfoot who underwent the anterograde calcaneo-stop procedure. Methods: All patients scheduled for surgical correction of painful flexible flatfoot between April and September 2011 were offered to participate in a study of dynamic pedobarographic and gait analyses before surgery and 3, 12, and 24 months after surgery. A healthy control group of similar age and physical characteristics also underwent dynamic pedobarographic and gait analyses. Results: Fifteen patients accepted to undergo dynamic pedobarography and gait analyses. The data were compared with fifteen controls of similar age and BMI. No significant differences were found on dynamic pedobarography within patients at different endpoints, except for a decreased percentage of plantigrade phase and increased percentage of digitigrade phase at 12 months post-op in comparison with 3 months post-op, nor when compared with control. Similarly, when range of motion was taken into consideration, no significant differences were found within patients at different endpoints, nor when compared with control, except for a decrease in ankle joint range of motion 24 months post-op in comparison with the controls. The stride was significantly decreased before surgery and became like controls 24 months after the procedure. The cadence, significantly decreased 24 months after surgery in comparison with the pre-surgical set, was similar to the controls. No significant differences were seen in the walking speed within patients at different endpoints and the controls. The cycle time significantly increased 24 months after surgery when compared to the pre-op situation, and was similar to the controls. Conclusion: Dynamic pedobarographic and gait analyses were useful not only to identify the gait impairment in patients with symptomatic flexible flatfoot, but also to measure the treatment outcome through the analysis of the surgery’s impact on the gait quality.

Foot orthoses for treating paediatric flat feet.

Foot orthoses for treating paediatric flat feet.

Застосування підтаранного артроерезу в лікуванні гнучкої плоско-вальгусної деформації стопи в дітей із гіпермобільністю суглобів

Актуальність. Гнучка плоска стопа є одним із найчастіших скелетних порушень у дітей та підлітків. Провідними хірургами при корекції плоско-вальгусної деформації стоп застосовується методика підтаранного артроерезу, проте відсутні повідомлення про використання даної методики в пацієнтів дитячого віку з гіпермобільністю суглобів на фоні дисплазії сполучної тканини. Матеріали та методи. В основу роботи покладений аналіз результатів хірургічного лікування 8 пацієнтів (16 стоп) із гнучкою плоско-вальгусною деформацією стоп на тлі дисплазії сполучної тканини віком від 6 до 14 років (чоловічої статі — 7 осіб, жіночої — 1). Діагностика дисплазії сполучної тканини виконувалася за допомогою критерію Брайтона, ступінь гіпермобільності суглобів визначався за шкалою Бейтона. На передньо-задній рентгенограмі визначали таранно-п’ятковий кут, на боковій — таранно-п’ятковий кут, кут інклінації п’яткової кістки та тало-метатарзальний кут до та після хірургічного лікування. Оцінку результатів хірургічного лікування проводили за шкалою AOFAS (Американська асоціація хірургів стопи та гомілково-ступневого суглоба) для заднього відділу стопи. Виконаний статистичний аналіз. Результати. Усі пацієнти скаржилися на болі в стопах після навантаження. Дисплазія сполучної тканини у всіх пацієнтів діагностована та підтверджена великими та малими критеріями Брайтона. Гіпермобільність суглобів діагностована за бальною шкалою Бейтона: у 1 пацієнта констатовано 8 балів, у 5 (48 %) — 7, у 2 (42 %) — 6, що свідчить про наявність тяжкого ступеня гіпермобільності суглобів. На підставі аналізу рентгенометричних показників стопи до та після проведеного хірургічного лікування, а саме виконання артроерезу стоп встановлено статистично вірогідне покращання показників тало-метатарзального кута (р &lt; 1,01 E–10), показника п’яткової інклінації (р &lt; 3,39 E–11) та таранно-п’яткового кута (р &lt; 4,05893E–11) після проведеного хірургічного лікування. Відмінний результат за шкалою AOFAS був відмічений у 2 пацієнтів (25 %), добрий — у 6 (75 %). Висновки. Підтаранний артроерез при лікуванні гнучкої симптоматичної плоско-вальгусної деформації стоп у дітей на тлі дисплазії сполучної тканини дозволяє проводити ефективну її корекцію, досягати стійкого ефекту стосовно больового синдрому та покращувати функцію ходьби.