Search

People with Charcot-Marie-Tooth (CMT) disease often undergo foot and ankle surgery, as foot deformities are common and cause a degree of functional limitations impairing quality of life. Surgical approaches are variable and there are no evidence-based guidelines. A multidisciplinary approach involving neurology, physical therapy and orthopaedic surgery is ideal to provide guidance on when to refer for surgical opinion and when to intervene. This review outlines the range of foot deformities associated with CMT, their clinical assessment, and their conservative and surgical and postoperative management. [ABSTRACT FROM AUTHOR]

Background: There has been increasing interest in the use of percutaneous or minimally invasive osteotomy techniques for bunionette correction. The aim of this systematic review was to investigate the clinical and radiographic outcomes following percutaneous or minimally invasive surgery for bunionette deformity correction. Methods: A systematic review following PRISMA guidelines was undertaken. All clinical studies published in MEDLINE, Embase, PubMed, and the Cochrane Library Database from inception until December 2023 reporting on the use of percutaneous or minimally invasive osteotomy techniques for bunionette deformity correction were included. The primary outcome was radiographic deformity correction. A meta-analysis of clinical and radiographic outcomes was performed to assess the mean difference following surgery. Risk of bias was assessed using the ROBINS-I tool. Results: A total of 942 potential studies were identified, of which 18 were included encompassing 714 feet in 580 patients. There were no comparative studies identified. The majority of studies (n = 14/18) used an unfixed distal osteotomy technique. All studies showed a statistically significant improvement in clinical outcomes (American Orthopaedic Foot & Ankle Society ankle-hindfoot score and visual analog scale for pain) and radiologic outcomes (fourth-fifth intermetatarsal angle and fifth metatarsophalangeal angle). Complication rates ranged from 0% to 21.4%. The nonunion rate was 0% to 5.6%. Overall risk of bias was low to moderate. The most common complication was development of a hypertrophic callus that tended to resorb over time without needing further surgical intervention. Conclusion: The results of this systematic review must be considered in light of the methodologic limitations of the studies analyzed—including additional procedures performed at the same time as the bunionette correction, lack of comparative studies, and heterogeneity of the case series included. Despite these limitations, our review suggests that percutaneous techniques for bunionette deformity correction are generally clinically safe and associated with improvement in radiographic alignment and patient-reported outcome measures. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcers (DFUs) are serious complications that induce a high risk of lower extremity amputations and mortality. Compared with the standard of care, few reports analyzed the outcome of surgical treatment mainly for diabetic toe deformities and ulcers. The aim of this study is to collate evidence on the outcomes of interphalangeal resection arthroplasty (IP-RA) in preventing and treating diabetic toe ulcers distal to the metatarsophalangeal joint. Methods: A search strategy has been developed including electronic databases from inception. Only ulcers distal to the metatarsophalangeal joints were included. Noninfected and infected ulcers were also included at any toe location (dorsal/side/plantar). Outcomes were defined as healing rate, time to heal, ulcer recurrence, ulcer transfer, postintervention infection, wound dehiscence, and additional surgeries including amputation. Proportional meta-analysis was conducted for frequency outcomes. Results: Six observational studies comprising 217 patients with 244 IP-RA procedures were included. The mean followup period was 23.4 ± 8.2 months. Weighted frequencies were as follows: healing rate (93.6%), ulcer recurrence frequency (4.3%), ulcer transfer frequency (15.4%), postoperative infection (10.5%), wound dehiscence (17.8%), revision surgery (5%), and amputation rate (3.4%). The mean healing time was 4.3 ± 1.8 weeks. Conclusion: This review suggests that IP-RA is effective in preventing and treating diabetic toe deformities and ulcers with a modest rate of complications for this specific and often challenging clinical presentation. [ABSTRACT FROM AUTHOR]

Background: Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines. Methods: A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy, Calcaneus, Syndrome, Insertional, Achilles tendon, and Tendinopathy. Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies. Results: A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO. Conclusion: Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund's deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed. [ABSTRACT FROM AUTHOR]

Background: Assessment of the foot is an essential part of the newborn examination. Foot abnormalities range from an isolated deformity due to intrauterine positioning to a functional impairment due to a structural malformation. The purpose of this article is to review assessment, abnormal findings, and current treatment options of common foot deformities. Evidence Acquisition: A review of literature was conducted using keywords in PubMed, Google Scholar, and CINAHL databases from 2018 to 2023. Results: Although assessment techniques for the neonatal foot remain the same, recent nonsurgical treatment options are available for a variety of neonatal foot deformities. Early recognition allows for proper evaluation of foot deformities and corrective measures. Implications for Practice and Research: Neonatal providers equipped with knowledge of common foot problems can provide support and anticipatory guidance to families. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to investigate the effect of ankle distortion taping on balance, gait, function, spasticity and quality of life in cerebral palsy cases with varus deformity. Material and Methods: A two-armed randomized controlled trial was carried out in rehabilitation center. A total of 32 children with CP were randomized into taping plus conventional therapy (T+CG) and conventional therapy group (CG). The children in the T+CG group were given distortion taping for 3 days in addition to CG. Participants were assessed before the treatment, in the immediate period after the first session, and in the acute period after the third session. The Timed Up and Go Test (TUG) and Single Leg Stance Test (SLST) were used to assess the physical performance-based function. The Modified Ashworth Scale (MAS) was measured the spasticity degree of individuals. Wisconsin Gait Scale (WGS) and Child Health Questionnaire (CHQ) were used to evaluate the gait and quality-of-life, respectively. Results: The mean ages of the children in CG and T+CG were 9.62±2.50 and 10.0±1.63, respectively. In immediate and acute periods, plantar flexor muscle spasticity decreased significantly in individuals with T+CG (p=0.0001). TUG and SLST scores improved significantly in the T+CG group, both in immediate and acute term (p=0.0001). In acute and immediate term, there was a statistically significant improvement for WGS in both groups (p<0.05). The quality of life of T+CG was improved in the acute period (p<0.05). Conclusion: The results showed the effectiveness of distortion taping in reducing the spasticity of ankle plantar flexor muscles and improving function, balance and gait. However, taping was not superior to control group. [ABSTRACT FROM AUTHOR]

Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will summarize the orthoses used for treatment of the most commonly encountered foot and ankle pathologies, with the exclusion of treatment for the diabetic foot because of the unique requirements of that disease process. [ABSTRACT FROM AUTHOR]

Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is dorsiflexed and forefoot is abducted due to a fixed dorsal dislocation of the navicular on the head of the talus and the cuboid on the anterior part of the calcaneus. The epidemiology and etiology of vertical talus is unknown. Dobbs et al. (J Bone Joint Surg Am 88(6):1192–200, 2006) described a minimally invasive alternative which allowed to avoid the need for extensive soft tissue release procedures in treatment of congenital vertical talus. Eleven congenital vertical talus feet (group 5 according to Hamanishi) in eight children (four boys and four girls) constituted the study material. Upon the diagnosis, the patients' age ranged from 5 to 26 months old (the mean – 14.6). The treatment involved serial manipulation and casting according to the reverse Ponseti method (from 4 to 7 casts) followed by a minimally invasive approach consisting in temporary stabilization of the talonavicular joint with the use of K-wire and Achilles tenotomy according to the Dobbs technique. Then patients continued the shoe and bar program for 2 years. The X-ray measurements on lateral radiographic included the talocalcaneal angle, tibiotalar angle and talar axis—first metatarsal base angle whereas AP radiographic images—the talocalcaneal angle and talar axis—first metatarsal angle. The Wilcoxon test was used to compare dependent variables. The final clinical assessment made during the last follow-up (the mean: 35.8 months, the range: 25–52) revealed that neutral position of the foot and normal range of motion were observed in ten cases and recurrence of foot deformity in one case. The last X-ray examination showed normalization all of radiological parameters, except for one case, and examined parameters were statistically significant. The minimally invasive technique described by Dobbs should be the first option in treatment of congenital vertical talus. It allows to reduce the talonavicular joint, brings good results and preserves foot mobility. The attention should be put on early diagnosis. [ABSTRACT FROM AUTHOR]

Mounting evidence suggests neuromuscular electrical stimulation (NMES) as a promising modality for enhancing lower limb muscle strength, yet the functional effects of a single electrical stimulation session for improving the function of the intrinsic foot muscles (IFM) has not been evaluated. To investigate the immediate effects of an NMES session compared with a sham stimulation session on foot force production, foot dome stability, and dynamic postural control in participants with static foot pronation. Randomized controlled clinical trial. Laboratory. A total of 46 participants (23 males, 23 females) with static foot pronation according to their Foot Posture Index (score ≥ 6) were randomly assigned to an NMES (n = 23) or control (n = 23) group. The NMES group received a single 15-minute NMES session on the dominant foot across the IFM. The control group received a 15-minute sham electrical stimulation session. All outcome measurements were assessed before and after the intervention and consisted of foot force production on a pressure platform, foot dome stability, and dynamic postural control. Statistical analysis was based on the responsiveness of the outcome measures and responder analysis using the minimum detectable change scores for each outcome measure. In the NMES group, 78% of participants were classified as responders for at least 2 of the 3 outcomes, compared with only 22% in the control group. The relative risk of being a responder in the NMES group compared with the control group was 3.6 (95% CI = 1.6, 8.1]. Interestingly, we found that all participants who concomitantly responded to foot strength and navicular drop (n = 8) were also responders in dynamic postural control. Compared with a sham stimulation session, a single NMES session was effective in immediately improving foot function and dynamic postural control in participants with static foot pronation. These findings support the role of NMES for improving IFM function in this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Abnormal foot mechanics in foot over-pronation has an identified relationship with mechanical low back pain (MLBP). OBJECTIVE: To explore the use of short foot exercises (SFEs) as a standalone treatment for MLBP with foot over-pronation. METHODS: Forty-six patients with MLBP (PwMLBP) presenting with and foot over-pronation were analyzed. They were randomized into the SFE (short foot exercise), SFE plus traditional physical therapy treatment (SFE + TPT), and control (CG) groups. Functional disability and pain level were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS), respectively. Ultrasonography measured the cross-sectional area (CSA) of the abductor hallucis (AbdH) muscle. The foot posture and navicular drop (ND) were investigated using the foot posture index-6 (FPI) score and ND test, respectively. RESULTS: The CSA of the AbdH and VAS scores improved significantly (p < 0.001) between the groups, more in the SFE + TPT group than in the SFE group (p < 0.001). The ND, FPI, and ODI measures improved significantly among the groups (p < 0.001), with no significant difference (p > 0.002) between the SFE and SFE + TPT groups. The CG did not show significant differences in the outcome measures (p > 0.002). Based on the effect size, SFEs significantly improved all the variables of interest (d > 1). CONCLUSION: SFEs, with or without TPT may offer an effective treatment for PwMLBP with foot over-pronation. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY To evaluate the mid-term clinical results of patients with Haglund’s deformity treated with the central tendon-splitting procedure, and to determine the factors related to patient satisfaction. A retrospective evaluation was made of 20 patients treated with the central tendon-splitting procedure for Haglund’s deformity by a single surgeon over a 5-year period. MATERIAL AND METHODS The patients were evaluated preoperatively and in the postoperative follow-up examinations with the American Orthopedic Foot and Ankle Society (AOFAS) scores and visual analog pain scale scores (VAS). Satisfaction with the surgical results was assessed at 3, 6, 12 months and the final follow-up visit, and the factors affecting patient satisfaction were examined. RESULTS Evaluation was made of 13 (65%) females and 7 (35%) males with a mean age of 45.8±8.1 years (range, 37–53 years). The AOFAS values were mean 44.4±8.4 preoperatively, and increased statistically significantly to 89.2±3.2 at the final follow-up examination (p<0.001). At 3 months postoperatively, 65% of the patients evaluated the results as good or excellent and this rate was 100% at the final follow-up examination. According to the correlation analysis, the main determinant of patient satisfaction was pain (r:-0.749, p<0.001), and a strong positive relationship was determined between the AOFAS score and satisfaction (r: 0.892, p<0.001). DISCUSSION The results of this study showed that the central tendon-splitting approach can be used in the treatment of Haglund’s triad, with low complication rates, and high success and patient satisfaction rates. CONCLUSIONS In addition, the two components underlying patient satisfaction with Haglund’s surgery were found to be the elimination of pain and the ability to return to normal daily activities. [ABSTRACT FROM AUTHOR]

Since Hippocrates, the treatment of idiopathic clubfoot has undergone many changes, with surgical techniques and conservative approaches evolving over the centuries. Today, a wide variety of practices exist in France and throughout the world; consequently, the treatment of idiopathic clubfoot remains controversial, but the Ponseti method and the functional method seem to stand out. Nevertheless, has one of them demonstrated superiority? The purpose of this review is to compare these two methods. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 recommendations, this research was conducted on Pubmed, Web of Science, and 1Findr. Only articles concerning patients with moderate or severe idiopathic clubfoot (10–17 on the Dimeglio scale) treated early using the Ponseti method or the functional method were eligible. After reviewing 49 studies, seven published between 2008 and 2018 were selected: five prospective cohort studies, one retrospective cohort study, and one meta-analysis. Each method, according to morphological and kinetic criteria, seems to have advantages that the other does not have. Although the Ponseti method is becoming the gold standard and appears more appropriate in poor countries, it is impossible to affirm its superiority over the functional method. Therefore, the combination of their advantages deserves attention: a hybrid method could be an appealing prospect for the future. [ABSTRACT FROM AUTHOR]

Purpose. This study is aimed at analyzing the application experience and feedback of the patients with poststroke ankle dorsiflexion disorders for 3D printed AFO with three different materials. Methods. 15 patients were randomly divided into three groups; 3D printed AFO with 3 different materials (PA2200, Somos NeXt, and PA12) was used to each group, according to the crossover study design, in order to ask the three groups of patients to use three different materials of 3D printed AFO. Assessment was taken by the end of each test round. Through statistical processing, the patient feedback data of the three groups of materials of 3D printed AFO were obtained. Results. In the material comfort assessment of the AFO, Somos NeXt was compared with PA2200, and the p value was <0.05; in the item of surface smoothness of the AFO, Somos NeXt was compared with PA2200, and the p value was <0.01; at the same time, PA12 was compared with PA2200, and the p value was <0.05. Conclusion. The 3 different materials of 3D printing AFO bring different experience, and we also have sufficient reason to believe that there will be differences in the auxiliary effect of this on patients, which leads the patient's selection too. The material Somos NeXt is much popular and has certain clinical advantages. [ABSTRACT FROM AUTHOR]

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Progressive Collapsing Foot Deformity (PCFD) can present with independent deformities, characterized by five classes: hindfoot valgus (Class A), midfoot abduction (Class B), forefoot varus (Class C), Peritalar Subluxation (PTS) (Class D) and ankle valgus (Class E). Conservative treatment includes the use of corrective insoles and orthotics. Arch support inflatable Ankle-Foot orthoses (IAFO) can help control symptoms in PCFD patients. However, the ability of IAFOs to correct deformities in PCFD is unknown. The aim of this prospective comparative and controlled study was to assess the ability of arch support IAFOs to correct 3D overall PCFD alignment as well as the five different PCFD classes independently. We hypothesized that IAFOs would correct PCFD 3D overall alignment as well as the five independent classes of deformity. Methods: After IRB approval, we enrolled 24 symptomatic PCFD and 24 controls matched on age, sex, and BMI. Flexible PCFD patients and controls were scanned using Weight-Bearing CT (WBCT) with and without an arch support IAFO. The Foot and Ankle Offset (FAO) was used to assess the 3D foot overall alignment. We measured the Hindfoot moment arm (HMA, Class A), the Talonavicular coverage angle (TNCA, Class B), the Meary's angle and medial cuneiform-to-floor distance (C1-floor) for the Class C and the middle facet uncoverage (MFunco, Class D). No Class E patients were included. Measurements were performed by two fellowship-trained surgeons. A power-analysis hypothesizing that IAFOs would be two times less efficient than the PCFD surgery in correcting the FAO, the requisite number of subjects was 24 per group. Data normality was assessed by Shapiro-Wilk test. Comparisons used normality based paired T-tests or paired-Wilcoxon tests. P-values < 0.05 were considered significant. Results: PCFD measurements performed in controls were all significantly less pronounced than unbraced PCFD patients, confirming the presence of collapse (ps < 0.0001). Comparing PCFD without and with IAFO, the FAO did not show significant improvement (respectively 6.6+/-3.7% vs 5.5+/-4.2%, p=0.101). The HMA (8.8+/-5.8 vs 8.1+/-5.8, p=0.66), the TNCA (24.2+/-10.6 vs 21.9+/-9.7, p=0.44) and the MFunco (37+/-12% vs 31+/-18%, p=0.17) also did not portray significant improvements when applying the IAFOs. The Meary's angle (17.6+/-7.2 vs 10.8+/-7.3, p=0.002) and C1-floor (17.2+/-3.3mm vs 24.1+/-5.3mm, p< 0.001) were the only to improve significantly with use of IAFOs. When comparing braced PCFD and controls, the only measurement that improved to normal values, similar to controls, in braced PCFD was the C1-floor (24.1+/-5.3mm in PCFD with IAFO vs 25.7+/- 5.4mm in controls, p=0.31). Conclusion: In this prospective comparative and controlled study, we found that arch support IAFOs was not able to correct overall 3D deformity and most of the specific classes in PCFD. The orthosis did not improve hindfoot valgus (Class A), midfoot abduction (Class B) or peritalar subluxation (Class D) in PCFD. The only deformity pattern to improve with the use of IAFOs was the medial longitudinal arch height (Class C). These improvements were expected by the presence of the inflatable bladder of the IAFO on the plantar aspect of the foot, pushing the longitunal arch up but not correcting the entire PCFD. [ABSTRACT FROM AUTHOR]

Background: Congenital talipes equinovarus (CTEV) or clubfoot refers to congenital anomalies in the feet with complex deformities. The non-surgical technique with the Ponseti method for clubfoot treatment has been adopted as initial therapy and proven effective for clubfoot treatment. Purpose: This study aims to evaluate the results of Ponseti therapy in patients with clubfoot who came to the Ponseti Clinic at the Dr. Soetomo Regional Public Hospital, Surabaya. Method: 14 patients consisting of nine men and five women were involved in the study. Based on the data obtained, ANOVA statistical test was performed on the Pirani score (total score), hindfoot score, and midfoot score. Furthermore, the statistical hypothesis testing was performed by comparing the degree of clubfoot severity with Pirani scores using the independent t-test. Results. The mean Pirani Score in the research subjects reached 1.178. The mean Hindfoot score of research subjects reached 0.5. The mean Midfoot Score of the Research Subject was 0.642. The statistical hypothesis testing results revealed that the mean Pirani Score in the degree of severity for the severe category was higher than the mean Pirani Score for the moderate category, which was statistically insignificant with a p-value of 0.126). Conclusion: Pirani score can be a reference as a clinical evaluation of patients with clubfoot who undertake conservative treatment with the Ponseti technique. Moreover, the Pirani score can also provide predictions of clubfoot severity. [ABSTRACT FROM AUTHOR]

Purpose: A flatfoot that fails to form a longitudinal foot arch is a common lower limb deformity in children. This study evaluated the structural and functional effects of the insole for pediatric flexible flat foot (PFFF). Materials and Methods: Twenty-nine PFFF patients (20 boys and 9 girls, 58 feet) with bilateral symptomatic flatfoot deformities between February 2017 and May 2019 were included in this study. Sixteen patients (32 cases, study group) were treated with a pressured based 3-dimensional printing insole, and 13 patients (26 cases, control group) were followed up regularly without any treatment. Flatfoot was diagnosed by a lateral talo-first metatarsal angle of more than 4° in convex downward and talocalcaneal angles of more than 30° and a calcaneal pitch of less than 20°. The foot pressures, including the midfoot pressure, total foot pressure, and the ratio of the midfoot pressure to the total foot pressure, were evaluated by pedobarography. The clinical scores were assessed using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Pediatrics Outcomes Data Collection Instrument (PODCI) scores. Results: The mean age of the study group was 9.16 years, and the mean age of the control group was 7.73 years. The mean follow-up period was 16 months. The change in the lateral talocalcaneal angle was -4.664°±1.239° in the study group and -0.484°±1.513° in the control group. A significant difference in the amount of change of the lateral talocalcaneal angle was observed between the two groups (p=0.034). The midfoot pressures were similar in the two groups. Conclusion: Pressure based customized 3-dimensional printing insole in PFFF may have some effect on the hindfoot bony alignment, but it does not affect the changes in midfoot pressure. [ABSTRACT FROM AUTHOR]

Background: Hammertoe deformities can seriously affect activity level and footwear. The use of prescription, moodaltering medications is very common, with some estimates as high as 25% of the population. Mood disorders, especially depression, negatively affect the results of medical and operative treatments. This study assessed the relationship of moodaltering medication use with the outcomes and complications of operative reconstruction of hammertoes. Methods: Data were prospectively collected from 116 patients who underwent hammertoe reconstruction, including demographic information, medical history, the use of mood-altering psychotropic medications (antidepressants, anxiolytics, hypnotics, and mood stabilizers), and postoperative complications. Preoperative patient-reported outcomes were measured using the visual analog scale (VAS) for pain and Short Form Health Survey (SF-36), which were repeated at 1-year follow-up. Results: A total of 36.2% of patients were taking psychotropic medications. Medication and nonmedication groups had similar pain VASand SF-36 PhysicalComponent Summary (PCS) scores before and after surgery.Comparedwith nonmedication patients, patients on psychotropic medications had significantly lower SF-36 Mental Component Summary (MCS) scores preoperatively (P = .001) and postoperatively (P = .006), but no significant difference in the change in MCS (DMCS) from preoperative to postoperative. Psychotropic medication use was associated with superficial wound infections (P = .048), but not other complications. Conclusions: Patients taking psychotropic medications were equally likely to benefit from forefoot reconstruction as nonmedication patients. Preoperative and postoperative PCS and VAS were not significantly different between medication and nonmedication groups. Although the medication group had lower absolute MCS, they reported the same magnitude of improvement in MCS (DMCS) as the nonmedication group. [ABSTRACT FROM AUTHOR]

Background: Operative correction of flatfoot deformity has been well studied in the older population. There is a subset of younger patients without congenital foot deformity that also develop a collapsing flatfoot. However, assessment of outcomes across age groups is limited, especially in the young demographic. The purpose of our study was to compare operative outcomes of flatfoot reconstruction between these 2 age groups. Methods: Seventy-six feet (41 left, 35 right) in 71 patients who underwent flexible flatfoot reconstruction were divided into 2 groups based on age: ≤30 years (n = 22) and >30 years (n = 54). Exclusion criteria included congenital causes of flatfoot (tarsal coalition, vertical talus, overcorrected clubfoot). Average age was 20.8 years (range, 14-30) and 55.4 years (range, 35-74) in the younger and older cohorts, respectively. Preoperative and minimum 2-year postoperative Patient-Reported Outcomes Measurement Information Systems (PROMIS) scores were compared. Five radiographic parameters were assessed pre- and postoperatively: talonavicular coverage angle, lateral talo--first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, and hindfoot moment arm. Procedures performed and incidence of minor (removal of symptomatic hardware) and major (revision) reoperations were compared. Results: Younger patients were less likely to undergo flexor digitorum longus transfer, first tarsometatarsal fusion, spring ligament repair, and posterior tibial tendon repair (all P < .05). Both younger and older cohorts demonstrated significant improvement in multiple PROMIS domains at an average follow-up of 30.6 (range, 24-44) and 26.8 (range, 24-45) months, respectively (P = .07). Younger patients demonstrated significantly higher pre- and postoperative Physical Function (mean difference postoperatively, 4.6; 95% confidence interval, 1.5-7.8; P = .03). There were no differences in radiographic parameters postoperatively. There were 8 (36.4%) reoperations (all minor) in the younger group, and 21 (38.9%) reoperations (6 major, 15 minor) in the older group (P = .84). Conclusion: Our data suggest that age may play a role in clinical outcomes, procedures indicated, and subsequent corrective reoperations. Younger patients maintained greater physical function with comparable radiographic correction, with less frequent indication for tendon transfers, arthrodesis, and additional corrective surgeries. [ABSTRACT FROM AUTHOR]

Background: Cavovarus foot constitutes a complex 3-dimensional deformity. The Coleman block test has traditionally been used to distinguish between forefoot- and hindfoot-driven deformity. However, there has been no objective evaluation of the Coleman block test using radiographs or weightbearing computed tomography (WBCT). The purpose of this study was to compare hindfoot alignment in adult cavovarus feet with and without the Coleman block using clinical examination, radiography, and WBCT. Methods: Six feet in 6 patients with a clinical diagnosis of cavovarus foot deformity were prospectively enrolled. All feet underwent clinical photography with the camera positioned at 0 degrees to the heel, hindfoot alignment view radiography with the beam positioned 20 degrees off the ground, and WBCT, both with and without the Coleman block in place. Clinical photos were characterized using the standing talocalcaneal angle (STCA), radiographs were characterized using the hindfoot alignment angle (HAA), and WBCTs were characterized using manual and automated hindfoot alignment angle (HAA) and foot and ankle offset (FAO). Using paired analyses, measurements taken with the Coleman block in place were compared to those taken without the Coleman block. Finally, the different methods of measuring hindfoot alignment were tested for correlation with each other. Mean age was 56 years (range 38-69). Results: On clinical photography, the STCA decreased by 3.8 degrees with addition of the block (from 10.0+6.6 degrees varus without block to 6.2+7.1 degrees varus with block; P = .001). On radiograph, HAA decreased by 9.0 degrees with addition of the block (from 16.8+8.4 degrees varus without block to 7.5+6.3 degrees varus with block; P = .07). On WBCT, hindfoot alignment angle changed an average of 3.2 degrees (33.4 degrees varus without block, 30.2 degrees varus with block; P = .008). On WBCT, FAO decreased by 1.4% (from 11.3% varus without block to 10.1% varus with block; P = .003). Clinical examination and automated WBCT measurements were strongly correlated with each other. Conclusion: Clinical examination, radiograph, and WBCT demonstrated improvements in hindfoot varus using the Coleman block test in adults, but no patient demonstrated complete resolution of deformity regardless of the measurement modality. Clinical examination correlated strongly with automated WBCT measurements. [ABSTRACT FROM AUTHOR]

Background: Lateral sliding calcaneus osteotomies are common procedures to correct hindfoot varus deformities. Shifting the calcaneal tuberosity laterally (lateralization) can lead to tarsal tunnel pressure increase and tibial nerve palsy. The purpose of this cadaveric biomechanical study was to investigate the correlation of lateralization and pressure increase underneath the flexor retinaculum. Methods: The pressure in the tarsal tunnel of 12 Thiel-fixated human cadaveric lower legs was measured in different foot positions and varying degrees of calcaneal lateralization. Results: The mean pressure increased from plantarflexion (PF) to neutral position (NP) and from NP to hindfoot dorsiflexion (DF), and with increasing amounts of lateralization of the calcaneal tuberosity. The mean baseline pressure in PF was 1.5, in NP 2.2, and in DF 6.5 mmHg and increased to 8.1 in PF, 18.4 in NP, and 33.1 mmHg with 12 mm of lateralization. The release of the flexor retinaculum significantly lowered the pressure. Conclusion: Increasing pressures were found in the tarsal tunnel with increasing lateralization of the tuberosity and with both dorsiflexion and plantarflexion of the ankle. Clinical Relevance: A pre-emptive release of the flexor retinaculum for a lateralization of the calcaneal tuberosity of more than 8 mm should be considered, especially if specific patient risk factors are present. No tibial nerve palsy should be expected with 4 mm of lateralization. [ABSTRACT FROM AUTHOR]

Diabetic foot complications are very common and can frequently lead to ulceration and amputation. However, a few simple measures can help prevent these devastating consequences. Being able to identify potential problems and intervene quickly is always better than trying to remedy an problem that has already occurred. This article provides a simple guide to diabetes foot care for non-specialist clinical staff and gives a few pointers on the battle against diabetes-related lower-limb amputations. [ABSTRACT FROM AUTHOR]

Foot Pronation, also called as "eversion" is a normal and necessary component of the gait cycle. However, abnormal pronation occurs when foot pronates, when actually it shouldn't. It occurs during the half of the stance phase. The foot rolls inward when one lands their foot on surface while walking and running. The complementing structures of the ankle or foot complex permits both stability and mobility depending on conditions acting on it. This article presents on overview on current knowledge on pronated foot and focuses on biomechanics, etiology diagnosis and treatment strategies, conservative treatment. [ABSTRACT FROM AUTHOR]

There is a wide range of foot disorders and deformities in children. While most of them are benign, some of the foot deformities may require operative intervention and/or a prolonged period of treatment. We will discuss the most common of these disorders: clubfoot, congenital vertical talus, calcaneovalgus deformity, metatarsus adductus, flexible flatfoot, tarsal coalitions and cavus foot. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to explore the variation in the provision of care for people with rheumatic and musculoskeletal diseases (RMDs), and foot and ankle problems between European healthcare systems. Methods: An electronic questionnaire was developed and piloted in seven countries prior to being distributed to the presidents of all 22 national health professionals in rheumatology associations within the European League Against Rheumatism (EULAR). Summary data were obtained using SPSS V22. Ethical approval was sought from the Medical Research Ethics Committee of University of Malaga (CEUMA‐91‐2015‐H). Results: Sixteen questionnaires (73% response rate) were completed (Austria, Belgium, Czech Republic, Denmark, France, Hungary, Ireland, Italy, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK). All 16 respondents indicated that foot and ankle healthcare services were provided in their country, but only three countries had services specializing in RMD‐related foot and ankle problems (the Netherlands, the UK and Malta). The professions providing care varied, depending on the pathology and the country. Foot and ankle pain was mostly treated by rheumatologists and physiotherapists; foot and ankle deformities by orthopaedic surgeons and orthotist/prosthetists; and foot and ankle ulcers by nurses. Services were predominantly delivered through the public sector, and in secondary care (hospital) settings. Conclusions: Only three countries reported having specialist foot and ankle services addressing the needs of people with RMDs. Variation was seen in the professions which provided care between countries, and also between the foot and ankle pathologies cared for. There is a lack of clinical pathways and guidelines for the management of patients with RMD‐related foot and ankle problems. [ABSTRACT FROM AUTHOR]

Background: This study employs multi-segment foot modeling (MSFM) to examine flatfoot reconstruction among ambulatory children with cerebral palsy (CP).Research Question: Does flatfoot reconstruction improve MSFM measures, physical examination and radiographic variables for forefoot varus and midfoot collapse and associated multi-planar compensatory features?Methods: MSFM was performed preoperatively and postoperatively in a cohort of ambulatory CP patients undergoing flatfoot reconstruction (surgical group, n = 24). A comparison group of non-surgical group of ambulatory CP patients with pes planovalgus (flatfoot) who did not undergo flatfoot reconstruction was also identified (n = 17). All patients in this comparison group underwent MSFM at two separate time points. Physical examination was performed and standing AP and lateral foot radiographs were obtained during each gait analysis session.Results: Patients in the surgical group had improvement in their forefoot varus deformity, as documented on physical examination and kinematics in the STJN position of the foot and ankle, as well as in the compensatory hindfoot eversion and midfoot abduction during stance phase of gait. Furthermore, patients in the surgical group had improvement in midfoot collapse as identified kinematically by midfoot dorsiflexion, physical examination descriptors of midfoot position, and radiographic measures of calcaneal pitch and AP and lateral talar-first metatarsal angle. Patients in the non-surgical comparison group did not demonstrate these changes.Significance: Improvements in foot motion after flatfoot reconstruction in ambulatory CP patients were identified by MSFM, physical examination measures, and radiographs. Patients in the surgical and non-surgical groups had similar pre-operative radiographic findings, suggesting that physical examination and MSFM data were important in the surgical decision making process. Finally, surgical intervention did not fully restore normal foot kinematic, physical examination, and radiographic parameters, which suggests that a different, perhaps more aggressive, surgical approach for flatfoot reconstruction is needed. [ABSTRACT FROM AUTHOR]

Deformities of the foot and ankle in neuromuscular conditions are often complex and occur at multiple levels. Careful examination of the patient is key to identifying the deformity, and whether it is flexible or fixed. This will help to guide management options. This paper outlines treatment options for the common deformity patterns seen in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Spasticity is the most common disorder of Cerebral Palsy (CP) and has the characteristics of decreased active movement, elastic hypertonia and hyperreflexia. Because of this, one of the main purposes of treatment is to decrease hypertonia. Thus, the herbal medicine Ziclague®, having an antispasmodic action, may offer a new possibility in addition to physiotherapy. Objective: Verify the effects of the application of the herbal medicine Ziclague on hypertonia of the sural triceps muscle of children with spastic CP. Methods: Ten children, between one and seven years of age, received application of Ziclague® spray on the triceps sural muscle before the physiotherapy sessions, during the period of twelve weeks. Evaluations were performed using the Modified Ashworth Scale (MAS), Durigon Protocol (DP) and goniometry, before and after application on the first day, after four weeks and at the end of twelve weeks. The four evaluations were compared. Results: After twelve weeks the results were more evident, with a decrease in hypertonia of the right lower limb (RLL) and left lower limb (LLL) verified by MAS (p= 0.06 and p= 0.13), and by the DP (p= 0.003 and p= 0.007). Goniometry showed increased range of motion for dorsiflexion of the RLL (p= 0.002) and LLL (p= 0.111). Conclusion: The use of Ziclague® associated with physiotherapy had a positive effect in decreasing hypertonia of the sural triceps muscle and in increasing the ankle dorsiflexion range of motion. [ABSTRACT FROM AUTHOR]

The article discusses the evidence-based recommendations for the management of in-toeing in children. Topics include an overview of the anatomical progression of in-toeing, the examinations to be conducted to confirm in-toeing and the role of physical therapists in assessing and educating the patients and their families about the functional and developmental implications of in-toeing.

Background: Neglected clubfoot (NC) includes a variable range of complex deformities of the foot that are refractory to conventional treatments or are treated inappropriately. The Ilizarov method has become established as a tool for treating these deformities Objectives: The main objective of this study is to evaluate the functional outcome of neglected club foot using ilizarov external fixator in case series. Materials and Methods: This study was conducted in Department of Orthopedics and Trauma, Khyber Teaching Hospital, Peshawar from January 2017 till December 2017. Data including age, gender, functional outcome and complications of surgery were documented on a pre-formed proforma. A limited soft tissue dissection like percutaneous Achilles sheath tenotomy and plantar fasciotomy were done, where needed. Progressive correction of the deformities was achieved through the standard and simple Ilizarov frame construct setting. After removal of Ilizarov frame, a short leg walking cast was used for an additional 6 weeks, followed by an ankle foot orthrosis for 3 months. SPSS 18 was used for analysis. Results: 18 feet in 12 patients were treated, 9 (72%) were male and 3 (28%) female. The mean age was 15 years (range: 6 to 30 years). The mean follow up period was 18 months. The final functional outcome according to Reinker and Carpenter scale was excellent in 5 (28%) feet, good in 10 feet (55%), fair in 2 (12%) and poor in 1(5%) feet. The main complications were pin track infection and loose wires. Conclusion: It is concluded from analyzing this case series that treatment of neglected clubfoot using an external fixator has a high rate of excellent results, with low frequency of complications. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of the "DUTh" device in achieving static maintenance of desirable characteristics of the foot after clubfoot correction over a period of one year. Materials and Methods: A prospective study was conducted of idiopathic clubfoot patients treated following the Ponseti protocol during the period 2014 through 2016. Dimeglio and Pirani scores were recorded before attaching the DUTh brace and at 3, 6, 9, and 12-month follow-up visits, including level of compliance and any complications with the brace. Results: The DUTh brace was applied to 47 feet of 30 patients. At initial brace application, there was no change in the Dimeglio or Pirani scores (p>0.05). The average daily period in the brace was 16,12, 9.5, and 9.5 hours for months 1 to 3, 4 to 6, 7 to 9, and 9 to 12 months, respectively. Conclusion: The DUTh brace is appropriate alternative foot abduction brace for post-correction maintenance of clubfoot correction. Advantages of the brace include greater comfort due to the brace being custom-made, light weight, easily adjustable for length and angle by parents, provision of easy heel accessibility, efficacy in static maintenance of the desirable foot position, and low incidence of complications. [ABSTRACT FROM AUTHOR]

Background: Intra-articular corticosteroid injections are used for both their therapeutic and diagnostic function. There is a paucity of literature investigating the efficacy of intra-articular corticosteroid injections into the midfoot. The aim of the study was to identify the efficacy of image guided intra-articular corticosteroid (Methylprednisolone) injections for midfoot osteoarthritis The null hypothesis of this study was there would be no benefit or increase of the Self-reported Foot and Ankle Score (SEFAS) from an intra-articular corticosteroid injection. Methods: SEFAS was collected at 4 and 12 months postinjection. A total of 37 consecutive patients who had 67 midfoot injections were recruited into the study over a 6-month period. Results: The mean SEFAS score preinjection was 17.0, at 4 months postinjection was 31.8 (P < .001), and 12 months postinjection 21.3 (P < .14). There was a statistically significant improvement in postinjection SEFAS (P < .001) at 4 months. The null hypothesis of this study was rejected. Response to the injection was varied but patients with BMI less than 30 had a sustained (P < .04) symptomatic improvement at 12 months when compared to the obese patients. Conclusion: Our findings support the use of corticosteroid injections as a viable diagnostic and therapeutic option following failed conservative treatment options prior to operative intervention. The results at 4 months were statistically significant with an additional finding of a difference observed between obese and nonobese patients. This may have implications for further educating the patient in effective weight loss that may improve symptom relief from intra-articular injection. Level of Clinical Evidence: Level III, comparative study. [ABSTRACT FROM AUTHOR]

Background: The advancement of 3D printing technology has allowed for the use of custom-designed implants for difficult-to-treat foot and ankle pathologies. This study reports on the radiographic and functional outcomes of a case series of patients treated with patient-specific 3D-printed titanium implants. Methods: Fifteen consecutive patients treated with custom-designed 3D-printed implant cages for severe bone loss, deformity correction, and/or arthrodesis procedures were included in this study. A minimum of 1 year of clinical and radiographic follow-up was required. No patients were lost to follow-up. Patients completed a visual analog scale for pain, the Foot and Ankle Ability Measure Activities of Daily Living score, and the American Orthopaedic Foot & Ankle Society Score outcomes questionnaires preoperatively and at most recent follow-up. All patients had postoperative radiographs and computed tomography (CT) scans to assess bony incorporation. The mean age was 53.3 years (range, 22-74 years) with a mean follow-up of 22 months (range, 12-48 months) for these 15 patients. Results: Radiographic fusion verified by CT scan occurred in 13 of 15 patients. There was significant improvement in pain and all functional outcome score measures. All patients who went on to fusion were satisfied with their surgery. There were 2 failures, consisting of 1 infection and 1 nonunion, with an overall clinical success rate of 87%. Conclusion: These patients demonstrated the successful use of patient-specific 3D-printed titanium implants to treat complex large bony defects, deformities, and arthrodesis procedures. These implants offer surgeons a novel and promising approach to treat both lower extremity pain and deformity that is not always available with current techniques. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

The human foot serves as an important part to support the body weight and accounts for the majority of our movements. A mangled limb involves injury to at least three out of four systems, namely the soft tissues, nerves, blood supply and bone. While amputation is indicated in some cases of mangled limb, with proper planning, limb salvaging surgical management is also a viable option. Special consideration to the skeletal stabilization, control of infection, vascular status and soft tissue coverage is paramount to the success of limb salvaging surgery. We present a case of mangled limb which was successfully treated with limb salvaging surgical management. Initial debridement, Kirschner wires insertion and cross ankle external fixation were used for skeletal stabilization. An antibiotic spacer was inserted for local antibiotic and to maintain the length left due to the loss of medial and intermediate cuneiform bones. The anterior tibialis artery and its venae comitantes were utilized for free vascularized fibular graft to provide bony reconstruction as well as soft tissue coverage for the mangled foot. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical significance and usefulness of a bone scan in accessory navicular bone. Materials and Methods: Eighty-five patients with foot pain and accessory navicular bone on radiography, who underwent bone scan from 2012 to 2015, were analyzed retrospectively. The subjects was divided into a symptomatic and asymptomatic group according to the presence of navicular bone tenderness. The grade of bone scan uptake was divided into 3 grades. Age, gender, grade of bone scan and size of the accessory navicular bone were analyzed. The symptomatic group were divided into a low (grade 0, 1) and high uptake (grade 2) group to determine the appropriate treatment. The low uptake group was treated conservatively for 3 months. The high uptake group was initially treated conservatively for 3 months and surgery was performed if pain persisted. For the clinical evaluation, the visual analogue scale, American Orthopaedic Foot and Ankle Society midfoot scale were evaluated in the first examination and last follow-up date. The patient's satisfaction grade was also evaluated at the last follow-up. Results: The asymptomatic group mostly showed no uptake in the bone scan. On the other hand, some patients in the asymptomatic group showed an increase in uptake. In these patients, the size of accessory navicular bone was related to the grade of bone scan uptake, showing that the bone scan uptake grade can be predicted when applying different cut off values for the bone size. The symptomatic group mostly showed uptake in the bone scan and the grade of uptake had a positive correlation with the size of the accessory navicular bone (p<0.05). Age and gender were not related to the bone scan uptake. In the clinical evaluation, conservative and surgical treatment showed a good outcome. Conclusion: The bone scan uptake grade alone cannot be used to completely predict the symptoms. On the other hand, the size of the accessory bone can increase the bone scan uptake. Therefore, the size of the accessory bone, and patient symptoms should be considered in patients with a high uptake when deciding treatment. [ABSTRACT FROM AUTHOR]

James Braid (1795-1860), the natural philosopher, gentleman scientist, the inquisitive and sagacious, structured thinker, the safe, innovative, and efficacious surgeon--renowned for his personal character, range of surgical skills, and overall clinical excellence (especially in the treatment of dangerous and difficult forms of disease, and the correction of deformities such as club-foot, spinal curvature, knock knees, bandy legs, squint, etc.)--the early adopter (and advocate) of ether anaesthesia and, significantly, the originator of scientific hypnotism and the intentional use of structured suggestion has, to a large extent, been written out of history. This article examines Braid's schooling, his apprenticeship as both surgeon and apothecary, his university training, and his interactions with colleagues; and how these, combined with his scientific and intellectual interests, and his professional challenges, came together in Mr. James Braid, surgeon (aged 46)--the 'right man' at the 'right time'--who encountered Charles Lafontaine, in Manchester, in November 1841. [ABSTRACT FROM AUTHOR]

Background: Congenital vertical talus (CVT) is a common foot deformity that occurs at birth and has two forms of syndromic and idiopathic. Treatments of this disorder include serial casting or surgical correction. Several studies have shown that Dobbs method (reverse Ponseti) is effective in improving deformity and function of the foot. The aim of this study was to evaluate 2-year treatment of syndromic vertical talus with this method. Methods: In this retroespective study, 21 patients with congenital vertical talus with neuromuscular disease and/or genetic syndrome from 2007 to 2014 referred to Shohada Hospital of Tabriz were studied. 35 feet (14 patients with bilateral and 7 patients with unilateral involements) with syndromic type of disorder, using manipulation and serial casting with Dobbs method (reverse Ponseti) treated by an orthopedic surgeon and serial radiographs in 2 years follow-up were performed to control. Results: The mean age of the patients was 16.9±20.9 years and the average number of cast was 7.5±1.6. Talocalcaneal angle and talus-base of first metatars angle significantly decreased after treatment (P<0.0001). There was no significant age-related changes in the studied angles (P>0.05). There was no significant correlation between talocalcaneal angle changes and the number of cast (P=0.108), but there was a significant association between talus-base of first metatars angle (P=0.015). Conclusion: This study showed that treatment with Dobbs method has successfully improved the foot deformity in the patients with syndromic CVT. [ABSTRACT FROM AUTHOR]

Aim: The number of patients with diabetes continues to explode in Japan. This has been accompanied by an increase in the number of patients with diabetic foot ulcers. The treatment of diabetic feet requires knowledge of wound management, revascularization, infection control, footwear, and surgical offloading. However, surgical treatment of foot deformities is not widely available in Japan due to the lack of podiatrists. Surgery for foot fractures is performed by orthopedic surgeons, but orthopedic surgeons tend to avoid operating on patients at risk of infection or ischemia. Therefore, at our hospital, plastic surgeons have been performing surgical offloading for patients with diabetic foot deformities since 2009. Method: The number of surgeries performed for Charcot foot between 2009 and 2021 was reviewed. Results / Discussion: A total of 33 surgeries were performed, and the number has been increasing in recent years. Tendon lengthening, tendon transfer, arthrodesis, and osteotomy were performed. Conclusion: Since the number of patients with diabetic foot deformities is expected to increase in Japan, plastic surgeons with expertise in wound management should actively participate in the treatment of Charcot foot. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Progressive Collapsing Foot Deformity (PCFD) comprises five independent deformities represented by five classes: hindfoot valgus (class A), midfoot abduction (class B), forefoot varus (class C), peritalar subluxation (class D) and ankle valgus (class E). Conservative treatment includes the use of corrective insoles and orthotics. Longitudinal arch support inflatable ankle-foot orthoses (IAFO) help control pain in PCFD patients. But we have no knowledge about the ability of IAFOs to correct deformities in PCFD. The aim of this prospective case-controlled study was to assess the ability of longitudinal arch support IAFOs to correct 3D overall PCFD alignment as well as the five different PCFD classes independently. We hypothesized that IAFOs will correct PCFD 3D overall alignment as well as the five independent classes. Methods: After IRB approval we enrolled 24 symptomatic flexible PCFD and 24 controls matched on age, sex, and BMI. Patients were scanned using Weight-Bearing CT with and without a longitudinal arch support IAFO. The Foot and Ankle Offset (FAO) was used to assess the 3D foot overall alignment. We measured the Hindfoot moment arm (HMA, Class A), the Talonavicular coverage angle (TNCA, Class B), the Meary's angle and the distance between the floor and the medial cuneiform (C1-floor) for the Class C and the middle facet uncoverage (MFunco, Class D). We did not have any Class E deformity in our PCFD cohort.. Data normality was assessed by Shapiro-Wilk test. Comparisons used normality based paired T-tests or paired-Wilcoxon tests. Hypothesizing that the IAFOs would be two times less efficient than the surgery (Day et al.) in correcting the FAO in PCFD, the requisite number of subjects was 24 per group. Results: Control measurements were all significantly different than unbraced PCFD measurements confirming our PCFD selection process. Comparing PCFD without and with IAFO via FAO did not show significant improvement (respectively 6.6+/- 3.7% vs 5.5+/-4.2%, p=0.101). The HMA (8.8+/-5.8 vs 8.1+/-5.8, p=0.66), the TNCA (24.2+/-10.6 vs 21.9+/-9.7, p=0.44) and the MFunco (37+/-12% vs 31+/-18%, p=0.17) did not show any significant improvement when applying the IAFOs. The Meary's angle (17.6+/-7.2 vs 10.8+/-7.3, p=0.002) and the C1-floor (17.2+/-3.3mm vs 24.1+/-5.3mm, p<0.001) were significantly improved by the IAFOs. The only measurements which was normalized when compare the PCFD to the control group after applying the IAFO was the C1-floor (24.1+/-5.3mm in PCFD with IAFO vs 25.7+/-5.4mm in controls, p=0.31) Conclusion: In this prospective case-control study, we found that longitudinal arch support IAFOs were less than half as effective as surgery in correcting overall 3D deformity in PCFD. Likewise, IAFOs were not efficient in correcting hindfoot valgus (Class A), midfoot abduction (Class B) and peritalar subluxation (Class D) in PCFD. On the other, IAFOs were effective in correcting forefoot varus and medial longitudinal arch collapse (Class C). This study provides relevant information to guide medical treatment and longitudinal arch support IAFO prescription in PCFD. [ABSTRACT FROM AUTHOR]

Background: The management of congenital talipes equino varus (clubfoot deformity) has been transformed in the last 20 years as surgical correction has been replaced by the non-surgical Ponseti method. The Ponseti method, consists of corrective serial casting followed by maintenance bracing, and has been repeatedly demonstrated to give best results - regarded as the 'gold standard' treatment for paediatric clubfoot. Methods: To develop the study protocol Level 2 evidence was used to modify the corrective casting phase of the Ponseti method in children aged up to 12 months. Using Level 4 evidence, the percutaneous Achilles tenotomy (PAT) was performed using a 19-gauge needle instead of a scalpel blade, a technique found to reduce bleeding and scarring. Results: A total of 123 children participated in this study; 88 male, 35 female. Both feet were affected in 67 cases, left only in 22 cases, right only in 34 cases. Typical clubfeet were found in 112/123 cases, six atypical, five syndromic. The average age at first cast was 51 days (13-240 days). The average number of casts applied was five (2-10 casts). The average number of days between the first cast and brace was 37.8 days (10-122 days), including 21 days in a post-PAT cast. Hence, average time of corrective casts was 17 days. Parents preferred the reduced casting time, and were less concerned about unseen skin wounds. PAT was performed in 103/123 cases, using the needle technique. All post tenotomy casts were in situ for three weeks. Minor complications occurred in seven cases - four cases had skin lesions, three cases disrupted casting phase. At another site, 452 PAT were performed using the needle technique. Conclusions: The 'fast cast' protocol Ponseti casting was successfully used in infants aged less than 8 months. Extended manual manipulation of two minutes was the essential modification. Parents preferred the faster treatment phase, and ability to closer observe the foot and skin. The treating physiotherapists preferred the 'fast cast' protocol, achieving better correction with less complication. The needle technique for PAT is a further improvement for the Ponseti method. [ABSTRACT FROM AUTHOR]

This study was to report the comparison of outcomes between Ilizarov ring fixator (IRF) and Taylor Spatial Frame® (Smith & Nephew, Memphis, Tenn.; TSF) in terms of the effectiveness of ankle-foot deformities correction, follow-up results, and complications. Fourteen patients with ankle-foot deformities were corrected using circular external fixation (IRF group = 7 patients; TSF group = 7 patients) and related procedures. Baseline data and treatment variables were recorded. The patients' mean age was 42.9 years. Mean follow-up time was 6.5 months. Most common cause of deformity/traumatic condition was post-traumatic equinus. There were successful results in 8 patients (57.1%), partial successful results in 5 patients (35.7%), and revision-needed in 1 patient (7.1%). TSF group demonstrated significantly higher rate of successful results than IRF group (P=0.033). A trend of lower complication rate was found in TSF group (P=0.286). Deformity corrections using TSF provided significantly better clinical scores and higher rate of successful outcome than conventional IRF. [ABSTRACT FROM AUTHOR]

Pedobarography and the centre of pressure (COP) progression is useful to understand foot function. Pedobarography is often unavailable in gait laboratories or completed asynchronously to kinematic and kinetic data collection. This paper presents a model that allows calculation of COP progression synchronously using force plate data. The model is an adjunct to Plug-In-Gait and was applied to 49 typically developing children to create reference COP data. COP progressions were noted to spend 8% of stance behind the ankle joint centre, traverse lateral of the longitudinal axis of the foot through the midfoot for 76% of stance and finishing past the second metatarsal head on the medial side for 16% of stance. It is hoped the model will bridge the information gap for gait laboratories lacking pedobarography during foot assessments and will open up the possibility of retrospective research into COP progression based indices on kinematic data. [ABSTRACT FROM AUTHOR]

Hallux valgus (HV) was one of the most frequent female foot deformities. The aim of this study was to evaluate mechanical responses and stabilities of the Kirschner, bandage and fiberglass fixations after the distal metatarsal osteotomy in HV treatment. Surface traction of different forefoot regions in bandage fixation and the biomechanical behavior of fiberglass bandage material were measured by a pressure sensor device and a mechanical testing, respectively. A three-dimensional foot finite element (FE) model was developed to simulate the three fixation methods (Kirschner, bandage and fiberglass fixations) in weight bearing. The model included 28 bones, sesamoids, ligaments, plantar fascia, cartilages and soft tissue. The peak Von Mises stress (MS) and compression stress (CS) of the distal fragment were predicted from the three fixation methods: Kirschner fixation (MS = 6.71 MPa, CS = 1.232 MPa); Bandage fixation (MS = 14.90 MPa, CS = 9.642 MPa); Fiberglass fixation (MS = 15.83 MPa, CS = 19.70 MPa). Compared with the Kirschner and bandage fixation, the fiberglass fixation reduced the relative movement of osteotomy fragments and obtained the maximum CS. We concluded that fiberglass fixation in HV treatment was helpful to the bone healing of distal fragment. The findings were expected to guide further therapeutic planning of HV patient. [ABSTRACT FROM AUTHOR]

The question of child degenerative-dystrophic diseases is predominate in orthopedic pathology, where the problem of its treatment is very acute. Excluding the modern treatment methods, the number of children suffering planovalgusdeformity is comparably more to total orthopedic patients. This article describes a surgical treatment method of child planovalgus deformity by applying porous biocomposite materials from TiNi alloy. The method involves inserting porous frustoconical composite TiNi implant into subtalar joint, which, in its turn, could correct the deformation and shape the arch of foot eliminating planovalgus deformity. [ABSTRACT FROM AUTHOR]

Objective: Challenges persist in the reconstruction of the ankle and the foot with exposed tendons, joints, and bones as a result of severe burns and trauma. In flap elevation involving the sensitive superficial nerve, the local nerve was always sacrificed to obtain an anesthetic donor site; however, such a procedure introduced the possibility of painful neuromas. In this study, we present a desired clinical application of a modified reversed superficial peroneal artery flap, in which the superficial peroneal nerve is preserved.Methods: From 2008 to 2015, 12 patients with ankle or foot defects were treated with the modified reversed superficial peroneal artery flap. The defects of the patients were caused by hot liquid scald (one patient), electrical injury (five patients), and trauma (six patients). The flap was utilized for covering defects on the ankle (seven patients) and the foot (five patients). The size of the flaps ranged from 4.0cm×6.0cm to 18.0cm×10.0cm. The superficial peroneal artery was involved in the flap, whereas the superficial peroneal nerve was spared by dedicate dissection. The reverse-flow flap was nourished by the superficial peroneal artery through the terminal peroneal artery perforator.Results: The obtained outcomes were satisfactory functionally and aesthetically. The flaps in 11 patients survived completely without complications, whereas partial necrosis occurred in a 78-year-old patient when the flap survived a week later during follow up. CT angiography revealed the stenosis of the popliteal artery. The wound healed after interventional treatment involving placing a stent and changing the dressings. Basic functions and configurations were salvaged in all cases. All patients were completely satisfied with the proposed flap and suffered no paresthesia in their lower leg.Conclusion: Exhibiting beneficial characteristics such as reliable blood supply, favorable thickness, wide rotating arc, and retention of major vessels and the superficial peroneal nerve, the modified reversed superficial peroneal artery flap is useful in the reconstruction of ankle and foot defects that would not cause any hypoesthesia of the foot. [ABSTRACT FROM AUTHOR]

Background: Clubfoot is one of the most common pediatric orthopaedic disorders. While the Ponseti method has revolutionized clubfoot treatment, it is not effective for all patients. When the Ponseti method does not correct the foot, patients are at risk for lifelong disability and may require more-extensive surgery.Questions/purposes: (1) What genetic and morphologic abnormalities contribute to the development of clubfoot? (2) How can this information be used to devise personalized treatment paradigms for patients with clubfoot?Methods: Human gene sequencing, molecular genetic engineering of mouse models of clubfoot, MRI of clubfoot, and development of new treatment methods all have been used by our group to understand the biological basis and improve therapy for this group of disorders.Results: We gained new insight into clubfoot pathogenesis from our discovery that mutations in the PITX1-TBX4-HOXC transcriptional pathway cause familial clubfoot and vertical talus in a small number of families, with the unique lower limb expression of these genes providing an explanation for the lack of upper extremity involvement in these disorders. MRI studies revealed corresponding morphologic abnormalities, including hypomorphic muscle, bone, and vasculature, that are not only associated with these gene mutations, but also are biomarkers for treatment-resistant clubfoot.Conclusions: Based on an understanding of the underlying biology, we improved treatment methods for neglected and syndromic clubfoot, developed new treatment for congenital vertical talus based on the principles of the Ponseti method, and designed a new dynamic clubfoot brace to improve strength and compliance. [ABSTRACT FROM AUTHOR]

Background: Moderate to severe midfoot-forefoot varus deformities are commonly found in several conditions. However, few techniques are available to correct these deformities. So, we evaluated the clinical and radiological outcomes of patients who underwent midfoot derotational osteotomy to achieve plantigrade foot.Methods: From 2006 to 2014, 6 patients (7 feet) underwent midfoot derotational osteotomy. A visual analog scale (VAS) pain and the American Orthopedic Foot & Ankle Society (AOFAS) functional score were evaluated. Radiographic parameters, including tibiocalcaneal angle (TCA) and navicular height (NH), were assessed.Results: The mean patient age at surgery was 48.0 years (37-58). From before the operation to the final follow-up, the mean VAS score decreased from 6.5 (2-9) to 1.3 (0-4) and the mean AOFAS score improved from 42.7 (34-58) to 77 (68-87). All patients were satisfied with outcomes. The mean TCA significantly improved from 33.8° (9.9-66.7) to 12.7 (5.1-27.6) (p = 0.018)and the mean NH decreased from 46.7 mm (32.8-67) to42.6 (30.1-60.8) (p = 0.018).Conclusion: Severe midfoot-forefoot varus deformities can be efficiently corrected by midfoot derotational osteotomy resulting in favorable clinical and radiological outcomes and high patient satisfaction.Level Of Evidence: IV, case series. [ABSTRACT FROM AUTHOR]