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At least 73 records · Page 4Linked to original sources
PubMed2006

Adult acquired flexible flatfoot, treated by calcaneocuboid distraction arthrodesis, posterior tibial tendon augmentation, and percutaneous Achilles tendon lengthening: a prospective outcome study of 20 patients.

BACKGROUND: Several methods for the treatment of acquired flexible flatfoot have been described. PATIENTS AND METHODS: We followed the outcome of calcaneocuboid distraction arthrodesis with lengthening of the lateral column prospectively in 20 patients (20 feet). The mean age of the patients was 55 (30-66) years and 16 were women. The lateral column lengthening was combined with percutaneous lengthening of the Achilles tendon and augmentation of the posterior tibial tendon in all patients. Fixed forefoot supination, hallux valgus, and/or symptomatic arthrosis, were corrected with arthrodesis of the first cuneiform-metatarsal joint (n = 8) and arthrodesis of the naviculocuneiform joint (n = 2). The Foot Function Index (FFI) and American Orthopedic Foot and Ankle Society (AOFAS) Clinical Rating Index hindfoot score (CRI) were completed preoperatively and at follow-up. Follow-up time was 25 (13-39) months. All patients were physically examined at follow-up at the outpatient clinic, and the overall satisfaction rate was registered. Standardized weight-bearing radiographs were taken preoperatively and at follow-up. The lateral and dorsoplantar talometatarsal angle was measured, together with the ground-navicular distance. RESULTS: At follow-up, 17/20 feet had complete relief of pain or only minor symptoms. The overall patient satisfaction rate was excellent or good in 15 patients and 17 patients reported an increase in daily and/or recreational activities. 3 patients complained of pain at the distraction site and/or cuboid-MT5 joint, without signs of arthrosis. All but 1 patient would have chosen to undergo the same procedure given the same circumstances. The improvement in both the FFI and CRI was statistically significant. On radiographic examination, the lateral and dorsoplantar talometatarsal angle and the ground-navicular distance improved significantly. Nonunion developed in 2 patients and united after bone grafting. 3 patients had either paresthesia or anesthesia in the distribution area of the sural nerve. INTERPRETATION: We found good short-term results after calcaneocuboid distraction arthrodesis, percutaneous tendon Achilles lengthening, and medial soft tissue augmentation for the treatment of degenerative/acquired flexible flatfoot. Pain or discomfort along the lateral aspect of the foot is the most common and worrying postoperative complaint.

Achilles Tendon↗
PubMed1997

Posterior tibial tendon dysfunction as a cause of acquired flatfoot in the adult: value of magnetic resonance imaging.

Dysfunction of the posterior tibial tendon is the most common cause of acquired flatfoot in adults; despite this, the condition is not commonly recognized. We report three cases with flatfoot secondary to spontaneous tendon rupture, in whom magnetic resonance imaging (MRI) was a helpful non-invasive technique to confirm the suspected diagnosis. This disabling entity, and the usefulness of MRI in the diagnosis and planning the appropriate treatment, are reviewed.

Diagnosis, Differential↗
PubMed1999

The role of calcaneal osteotomies for correction of adult flatfoot.

The surgical treatment of flatfoot deformity has evolved during the past three decades. Soft tissue procedures alone fail to reestablish anatomic bony alignment, and bony procedures alone fail to provide dynamic support to the arch. The goal of any procedure is to reestablish the inherently stable bony configuration with adequate soft tissue balance (tendon transfer) to maintain stability in the dynamic situation. Therefore, a combination of procedures, such as soft tissue procedures combined with calcaneal displacement osteotomies and/or lateral column lengthening, may provide optimal results. The focus of this review is the role of bony correction in the treatment of the adult acquired flatfoot deformity.

Adult↗
PubMed1976

Peroneal spastic flatfoot syndrome.

Tarsal coalitions are not the sole cause of peroneal spastic flatfoot, and any irritative lesion in the peritalar area can induce protective contraction of any or all of the muscles bridging the peritalar joints. True muscular peroneal spasm has been shown to be present on a clinical basis in this entity where tarsal coalitions are not present. Neoplasm should be included in the differential diagnosis of the rigid flatfoot deformity.

Adolescent↗
PubMed2005

Calcaneal lengthening: investigation of deformity correction in a cadaver flatfoot model.

BACKGROUND: Evans showed that lengthening the lateral column by inserting structural bone graft into the anterior calcaneus could correct abduction and valgus deformity in flatfoot. To better understand the mechanism of correction and the three-dimensional effect of this procedure a cadaver study was done. METHODS: Three cadaver flatfoot models were used. Computed tomographic (CT) scans were made of each specimen before and after lengthening. Data from these scans were used to determine the center of volume of the talus, navicular, cuboid, and calcaneus. The angular and translational motions for each bone were determined. RESULTS: On average, relative to the talus, the navicular moved 18.6 degrees of rotation in adduction, 2.6 degrees of rotation in pronation, and 3.4 degrees in plantarflexion. The average translation was 5.6 mm medial, 0.4 mm posterior, and 1.8 mm plantar. The cuboid moved an average of 24.2 degrees of rotation in adduction and lengthening, 13.9 degrees in pronation, and 1.9 degrees in plantarflexion. The average translation was 9.4 mm medial, 2.6 mm distal, and 1.5 mm plantar. The calcaneus moved an average of 4.4 degrees of rotation in adduction, 0.1 degrees of rotation in eversion, and 1.3 degrees of plantarflexion. The average translation was 3 mm medial and 0.7 mm posterior with no plantar translation. CONCLUSIONS: The mechanism of Evans calcaneal lengthening involves adduction and plantarflexion of the midfoot relative to the hindfoot. The cuboid and navicular appear to move as a unit. The shape of the talar head, axis of the subtalar joint, degree of initial deformity, competence of plantar soft tissues, such as the long plantar ligament, and adequate length of the Achilles tendon are important. Knowing what qualitative three-dimensional changes take place allows a better understanding of the mechanics of the procedure and its possible applications.

Cadaver↗
PubMed2005

Giannini prosthesis for flatfoot.

BACKGROUND: To determine the clinical and radiographic results of arthroereisis using the Giannini endo-orthotic implant for the treatment of pediatric flatfoot deformity, we retrospectively evaluated 37 patients (65 feet). METHODS: Twenty-two boys and 15 girls were followed for an average of 26.5 months. Their overall average age was 9.4 (range 5 to 14) years. Pain, function, participation in sports activity, and the changes in radiographic measurements taken at 3, 6, and 12 months and then at 1-year intervals were evaluated. RESULTS: Pain or discomfort decreased from 60% (22 patients) preoperatively to 6% (2 patients) postoperatively. The percentage of normal postoperative footprints was 59% (38 feet) with first-degree flatfoot present in 27 feet (41%). Sports activities were taken up by 19 patients (51%) after surgery. An 8-mm endo-orthotic implant was used in 43 (66%) feet and an Achilles tenotomy was done in 38 feet (59%). The radiographic angles with the greatest degree of correction when compared to preoperative angles were the talar-first metatarsal angle (99%) and the calcaneal-pitch (36%). After placement of the endo-orthotic implant, the talar angle influenced the rest of the radiographic measurements. There was no postoperative deterioration in any of the radiographic angles measured during the monitoring period. Complications occurred in 10.7% of the patients, with postoperative pain being the most frequently reported (6% of patients). There was no infection or local reaction to a foreign body. Removal of the endo-orthotic implant was not done on a routine basis. CONCLUSION: This operative technique respects the anatomical structure of the foot and produces good clinical and radiographic results.

Achilles Tendon↗
PubMed2006

Evans calcaneal lengthening procedure for spastic flexible flatfoot in 32 patients (46 feet) with a followup of 3 to 9 years.

BACKGROUND: The purposes of this study were to evaluate the outcome of calcaneal lengthening in severe pediatric flexible flatfoot deformities of spastic origin and to determine the necessity of additional procedures. METHODS: In a prospective study, 32 patients (46 feet) were evaluated clinically and radiologically. The mean age of patients was 11 (range 4 to 22) years. The mean period of followup was 66 (range 36 to 108) months. RESULTS: Additional soft-tissue procedures (Strayer procedure, peroneus lengthening, reefing medial capsule) were performed in 39 of 46 feet; other bony procedures were performed in eight. Among the 46 feet, 11 outcomes were classified as excellent, 19 as good, nine as fair, and seven as poor. Poor outcome was related to overcorrection in three and deformity relapse in four. Calcaneocuboid subluxation was seen in nine feet. Radiographic evaluation demonstrated an improvement of all parameters determined. CONCLUSION: The Evans procedure is effective for the correction of severe, flexible flatfoot deformity in children with cerebral palsy in the short and mid term. Additional soft-tissue procedures frequently are required. However, correction of this multiplanar deformity predominantly occurs in the forefoot abduction component of the deformity, and the concomitant naviculocuneiform sag remains uncorrected. Despite successful outcomes, overcorrection and undercorrection remains a problem of clinical relevance.

Adolescent↗
PubMed2006

The use of standing lateral tibial-calcaneal angle as a quantitative measurement of Achilles tendon contracture in adult acquired flatfoot.

BACKGROUND: To quantitate the association of Achilles tendon contracture (ATC) with adult acquired flatfoot, the authors hypothesized that the standing lateral tibial-calcaneal angle increases because of ATC. METHODS: The standing lateral tibial-calcaneal angle, talo-first metatarsal angle, lateral talocalcaneal angle, lateral standing medial cuneiform, arch height, and anteroposterior talonavicular coverage angle were measured in 21 patients (25 feet) with clinical diagnoses of ATC and adult acquired flatfoot (AAF) and compared to the same measurements in a control group of 15 patients (30 feet) with no foot deformities or previous foot surgeries. RESULTS: The mean lateral tibial-calcaneal angle in the control group was 64.43 degrees and in the AAF group 71.24 degrees (p < 0.001). The mean lateral talo-first metatarsal angle in the control group was 11.77 degrees, and in the AAF group with ATC it was 25.80 degrees (p < 0.001). The mean arch height in the control group was 17.90 mm and in the AAF group, 8.48 mm (p < 0.001). In the ATC and AAF group an increasing standing lateral tibial-calcaneal angle was correlated with a decreasing lateral talo-calcaneal angle (p = 0.044), and a decreasing arch height was correlated to an increasing lateral talo-first metatarsal angle (p < 0.001). CONCLUSION: Adults with flatfeet and Achilles tendon contracture may have a statistically significant increase in the standing lateral tibial-calcaneal angle. This angle may be a reproducible measure of ATC. An increase in the standing lateral tibial-calcaneal angle may confirm and quantitate the clinical diagnosis of Achilles tendon contracture. Further studies with more patients are needed.

Achilles Tendon↗
PubMed1995

Selective hindfoot arthrodesis for the treatment of adult acquired flatfoot deformity: an in vitro study.

An acquired flatfoot deformity with significant laxity at the transverse tarsal joint was created experimentally and the amount of correction that was obtained with selective hindfoot fusions was measured radiographically. Results showed that the talonavicular, double (talonavicular and calcaneocuboid), and triple arthrodeses were able to fully correct the deformity, including correction of hindfoot valgus with just a talonavicular fusion. Subtalar and calcaneocuboid fusions failed to completely correct the deformity. This study provides experimental evidence that although the triple joints are interconnected, they differ with respect to their ability to malalignment. We conclude that talonavicular or double arthrodesis will correct deformity in a flatfoot with considerable laxity through the transverse tarsal joint, but that a subtalar fusion will not provide consistent correction.

Adult↗
PubMed1997

Subtalar arthrodesis versus flexor digitorum longus tendon transfer for severe flatfoot deformity: an in vitro biomechanical analysis.

We defined the mechanical behavior of the foot after an operation for treatment of the flatfoot deformity, subtalar arthrodesis, and compared results with those from flexor digitorum longus tendon transfer. Twelve fresh-frozen human foot specimens were used. Supporting elements were sectioned to create a flatfoot deformity. To simulate midstance phase of gait, loads were applied axially to the plantar foot and to five tendons. Reduction of deformity in metatarsal-talar, calcaneal-talar, and talar-tibial positions was achieved and was significantly greater after subtalar arthrodesis operation than after flexor digitorum longus transfer.

Adult↗
PubMed1999

Defining flatfoot.

Pes planus is a term frequently used in describing flatfoot; however, no study has objectively defined flatfoot. We evaluated the single leg stance footprint of 40 feet in 21 people with no history of foot problems, using pressure-sensitive film and a Harris mat. The medial and lateral aspects of the forefoot, midfoot, and hindfoot were assessed. The midfoot was further analyzed by dividing the medial midfoot force by the total midfoot force. The mean medial midfoot force/total midfoot force was 11.1% (SD = 6.5%). Pes planus was defined as the medial midfoot force/total midfoot force > 24.0% (mean + 2 SD). A population associated with pes planus (124 feet in 63 patients with Marfan syndrome) was then evaluated in the same fashion. Although the mean medial midfoot force/total midfoot force was not statistically different (16.0%), a distinct group of patients (25%) had forces that were outside the range of normal midfoot forces.

Adult↗
PubMed1993

Tear of the posterior tibial tendon causing asymmetric flatfoot: radiologic findings.

OBJECTIVE: The purpose of this study was to describe the preoperative radiographic appearance of the acquired asymmetric flatfoot caused by a tear of the posterior tibial tendon. These radiographic changes reflect the loss of tendon function and the development of flatfoot deformity. SUBJECTS AND METHODS: Preoperative radiographs of 30 patients (mean age, 48 years) with surgically proved complete tears of the posterior tibial tendon were evaluated. Erect anteroposterior and lateral views of the feet were obtained in all patients and were frequently supplemented with anteroposterior views of the ankles to evaluate valgus tilt. Calcaneal plantar, talocalcaneal, and talometatarsal angles were measured on radiographs and compared with the measurements in normal control subjects. Additional osseous and soft-tissue abnormalities were also evaluated. RESULTS: Findings on preoperative radiographs of the foot were abnormal in 50% of patients. These abnormalities included decreased calcaneal plantar angle (50%), increased lateral talometatarsal angle (47%), increased anterior talocalcaneal angle (43%), and increased lateral talocalcaneal angle (13%). Bone and soft-tissue abnormalities included osteoporosis (37%), medial soft-tissue swelling (27%), tarsal osteoarthritis (20%), distal tibial proliferative changes (7%), and the presence of accessory navicular bones (17%). CONCLUSION: Multiple abnormalities of the intertarsal relationships are seen as a result of tears of the posterior tibial tendon with the development of hindfoot valgus, midfoot abduction, and forefoot pronation.

Female↗
PubMed1998

Pediatric peroneal spastic flatfoot in the absence of coalition. A suggested protocol.

While most pediatric patients with peroneal spastic flatfoot demonstrate tarsal coalitions, not all do. The absence of coalition may present a diagnostic challenge and make appropriate treatment difficult. Past and present etiologic theories, diagnostic modalities, and treatments are outlined in this article. The common peroneal nerve block is of great value in the diagnosis and treatment of peroneal spastic flatfoot with or without coalition. With adjunctive treatments, increased motion and decreased symptomatology are often obtained. A protocol, applied to five cases described herein, is suggested.

Adolescent↗
PubMed1999

Flatfoot and calcaneal deformity secondary to osteomyelitis after neonatal heel puncture.

Deformity of the calcaneus was observed in three patients who developed osteomyelitis after neonatal heel puncture for newborn blood studies. Septic involvement of the calcaneal apophysis may produce an abnormal and early closure of this growth plate. Progressive deformity of the calcaneus, despite appropriate treatment, develops into an asymptomatic flatfoot. A strictly aseptic technique is mandatory for neonatal puncture of the heel to avoid this unusual complication. An infectious cause of flatfoot is proposed in this report.

Anti-Bacterial Agents↗
PubMed1992

Foot-ground pressure pattern of flexible flatfoot in children, with and without correction of calcaneovalgus.

The footprint-measuring instrument was used to establish foot-ground pressure pattern of flexible flatfeet in male and female children, aged four to six years. Standing at ease, the children exerted most of their ground pressure by the posterior weight-bearing area (WBA). The rest was distributed between the middle and anterior WBAs, with the middle area usually exerting about 17%, and in extreme cases, as much as 30% of the total foot-ground pressure. Correcting valgus inclination of the calcaneus into neutral by inserting a leather wedge under the medial portion of the heel restored the longitudinal arch and the normal distribution of the foot-ground pressure of the standing child. The middle WBA exerted only 6% of the total pressure. This measuring system can differentiate between a normal foot, a flexible flatfoot, and a rigid flatfoot. It also can measure the exact amount of abnormal pressure being exerted by the middle WBA.

Biometry↗
PubMedDate not supplied

Current concepts for treatment of the painful flatfoot in the elderly.

Flatfoot deformities are predominantly asymptomatic variants of normal, which do not adversely affect function. However, the acquired flatfoot deformity secondary to attrition of the posterior tibial tendon is a progressively painful condition, ultimately affecting the hindfoot, midfoot, and forefoot. It is most common during the sixth and seventh decades of life. Chronic micro-trauma to the tendon causes eventual rupture and the resulting deformity. Prior to tendon rupture, early symptoms are those of a unilateral localized inflammatory condition with tenderness and swelling behind the medial malleolus of the ankle. Early diagnosis is a key factor in limiting patient disability.

Aged↗
PubMed2006

Arthrodesis techniques in the management of stage II and III acquired adult flatfoot deformity.

The proper management of acquired flatfoot deformity requires obtaining a careful patient history and physical examination of the foot, ankle, and lower extremity. Accurate assessment of foot flexibility and localization of pain will aid in decision making. Nonsurgical management may not be successful in patients with advanced disease, particularly with the development of degenerative changes. Surgical management of advanced acquired adult flatfoot deformity (stages III and IV) is indicated with failure of nonsurgical management and consists primarily of arthrodesis for the foot component of the deformity. The foot component may include the subtalar, talonavicular, calcaneocuboid, or tibiotalar joints, or a combination of these joints. Adjunctive procedures, such as Achilles tendon lengthening, medial displacement calcaneal osteotomy, lateral column lengthening, and plantar flexion osteotomy of the first ray are useful in correcting residual deformities after hindfoot realignment. Proper selection of surgical procedures will maximize the potential for a good outcome. It is critical to correct all components of the deformity simultaneously in order to minimize recurrence of the deformity.

Adult↗
PubMed1989

Abnormal biomechanics of flatfoot deformities and related theories of biomechanical development.

The flatfoot deformity has been investigated over this century by many leading authorities with regard to its etiologies and pathogenesis. A large number of articles in the early orthopedic literature concerning the flatfoot deformity defined the primary abnormalities of the structure without strong emphasis on its relationship to abnormal functional etiologies leading to the pathogenesis of the deformity. This article emphasizes abnormal biomechanics and theories of development.

Biomechanical Phenomena↗