Unilateral Flatfoot Research Articles

Prevalence of Flatfoot in School-Going Children, Lahore

Background: Flatfoot is characterized by a reduced medial longitudinal arch height and can be flexible or fixed, congenital, or acquired. It can influence physical activity and mood in children, and its prevalence varies widely among different populations. Objective: To determine the prevalence of flatfoot among school-going children aged 7-15 years in Lahore, Pakistan, and to assess its distribution across different age groups and genders. Methods: A cross-sectional study was conducted over six months at Dar-e-Arqam School, Westwood campus, Lahore. The sample size of 106 was calculated using the formula { n = Z^2 P(1-P) / d^2 } with a 16% expected prevalence, 7% precision, and Z value of 1.96. Non-probability sampling was used. Inclusion criteria were children aged 7-15 years of both genders, excluding those with fractures, congenital deformities, or a history of ankle sprain. Footprints were obtained using ink-impregnated pads, and the Chippaux-Smirak index (CSI) was used to diagnose and grade flatfoot. Data were analyzed using SPSS version 25, with descriptive statistics presented as frequencies and percentages. Results: The prevalence of flatfoot among the children was 40.6%, with 4 cases of unilateral flatfoot (3.8%) and 39 cases of bilateral flatfoot (36.7%). Normal arches were found in 62 children (58.5%), and 1 child (0.9%) had a high arch. Among those with flatfoot, 17 had grade 1 flatfoot (16.0%), 12 had grade 2 flatfoot (11.3%), and 14 had grade 3 flatfoot (13.2%). The highest prevalence of flatfoot was observed in the 7-9 years age group (23 cases), while the 13-15 years group had the highest number of normal arches (29 cases). There was no significant difference in the prevalence of flatfoot between genders. Conclusion: Flatfoot is relatively common among children in Lahore, with a prevalence of 40.6%. The condition's prevalence decreases with age, and no significant gender differences were observed. Further research should include a larger sample size, random sampling, and assessment of symptomatic aspects to enhance understanding.

Pelvic coronal inclination change in adolescent flexible flatfoot surgically treated with arthroereisis

Objective: To evaluate adolescent pelvic coronal inclination angle change after flatfoot treated with arthroereisis. Method: A case-series study. From June 2018 to September 2020, 25 children with flexible flat foot and pelvic obliquity were included in this retrospective study in Peking University Shenzhen Hospital. There were 17 males and 8 females with a mean age of (11.2±2.2) years (9-15 years). There were 5 cases of unilateral flatfoot and 20 cases of bilateral flatfoot. All of the patients were surgically treated with arthroereisis. Regular follow-up was done in 3 months, 1 and 2 years postoperatively. Weightbearing fluoroscopy of entire lower limb and foot were investigated to measure Meary's angle, calcaneal pitch angle, height difference at ankle and pelvic plane, pelvic inclination and sacrum-iliac distance (F value) on coronal plane. Results: The mean Mearys' angle at 3 month postoperatively was improved when compared with that before the operation (3.1°±1.5° vs 25.9°±4.3°, P<0.001), and it remained at the same level 2 years after the operation (compared with that at 1 year after the operation, P=0.748). The calcaneal pitch angle improved significantly at 3-month follow-up when compared with that before the operation (16.6°±2.4° vs 9.9°±1.5°, P<0.001), and there was no significant change between 1 year and 2 years after operation (P=0.542). The height difference at mortise plane were also reduced at the 3-month follow-up(P<0.001), and it remained at the same level at 1 year and 2 years after the operation (P=0.159). Pelvic height difference decreased dramatically from (12.4±1.7) mm (before operation) to (7.1±1.2) mm(3 month after the operation) (P<0.001), it decreased to (3.6±1.8) mm 1 year after the operation (compared with that at 3 months after the operation, P<0.001), and no further reduction was observed 2 years after the surgery (P=0.483). The pelvic inclination angle and sacrum-iliac distance were also improved at 3-month follow-up when compared with those before the operation (both P<0.001), and they declined further 1 year after the operation(both P<0.05), but the decreasing trend disappeared at the 2-year follow-up (both P>0.05). Conclusion: For adolescent flexible flat foot patients with pelvic obliquity, the coronal inclination and pelvic height discrepancy would partially recovered with correction of flatfoot deformity, but it could not be completely corrected in the mean follow-up period of 2 years after the operation.

The Influence of Bilateral and Unilateral Flatfoot on Coronal Spinopelvic Alignment in Asymptomatic Young Healthy Males.

This cross-sectional retrospective study aimed to present the influence of unilateral and bilateral flatfoot on coronal spinopelvic alignment in asymptomatic young healthy males. This study was performed by examining the medical reports of individuals who applied to the National Health Board to work in positions requiring physical fitness between January 1, 2018, and January 1, 2019. Plain radiographs of the feet, pelvis, and spine were analyzed. The calcaneal pitch angle for flatfoot, pelvic obliquity, and the Cobb angle for spinal asymmetry were measured. After all of the analyses were completed, participants were divided into two groups-unilateral or bilateral flatfoot, depending on the calcaneal pitch angle measurements-and compared. There was no significant difference in age between groups (P = .609). The unilateral flatfoot group showed higher values in terms of body mass index, with a significant difference (P = .01). The curve patterns were identified as single thoracic, lumbar, and double. Post-hoc analyses suggest that young males without spinal asymmetry were more likely to have unilateral flatfoot (P < .008). There were significant differences between groups in pelvic obliquity and Cobb angle (P < .05). The effect size was found to be small to medium for pelvic obliquity and medium to large for Cobb angle. Young males with bilaterally increased foot pronation demonstrate more increased pelvic obliquity and spinal curvature.

Calculation of Staheli's Planter Arch Index, Chippaux-Smirak Index, Clarke’s Angle Prevalence and Predictors of Flat Foot: a Cross Sectional Study

Human foot is the region most affected by anatomical variations, which presents a highest level of variability and the medial longitudinal arch along with various index that provides a quantitative measurement of the plantar arch. A non-interventional descriptive cross sectional study was conducted among 300 preclinical undergraduate students Staheli's planter arch index, Chippaux-Smirak index, Clarke’s angle and truncated foot length was calculated using Foot Impression gaining kit with Ink Pad. For inferential analysis, unpaired student t-test was applied and regression equations was derived along with ROC curve. Staheli's, Chippaux-Smirak planter index, Clarke’s angle on right side foot was found to be 60.98±23.24, 36.09±13.94, 32.74±7.8 and 63.85±24.63, 36.64±14.62, 36.45±8.51 on left foot respectively. Significant difference was present in between BMI, navicular height and truncated foot length (p&lt; 0.05). A bivariate logistic regression model was created, which revealed BMI, mid foot length, truncated foot length a strong predictors (regression coefficient, R=0.94, 0.78, 0.81, p&lt;0.01), which were independently associated with flat foot to be detected by CSI and SPI. Receiver Operating Curve (ROC) revealed SPI (AUC=0.942, SEE-0.018, p&lt;0.01) was seen to be highly sensitive and specific. Most of student have medium to high medial longitudinal arch. To find whether the foot is flat or not, plantar arch index can be performed and categorize into unilateral flat foot and bilateral flat foot. Staheli’s planter index was sensitive for identification of flat foot.

Observational Study of Weight Distribution on the Feet and Moment Arm of the Ground Reaction Force around the Ankle in Standing Position in Women with Flatfoot

Introduction: By reduction or absence of the medial longitudinal arch in flatfoot deformity, a large part of the contact forces of the body weight transmit to the upper joints. The present study investigated weight distribution on the feet and the external moment around the ankle in women with flatfoot. Materials and Methods: The statistical population included women students aged 19 to 25 years in Alzahra University, Tehran, Iran. The control group was composed of twelve healthy women, and 37 with flatfoot deformity were divided into three experimental groups. Those in the experimental group 1 had unilateral flatfoot deformity, group 2 had rigid bilateral flatfoot deformity, and group 3 had flexible bilateral flatfoot deformity. The displacement of the center of pressure in the mediolateral and anteroposterior directions was calculated for assessing weight distribution on the feet and the external moment around the ankles. Force plate and 8 motion analysis cameras were used to collect data. MATLAB and SPSS software were used to calculate the displacement of the center of pressure and statistical analysis, respectively. Results: Experimental groups 2 and 3 and the control group significantly used the right foot for carrying body weight (P < 0.01); while in the experimental group 1, there was no significant difference in weight distribution on a flat or normal foot. There was no significant difference in the mean displacement of the center of pressure between the experimental and control groups. Only in experimental groups 2 and 3, there was a significant difference between the mean displacement of the center of foot pressure under the right and left feet (P = 0.02). Conclusion: Women with bilateral flatfoot are more subjected to external moment acting on one foot, which is the same foot that bears body weight in a standing position for a longer time.

Prevalence and effect of flatfoot among army privates

Background: Specific populations require strenuous activities such as soldiers, and flatfoot deformity can cause significant problems during training or operations. Prevalence of this deformity among Thai Army privates is limited and underestimated due to improper screening techniques. We would like to report the prevalence of flatfoot deformity using a new standardized device and compare performances of army privates between normal foot and flatfoot deformity Study design: The study employed a cross-sectional design Materials and Methods: A prospective study of 490 army privates in the King’s Guard, 2nd Cavalry Division, between June 2015 and November 2015 was conducted. Footprints were collected from all participant using a Harris Mat imprinter and the shape of their feet was recorded based on arch height. The Stahili index &gt;0.77 (NY index) and arch height less than 6 mm were used as cut-off point values to diagnose flatfoot deformity. Additionally, military training performance (running 2 km) was evaluated using validated functional outcome (VAS-FA) and compared between normal arch and flatfoot deformity groups. Results: The prevalence of flatfoot deformity determined using footprints was 52.5% (233 participants: 111 of 233 participants were unilateral (47.6%) and 146 of 233 participants (52.3%) were bilateral flatfeet). The physical training revealed significant differences when compared between bilateral flatfeet and normal arch groups (p= 0.038) and bilateral flatfeet unilateral flatfoot groups (p= 0.009) BMI, VAS score and flatfoot deformity significantly affected the performances of their training (p= 0.03, 0.02, and 0.03 for BMI, VAS score and flatfoot deformity, respectively.) Conclusion: The prevalence of flatfeet deformity among army privates from this study was higher than relates studies. Bilateral flatfeet deformity had a significant effect on physical training. Although many factors affect training performance, BMI, VAS score and flatfoot deformity significantly affected the military training program.

Correlation between primary flat foot and lower extremity rotational misalignment in adults.

The goal of this study was to identify rotational abnormalities of the lower limb in adult patients with primary symptomatic flatfoot. From September 2009 to May 2012, 24 patients (12 women, 12 men; mean age: 40 years) were prospectively included in the study. Each patient underwent radiographs of the flat foot and weight-bearing upright EOS® examination. Three-dimensional reconstructions of the lower extremities were performed with derived measurements (length, hip and knee parameters, rotations). A total of 31 symptomatic primary flat feet (bilateral flat foot, n=7 patients; unilateral flat foot, n=17 patients) were studied and compared to 30 control subjects matched for age and gender. A comparison between the two groups was made with the Student t-test. No significant differences were found between patients and control subjects on the coronal and sagittal planes. Similarly, no significant differences were observed between the 2 groups for rotation of the lower limbs (femoral torsion, tibial torsion, tibiofemoral rotation). There are no rotational abnormalities of the lower extremities in adult patients with primary symptomatic flat foot.

Influence of Bilateral and Unilateral Flatfoot on Pelvic Alignment

Influence of Bilateral and Unilateral Flatfoot on Pelvic Alignment

Isolated Spring Ligament Failure as a Cause of Adult-Acquired Flatfoot Deformity

Adult-acquired flatfoot deformity is usually secondary to failure of the tibialis posterior tendon, with secondary injury to the surrounding osseous-ligamentous complex. Rarely, patients may present with a normal tibialis posterior tendon and an isolated injury of the plantar calcaneonavicular, or spring, ligament. The current study describes the clinical presentation and operative management of 6 patients with isolated spring ligament ruptures who presented with symptomatic flexible flatfoot deformities. Six consecutive patients with unilateral flatfoot deformities secondary to spring ligament failure were operatively treated at one institution between 2003 and 2010. All patients presented with symptomatic flatfoot deformities recalcitrant to conservative management. No patients had previous flatfoot reconstructive surgery, but all had undergone some combination of orthotic use, immobilization, or activity modifications prior to operative treatment. In each case, intraoperative findings demonstrated a tear of the spring ligament complex with a normal tibialis posterior tendon. To address the deformities, spring ligament repairs and adjunctive flatfoot reconstructions were performed. A retrospective chart study was performed to document patient presentation, demographics, and outcomes. Average patient age was 42 years. All 6 patients were female. All patients presented with medial foot pain for a mean of 27 months prior to presentation. Spring ligament abnormality was demonstrated in all 5 patients who received preoperative magnetic resonance imaging. Intraoperatively, all 6 patients demonstrated spring ligament tears and no significant tibialis posterior tendon abnormality. All 6 patients underwent spring ligament repairs with or without adjunctive flatfoot reconstructions. At mean follow-up of 13 months, all but 1 patient were pain-free without orthotics, and all patients were without residual deformity. There was a single patient with delayed bone graft healing and no other minor or major complications in this series. Adult-acquired flatfoot deformity is usually secondary to tibialis posterior tendon failure but in rare cases may be secondary to isolated spring ligament injury without tibialis posterior tendon abnormality. This unique clinical entity should be considered in patients who present with flatfoot deformities. In this study, although preoperative magnetic resonance imaging was not required, it identified a suspected spring ligament tear in all cases in which it was used. Thorough intraoperative exploration can identify an injury to the spring ligament and a normal tibialis posterior tendon. Failure to recognize an isolated spring ligament injury as the primary cause of a flatfoot deformity could lead to inappropriate operative management. Level IV, retrospective study.

Relevant factors influencing flatfoot in preschool-aged children

The aim of this study was to discuss the influence of age, gender, obesity status, joint laxity, and the W-sitting habit on flatfoot in preschool-aged children. A total of 1,598 children (833 boys and 765 girls) between 3 and 6 years of age from kindergartens in the central area of Taiwan were studied. The children were divided into a normal group (n = 733), a unilateral flatfoot group (n = 266), and a bilateral flatfoot group (n = 599), and a multinomial logistic regression model was used to analyze the data. The prevalence of flatfoot decreased significantly with increasing age: 54.5% of 3-year-old but only 21% for 6-year-old children had bilateral flatfoot. In the bilateral flatfoot group, the risk decreased with increased age, increased with increasing weight beyond the normal range, and was higher for boys than girls. Age and obesity status were not significantly influential in the unilateral flatfoot group. Children with higher joint laxity and a habit of W-sitting also experienced higher risk in both flatfoot groups. In conclusion, this study demonstrates a significant association of age, gender, obesity status, joint laxity, and the W-sitting habit with the bilateral flatfoot in preschool-aged children. Children with unilateral flatfoot differ from those with normal feet and bilateral flatfoot. It is suggested that the unilateral flatfoot deserves special attention in future studies.

Surgical treatment of flatfoot resulting from calcaneal fractures malunion

To explore the operative approach and efficacy of flatfoot after calcaneal fractures malunion. A total of 116 flatfoot patients after old calcaneal fractures were treated from January 1998 to January 2008. There were 94 males and 22 females with an average age of 33.5 years old (range: 16 - 46). They included unilateral flatfoot after old calcaneal fractures (n = 110) and bilateral flatfoot after old calcaneal fractures (n = 6). The surgical treatments included open reduction, calcaneal osteotomy without subtalar fusion or a reconstruction of calcaneal thalamus and subtalar arthrodesis. A total of 101 patients were followed up for an average of 14 months (range: 12 - 24). No wound healing problem or infection was observed. Solid union was obtained without redislocation in all patients. The mean time of bone union was 12 weeks (range: 10 - 14). The mean time of complete weight loading was 13 weeks (range: 11 - 15 weeks). The height of foot arch increased from 4.2 mm ± 1.7 mm to 14.1 mm ± 4.1 mm (P < 0.05). Calcaneal inclination angle increased from 11.2° ± 2.5° to 19.1° ± 4.4° (P < 0.05). Bohler angle increased from 5.4° ± 3.5° to 25.8° ± 5.2° (P < 0.05). Meary angle recovered from 22.2° ± 4.4° to 5.1° ± 3.2° (P < 0.05). The mean AOFAS Ankle and Hindfoot score increased from 33.4 (range: 27 - 43) to 85.8 (range: 78 - 98). As to flatfoot after old calcaneal fractures, surgical treatment has a favorable efficacy. A customized operative approach may achieve a satisfactory outcome.

Incidence of Pes planus amongst the people of Cross River State

The incidence of Pes planus was determined among the people of Cross River State. A total of 1000 individuals comprising 500 males and 500 females of Cross River State origin and aged 20-30 years were used to assess the prevalence of Pes planus. All volunteers involved in the study had no deformities or previous fractures of the lower extremities especially of the foot. For each volunteer, bilateral plantar prints were obtained using ink procedure method. All prints were counted, separated into sexes and the incidence of flat foot calculated for both sexes. A total of 111 individuals had flat foot comprising 44 males and 67 females. The overall incidence of Pes planus was 22.20% with a prevalence of 8.80% amongst males and 13.40% amongst females. Bilateral flat foot was more common in females (11.20%) than in males (6.00%). Unilateral flat foot was more common in males (2.80%) than in females (2.20%). Our result shows that the prevalence of flat foot is higher amongst the females than the males in Cross River State with the prevalence being 22.20%.

Acquired unilateral pes planus in a child caused by a ruptured plantar calcaneonavicular (spring) ligament

A traumatic cause for acquired pes planus in children is uncommon and it is not often considered as a primary diagnosis. We describe a patient, who ruptured her plantar calcaneonavicular (spring) ligament and presented late with an acquired unilateral flat foot similar to a tibialis posterior rupture. Corrective surgery in the form of calcaneal osteotomy with iliac graft lengthening and medial advancement of tibialis posterior achieved excellent results with patient remaining asymptomatic and returning to routine activities. In the presence of an acute traumatic onset of unilateral pes planus, spring ligament and tibialis posterior tendon rupture should be considered in the differential diagnosis.

The Incidence Of Pes Planus Amongst Akwa Ibom State Students In The University Of Calabar

The prevalence of pes planus was determined among the people of Akwa Ibom State of Southern Nigeria. From the University of Calabar Community, a total of 1000 students comprising of 500 males and 500 females of Akwa Ibom State origin and aged 20-30 years were used for the study. All volunteers had no deformities or previous fractures of the lower extremities especially of the foot. The dynamic footprints of the students were obtained using endorsing ink and plain duplicating paper. The contact index II was determined as the ratio of the contact width to the total width of the foot print. Descriptive statistics for each variable included mean and standard deviation (SD). Mean±1-2SD was regarded as normal but greater than this was considered abnormal (flat foot). A total of 67 individuals had flat foot comprising of 29 males and 38 females. The overall prevalence of pes planus was 13.4% with a prevalence of 5.8% among males and 7.6% among females. Bilateral flat foot was commoner among females (6.2%) than males (5.0%). Unilateral flat foot was also commoner among females (1.4%) compared to males (0.8%). Our results showed that the prevalence of pes planus was higher among females than males in Akwa Ibom state of Nigeria.

Tibialis posterior tendon rupture in children

The complete traumatic rupture of tibialis posterior tendon (TPT) is very rare [6]. Acquired mobile flat foot deformity in children due to TPT dysfunction is usually due to penetrating trauma [3]. Presentation of such deformity in children due to closed ankle injury without associated fracture has not been described before. We present one child who sustained posttraumatic unilateral flat foot deformity. Investigation confirmed a close rupture of TPT. The child underwent a primary repair with a good result.

Adult acquired flatfoot deformity at the talonavicular joint: reconstruction of the spring ligament in an in vitro model.

The mobile unilateral flatfoot deformity of chronic posterior tibial tendon insufficiency has been difficult to correct by soft tissue procedures. The procedures can decrease pain, but they do not always correct the longitudinal arch or relieve all the symptoms. Using 10 fresh frozen cadaveric specimens and a rig for stimulation of weightbearing, the deformity associated with chronic posterior tibial tendon insufficiency was produced by multiple ligamentous release and documented by AP and lateral radiographs. Reconstruction of the spring ligament using a ligament bone autograft from the superficial deltoid ligament was then performed and tested under load. The mean correction was within 2.5 degrees of normal (over or undercorrection) on both the AP and lateral radiographs with the specimens under load. Clinical Relevance. In posterior tibial tendon insufficiency, it may be possible to address the ligament as well as tendon insufficiency to gain a corrected arch. The success of such a procedure will depend upon adequate tendon and ligament reconstruction in a fully mobile deformity. Questions remain as to the adequacy of this ligament graft, and a stronger free ligament graft, as well as correction of any bony malalignment, may be required.

The use of footprint contact index II for classification of flat feet in a Nigerian population.

The objective index as developed by Qaura, Deodhar, and Jit, in 1980 was used to estimate the incidence of flat foot (pes planus) in 990 school pupils (532 females and 458 males) between the ages of 5 and 14 years. The ratio of contact area to the total area of the middle of the footprint (contact index 1) (4/10), usually measured with a planimeter, is accepted as the true representative of the condition of arches. In this field study, contact index II (ratio of contact width to the total width of the foot) which is simple, reliable, and correlates with contact index I has been used to assess flat foot. The mean for the contact index and standard deviation have been calculated. Feet have been considered as normal up to 1 SD around the mean value of the index and values greater or lesser than this have been considered abnormal. Furthermore, mean +/- 1 SD to 2 SD has been considered as possible flat foot, whereas mean +/- 3 SD and above has been taken as definite flat foot. On the whole, bilateral flat foot is not common among children of school age in Port Harcourt (0.60%). It is, however, more common in females (0.75%) than males (0.44%). Unilateral flat foot (2.22%) is found to be more common than bilateral flat foot. Early introduction to the use of shoes may predispose to flat foot. We were not in a position to say if any of the subjects found with flat foot would have a painful foot.(ABSTRACT TRUNCATED AT 250 WORDS)