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At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

Survey of foot deformities among 166 geriatric inpatients.

A clinical survey on foot deformities among 166 geriatric inpatients was carried out. Direct measurements on hallux valgus, great toe movements, great toe deformities, lesser toe deformities, arch of the foot, callosities, ankle movements, inversion, and eversion were done by using the goniometer. A specially designed goniometer was created to measure inversion and eversion. The Harris Mat was used to study foot prints in correlation with the various deformities. About 50% of geriatric patients were found to have foot deformities of various types. This compared well with available data in literature. The target population was also checked for their symptomatology which, amazingly, was found to be really insignificant compared with the deformities present. This finding was found to be very much unlike data for Caucasian individuals with foot deformities, 50% of whom had symptoms related to pain and footwear. This major difference in the clinical presentation encourages the authors to carry on their study and, perhaps, direct cross-cultural studies in the future.

Aged↗
PubMed2000

The pathogenesis and surgical management of foot deformity in Charcot-Marie-Tooth disease.

The foot deformities in CMT follow certain general patterns; however, like the underlying motor failures that cause them, the deformities present in each patient are unique, and care must be individualized. There is no simple algorithm that can be applied to all patients. The hindfoot, forefoot, and toe deformities in CMT all ultimately are interconnected. As a general rule, it makes sense to address the plantar fascia, then proceed from the hindfoot to the forefoot in analyzing the deformities and in surgery. Releasing the plantar fascia may alter the amount of bony correction required in any concomitant hindfoot procedure. Likewise, only after the heel is realigned can any residual forefoot valgus be assessed, and a hindfoot procedure may alter the resting tension of the digital flexors and extensors. Finally, if a patient has purely dynamic clawtoes preoperatively, the toes may appear perfectly normal in the operating room with the ankle plantar flexed. Tightness of the flexor digitorum longus should be elicited by bringing the ankle up to neutral as a final check. The variety of foot deformities in CMT present a unique challenge to the orthopedic foot and ankle surgeon. It is vital for the patient and physician to remember that CMT is an inexorably progressive disease, and an initially good result can deteriorate with changing motor function. With meticulous attention to the neurologic examination and the balance of supple and fixed deformities in the foot, very satisfying outcomes usually can be obtained.

Charcot-Marie-Tooth Disease↗
PubMed1988

Pathomechanics of structural foot deformities.

This article presents the most common structural foot deformities encountered in clinical practice. The deformities are defined, and the expected compensations at the subtalar joint (STJ) are described. The theoretical consequences of the STJ compensations on proximal and distal tissues are presented. A biomechanical rationale for certain tissue disorders is described. The possible effects of abnormal STJ compensation on osseous development are briefly discussed.

Ankle Joint↗
PubMedDate not supplied

Partial wound closure after surgical correction of equinovarus foot deformity.

Full correction of severe equinovarus foot deformities is frequently lost at the end of surgical release when the surgeon closes the skin incision. We retrospectively review 31 feet in 22 patients whose medial skin incisions were left open (typically 10 mm) to heal by secondary intention. The criterion to leave a wound open was if primary closure with the foot in full correction might compromise circulation to the skin or if closing the incision would require loss of corrected position. One or two cast changes were performed under outpatient anesthesia at 7- to 14-day intervals for wound care. All wounds except one were healed by week 6 at time of outpatient clinic cast removal. The appearance of the incisions is similar to feet in which primary closure is possible. One foot required split-thickness skin grafting at 3 weeks postoperatively to achieve wound coverage. There were no infections. We conclude that primary skin closure is not essential after surgical correction of equinovarus foot deformity, and that correction need not be compromised to approximate skin.

Child↗
PubMed1984

Foot deformities secondary to gluteal injection in infancy.

We report six cases of foot deformities in children due to sciatic nerve dysfunction that appear to have been caused by gluteal intramuscular injection. Of four patients who developed cavovarus foot deformities, two also exhibited a component of ankle equinus. A fifth patient had a calcaneocavus foot deformity. In the sixth patient foot palsy resolved completely 1 year after injury, and no deformities developed. Identification of the muscle imbalance, as well as appropriate correction of the deformity before the implementation of muscle balancing procedures, led to the attainment of a satisfactory plantigrade gait in the first five patients with deformities. Bases on our experience with these six cases and reports in the literature, we recommend that the superolateral gluteal area between the crest of the ilium and the greater trochanter be properly defined as the preferred site for intramuscular injection.

Buttocks↗
PubMed1999

[Soft tissue operations in neuromuscular foot deformities].

The management of neuromuscular foot deformities in children and adolescents must be individualized because of differences in etiology and pathomechanics. If conservative treatment fails or reaches a plateau early soft tissue procedures are recommended. Treatment should focus not only at correction of the deformity but also at reestablishment of muscular balance. Early postoperative mobilisation is usually possible provided adequate orthotic control is maintained. Regular clinical follow-ups help to minimize postoperative problems. The general aim should be an optimization of functions and only rarely to achieve a normal foot. The basic principles of management can be described as correction of deformity, stabilization of unstable joints and balance of muscle power.

Adolescent↗
PubMed1997

[Realignment, fusion, and staple fixation of the chopart joint in neurogenic foot deformities.].

GOAL OF SURGERY: Restoration of a plantigrade foot in adolescents suffering from a neurogenic foot deformity with an important, irreversible malposition of the talocalcaneonavicular joint complex. INDICATIONS: Severe, non reducible hindfoot deformity which cannot be corrected through soft tissue procedures alone. Important tarsal instability. Progressive forefoot deformities. CONTRAINDICATIONS: Presence of supple club foot deformities. Severe deformities necessitating removal of a bone wedge. Important degenerative changes of the subtalar joint. Presence of skin infection or sores. POSITIONING AND ANAESTHESIA: Supine with buttock of operated side slightly elevated. General or regional anaesthesia. Tourniquet at thigh. SURGICAL TECHNIQUE: Two skin incisions, one overlying the talonavicular and the other the calcaneoucuboid joint. Subperiosteal dissection until both approaches meet. Arthrodesis of the calcaneoucuboid and talonavicular joints after resection of articular cartilage and correction of deformity. Temporary fixation with Kirschner wires, visual control of correction and permanent fixation with titanium staples. Long leg cast which is split immediately. Additional tendon surgery may be necessary POSTOPERATIVE MANAGEMENT: Elevation of foot. Low molecular heparin. Well molded fibreglass cast after 2 weeks and heel added 2 weeks later. Orthopaedic shoes 10 to 12 weeks postoperatively. POSSIBLE COMPLICATIONS: Injury of neurovascular structures. Pressure sores. Thrombophlebitis. Wound dehiscence, deep infection. Displacement or breakage of staples. Absence of bony fusion. RESULTS: Between August 1990 and April 1993 the technique was performed 20 times in a total of 15 patients. Follow-up 14 to 36 months. A bony fusion occurred in all patients at 12 weeks. Eighteen times the functional result was good to satisfactory and these patients were free of pain. The following complications were observed: hindfoot varus (2), transient loss of sensation of foot (1), necrosis of the wound edges (2) and breakage of the staple (1).

English Abstract↗
PubMed1989

Split posterior tibial tendon transfer for spastic equinovarus foot deformity.

This paper describes a simplified technique for split posterior tibial tendon transfer in the treatment of spastic equinovarus deformity of the foot. Thirteen children with spastic equinovarus foot deformities were treated at Children's Rehabilitative Services in Phoenix, Arizona, from 1983 to 1986. The technique was modified in 10 of the 13 patients by attaching the split posterior tibial tendon more proximally to the peroneus brevis, compared to a more distal attachment as described by other authors. The mean length of followup was 21 months. Eleven patients obtained a good or excellent result. Two patients were considered to have a fair result. No poor results or complications were noted in any of the patients. It was felt that the split posterior tibial tendon transfer was an effective procedure for correction of spastic equinovarus as reported by other authors. Modification of the technique significantly simplifies the operation by requiring less dissection while still producing favorable results.

Adolescent↗
PubMed2004

[The surgical management of spastic foot deformities].

Any surgical treatment of spastic foot deformities must be preceded by an exact preoperative analysis of every aspect of the deformity and its functional consequences. The goals of surgical treatment are correction of the deformity, reestablishment of the stability of the foot and preservation of functionally important ranges of motion and muscle strength. These goals can usually be achieved only by a package of several simultaneous procedures. The foot must never be treated in isolation. Proximal joints have to be considered as well as the opposite side, because a plantigrade position of the foot is only possible when the leg is straight. Any postoperative evaluation must also take into account the proximal joints and the opposite leg in unilateral cases. The mere static evaluation of the postoperative results by reporting clinical and radiographic values should be supplemented by dynamic measurements which allow more insight into the functional results.

Adolescent↗
PubMed2000

Foot deformities in rheumatoid arthritis and relevance of disease severity.

OBJECTIVE: To investigate foot deformities in rheumatoid arthritis (RA) in relation to the disease severity. METHODS: Radiographs of 100 weight bearing feet of 50 patients who had had RA for >10 years (mean 13.5 years) were studied. The patients were classified into 2 study groups according to the severity of disease. We measured hallux valgus angle (HVA), intermetatarsal angle between first and 2nd (M1/2), and intermetatarsal angle between first and 5th (M1/5) on anteroposterior (AP) radiographs, as well as calcaneal pitch (CP) and first metatarsal pitch (MP) on lateral radiographs. The differences in these angles between the 2 groups (Inter-group study) and the correlations among angles within each group (Intra-group study) were examined. RESULTS: Inter-group study showed significant differences between the 2 groups for all variables. Intra-group study, on the other hand, showed no correlation between variables of the 2 deformities, i.e., splaying of forefoot (M1/2 and M1/5) and flattening of longitudinal arch (CP and MP). Only HVA correlated with the splaying (M1/2 and M1/5) in both study groups. CONCLUSION: Disease severity is related to the progression of foot deformities in RA, but the flattening and the splaying are not correlated with each other. We believe that foot deformities should be treated properly and early, especially for patients who are expected to have severe disease.

Adult↗
PubMed2006

Dynamic foot pressure measurements for assessing foot deformity in persons with spastic cerebral palsy.

OBJECTIVES: To identify characteristics of foot pressure distribution in different foot deformities using a computerized insole sensor system, and to identify changes in these parameters after corrective surgery in children with spastic cerebral palsy (CP). DESIGN: Before-after trial. SETTING: University hospital. PARTICIPANTS: Sixty-seven limbs of 44 children with spastic CP were assessed (35 equinus, 17 equinovarus, 15 equinovalgus). INTERVENTION: Orthopedic surgery for foot deformities. MAIN OUTCOME MEASURES: Parameters of foot contact pattern, pressure-time integral (PTI), and center of pressure (COP) trajectories were assessed before and at a minimum of 6 months postsurgery, using the F-scan system. RESULTS: Prior to surgery, the medial midfoot relative impulse, which is PTI normalized by a percentage of the entire foot, differed significantly between foot deformity groups. Relative impulse was high on the lateral column of the foot in the equinovarus group and on the medial column of the foot in the equinovalgus group. Center of pressure index (COPI) and coronal index reflecting the asymmetry of the medial and lateral columns of the foot differed significantly between the equinovalgus and equinovarus groups. After surgery, significant changes occurred in foot contact patterns, including total contact area, contact length, contact width of hindfoot, and the relative impulse of specific areas of the foot. In addition, there were significant changes in the parameters of COP, such as anteroposterior displacement, slope, and velocity. CONCLUSIONS: In dynamic foot pressure measurements using a computerized insole sensor system, the parameters reflecting medial or lateral changes in weight bearing, such as COPI and coronal index, appear to be useful for evaluating abnormalities and improvements after intervention in the frontal plane, such as varus and valgus. Additionally, assessment of parameters in foot contact patterns, PTIs, and COP path trajectories appears to be helpful in evaluating outcomes after corrective surgery.

Adolescent↗
PubMed1996

Preventive treatment of foot deformities in type 1 diabetic patients aged 15-50 years--an epidemiological and prospective study.

OBJECTIVES: To prevent worsening of foot deformities in diabetic patients. DESIGN: A population-based and prospective study. SUBJECTS: All patients in the county of Umeå with Type 1 diabetes mellitus (DM) (n = 308) aged 15-50 years. MAIN OUTCOME MEASURES: Examination and individual education was performed. Patients with the most pronounced foot deformities (n = 67) were fitted with custom-made insoles and had repeated foot examinations. An identical examination was used at a 3-year follow-up. RESULTS: Patients who were fitted with insoles had higher sensory thresholds for vibration compared to those with no insoles. They were older and had longer duration of DM. Improvement of foot deformities was significantly more common in patients after treatment with insoles than in patients without. Plantar ulcers did not occur in patients with moulded insoles. CONCLUSION: Information, follow-up examinations and moulded insoles improve neuropathic foot deformities in many patients, even in those with pronounced deformities.

Adolescent↗
PubMed1988

Foot deformities in the newborn--incidence and prognosis.

In a consecutive screening of 2,401 newborn, a foot deformity was noted in 100 of the infants (4.2 percent). At follow-up 5-6 years later, the children with a foot deformity were reexamined and compared with normal controls. Seventy-six infants had some adduction deformity of the foot at birth. At reexamination, 87 percent of the examined children had normal feet. No association was observed between sleeping prone and the presence of adduction deformity at the reexamination. Pes calcaneovalgus was diagnosed in 18 newborn. Of those reexamined, all had normal feet. Up to the age of 6 years, 4.3 percent of the 2,401 had been referred to the department of orthopedics because of a foot deformity; 50 because of an adduction deformity, and in 10 of these children the deformity was observed at birth. The investigation indicates that no treatment is required for pes calcaneovalgus or adductus deformity confined to the forefoot.

Child, Preschool↗
PubMed2002

Assessment of the position of the navicular by three-dimensional magnetic resonance imaging in infant foot deformities.

As the navicular is unossified in infants with foot deformities, until 5 years old (boys) and 3 years old (girls), it is difficult to give the exact position of hindfoot bones. Magnetic resonance imaging associated with three-dimensional reconstruction allows the visualization of the cartilaginous volume of the bones and the measurement of the relationships of the navicular with the talus. In normal feet, we noted that in the coronal plane the navicular was laterally situated (75%) relative to the talus. In club feet (17 patients), the navicular and the cuboid had a large medial displacement (77%) with a slight pronation movement in the sagittal plane. In suspected skewfoot (seven feet) we noted three cases with a lateral subluxation of the navicular. This objective technique of measurement may be of value for diagnosis and treatment of foot deformities.

Case-Control Studies↗
PubMedDate not supplied

Preoperative Ilizarov frame construction for correction of ankle and foot deformities.

The Ilizarov method is being used increasingly to correct many orthopedic deformities. The frames required for ankle and foot deformity correction are among the most difficult to construct owing to the complexity of the deformities which must be corrected. A technique using a rubberized material (Pedilen) to create an exact replica of a preoperative ankle and foot deformity is described. This exact model, both in size and shape, may then be used on a workbench to preconstruct an Ilizarov frame that resembles the patient's deformity exactly in three dimensions with respect to size and shape. This allows thoughtful frame construction before operation reducing operating time and minimizing frustrations that may arise with complex deformities.

Adolescent↗
PubMed1983

Foot deformity in myotubular myopathy. Pathology of intrinsic foot musculature.

An intrinsic foot muscle biopsy specimen was taken from a patient with myotubular myopathy who underwent surgical correction for orthopedic deformity. Pathologic findings were typical of primary muscle disease. Foot deformity in myotubular myopathy may result from abnormalities of intrinsic foot muscles, as well as those of more proximal musculature.

Biopsy↗
PubMedDate not supplied

Correction of cavovarus foot deformity in Charcot-Marie-Tooth disease.

Operative correction of cavovarus foot deformity in Charcot-Marie-Tooth disease (CMT) is challenging. This progressive peripheral sensory and motor neuropathy commonly involves the forefoot, midfoot, hindfoot, and toes. The authors present a new imaging technique that allows the surgeon to assess the flexibility of the hindfoot in patients with CMT to determine the best operative procedure to correct the deformity. Twenty-five patients (41 feet) with CMT and cavovarus foot deformity were evaluated and a new radiographic technique was studied in some of these patients to determine the usefulness of this imaging modality. The authors believe that this new imaging method will aid in determining the optimal operation for correcting this complex deformity.

Adolescent↗