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At least 91 records · Page 5Linked to original sources
PubMed1989

Idiopathic flexible flatfoot in the adolescent.

In summary, factors to consider in treatment are (1) the patient's age; (2) the flexibility of the condition; (3) the severity of deformity; (4) the presence of equinus; (5) abnormal shoe wear; and (6) the symptoms. When a child presents with severe flexible flatfoot one should rule out an underlying neuromuscular disorder and perform a complete biomechanical evaluation to ascertain any rotational or angular conditions of the legs that might influence the treatment. If a child is in group 1 (ages 4 to 7), a Helfet heel seat with a medial plantar wedge is usually adequate treatment. In the group II (ages 8 to 12) adolescent with flexible flatfoot, more control of the calcaneal eversion is needed. This is obtained by using a device constructed from a plaster mold taken while the foot is in neutral position. This UCBL type of device must usually extend to the metatarsal heads and be elevated on the medial and lateral sides. The group III (ages 13 to 17) adolescent usually has the additional problem of a forefoot varus, which must be controlled using a forefoot post. It is also not unusual to have to add additional wedging inside the heel of the shoe to invert the heel.

Adolescent↗
PubMed1989

The conservative treatment of adult flexible flatfoot.

The purpose of this article is to attend to the nonsurgical treatment of adult symptomatic flexible flatfoot and its sequelae. Other articles in this issue thoroughly discuss the etiology, radiographic changes, and nonconservative treatment of the congenital and acquired flatfoot presented in children and adults.

Adult↗
PubMed1988

Surgical management of the flatfoot.

The flatfoot in a child with sufficient deformity and symptoms to warrant surgery occurs infrequently. A prolonged trial of nonsurgical measures is always indicated. With the exception of the spastic paralytic foot, surgery involving alteration of the bony anatomy should be postponed until the child's foot matures. Restoration of the longitudinal arch at the midfoot naviculocuneiform articulation is a reliable solution to the symptomatic hypermobile flatfoot. The spastic paralytic foot requires tendo Achillis lengthening, medial imbrication, and Grice subtalar stabilization. The symptomatic, cartilaginous tarsal coalition will respond to resection. Treatment of the skewfoot must be individualized depending on the severity and location of symptoms, age of the patient, and joint mobility.

Cerebral Palsy↗
PubMedDate not supplied

Surgical management of forefoot supinatus in flexible flatfoot deformity.

In the past, many surgical procedures have been advocated for correction of painful flexible flatfoot deformity. More recent opinions advocate the concept that no one procedure is appropriate to all flatfoot deformities. Individual assessment is now necessary to determine the predominant component deformities. One such component deformity frequently encountered is forefoot supinatus. The authors review the more commonly performed procedures for this problem, as well as their preferred approach of the modified Hoke arthrodesis or Cotton osteotomy. The choice of procedure is dictated by whether the first metatarsal or longitudinal axis subluxation predominates.

Adolescent↗
PubMed1984

Developmental flatfoot.

An overview of the clinical entity referred to as developmental flatfoot has been discussed. Specific reference has been made to its occurrence, etiology, identification, pathomechanics, clinical significance, and management rationale. This often overlooked, inconspicuous condition is the most common musculoskeletal abnormality affecting the foot of the child under 6 years of age. Recognition of the fact that the developmental flatfoot is the logical precursor of foot dysfunction, deformity, and resultant disability later in life will allow the practitioner to design a management program for today that will meet the foot health needs of tomorrow.

Biomechanical Phenomena↗
PubMed1995

[The lax juvenile flexible flatfoot--disease or normal variant?].

The spectrum of normal variations of children's feet is extremely broad and often difficult to separate from pathological conditions. Especially the flexible flatfoot normally disappears during growth, and even if it persists up to adult life, it hardly has any pathological significance. The natural course taken even by severe flexible flatfoot in children leads to results that are as good, if not even better than when surgery had been performed; therefore, more reticence with surgical treatment in such cases is advocated.

Child↗
PubMedDate not supplied

Rigid flatfoot.

The proper management of the rigid flat-foot requires an accurate diagnosis since the condition is treated on causal or rational basis. Calcaneonavicular coalition best seen on an oblique view of the foot may be treated by resection of the coalition with extensor digitorum brevis interposition. If the diagnosis is made sufficiently early, the resection can lead to an essentially normal foot. Coalition between the talus and the calcaneus may occur in the posterior, middle or anterior facet. The most common coalitions are seen in the middle facet area followed by those in the anterior facet with the posterior facet coalition rarely being seen. Coalitions in the area of the middle facet are usually managed nonoperatively; triple arthrodesis is used only if symptoms are not relieved by nonoperative measures. Resection of a talocalcaneal coalition in the middle facet is rarely indicated but occasionally will give relief when the coalition either presses on the medial plantar nerve or causes a mechanical disturbance of the ankle. Anterior facet coalitions should receive a trial of cast immobilization but frequently require triple arthrodesis. Other conditions such as rheumatoid and post-traumatic arthritis will frequently respond to a period of immobilization in a plaster cast. Triple arthrodesis has not been required in rheumatoid arthritis in the author's series but occasionally is necessary in the post-traumatic rigid flatfoot. Other rare causes of the rigid flatfoot should be kept in mind for a complete diagnostic evaluation since even a neoplasm (fibrosarcoma) has been reported to cause this symptom complex.

Arthrodesis↗
PubMed1995

Flatfoot in the Adult.

Flatfoot in the adult has long been a poorly understood "wastebasket" diagnosis, often used to unfairly deny asymptomatic individuals equal employment opportunities in our society. Now that flatfoot has been classified into a variety of congenital and acquired conditions, the parameters for assessment have been well defined, and rational treatment protocols have been established. Clearly, if the foot painlessly supinates/inverts to become a rigid lever for push-off and pronates/everts to absorb stress during stance, then it "functions normally" no matter what the height of the arch. However, the biomechanically offset position of pes planus with excessive heel valgus coupled with rigidity or instability can alter the connected interplay of the bones of the foot and weaken the entire kinetic chain of the lower extremity. Careful clinical and radiographic evaluation, coupled with a thorough understanding of the anatomy and biomechanics of the foot, will allow accurate evaluation and appropriate treatment.

Journal Article↗
PubMed2006

The correlation between selected measurements from footprint and radiograph of flatfoot.

OBJECTIVES: To assess the subarch angle obtained from electronic footprints using a capacitive mat transducer system in children with flatfeet, to evaluate other foot arch indexes, and to compare the results with radiographic measurements. DESIGN: A cross-sectional study. SETTING: Rehabilitation clinic in a municipal hospital. PARTICIPANTS: Thirty-two children (age range, 7-13y) diagnosed with flatfeet. INTERVENTIONS: Radiographic measurements and foot shape measurements obtained from feet. MAIN OUTCOME MEASURES: Talo-first metatarsal angle, talocalcaneal angle, talo-horizontal angle, and calcaneal angle were obtained from radiographs. Subarch angle, arch indexes, and long plantar angle were all captured and calculated via a capacitive transducer plate. RESULTS: Correlations between the subarch angle and the talo-first metatarsal angle, talo-horizontal angle, and arch height were significant, as was the correlation between midfoot arch index and talo-horizontal angle. The forefoot arch index had no significant relationship with radiographic parameters. The talo-horizontal angle and arch height had significant relationships with the long plantar angle. CONCLUSIONS: Measurement of the subarch angle had significant correlation with the radiographic parameters in children with flatfeet and it was accurately and easily obtained from a capacitive forceplate. Measurement of the subarch angle can be a useful tool in the assessment and diagnosis of flatfoot.

Adolescent↗
PubMed2005

Posterior calcaneal displacement osteotomy for the adult acquired flatfoot.

The posterior calcaneal displacement osteotomy with flexor digitorum longus tendon transfer is an accepted approach to the stage II posterior tibial tendon dysfunction flatfoot. This reconstructive osteotomy provides a viable alternative to isolated hindfoot arthrodesis procedures. Proper patient selection and sound surgical technique ensure favorable postoperative results. Complications, though limited, may include sural neuritis, peroneal tendonitis, undercorrection, and peritalar arthrosis.

Adult↗
PubMed2006

Pediatric and adult flatfoot reconstruction: subtalar arthroereisis versus realignment osteotomy surgical options.

One of the most common presenting problems to most foot and ankle surgical practices is the painful flatfoot. Often, the problem is treated with excellent outcomes through a combination of conservative options. In certain cases, conservative care may not alleviate the associated symptoms of foot, ankle, knee, and possibly even back fatigue, pain of the foot and leg, and arthritis of the midfoot, rearfoot, or ankle. In such cases, multiple surgical options are available to treat the underlying deformity and associated symptoms. it is essential to treat the foot and leg as a unit and not to perform surgical based on rapid recovery abut rather on a long-term stable and lasting outcome.

Adult↗
PubMedDate not supplied

The severe flexible flatfoot: a combined reconstructive procedure with rerouting of the tibialis anterior tendon.

A combined procedure is described that addresses all the components at fault in the severely flexible flatfoot deformity in children. The Evans calcaneal distraction wedge osteotomy will lengthen the lateral column, correcting the heel valgus and forefoot abduction. A naviculo--first cuneiform wedge resection (medial and plantar) and fusion will shorten and reshape the collapsed medial arch. This is augmented by reconstruction and plication of the lengthened plantar ligaments, with plantar rerouting of the tibialis anterior tendon to act as a strong plantar ligament. In addition, shifting the tibialis anterior's pull proximally acts as a sling to the talar head. Z plasty of the tight tendo Achillis is always needed. Nineteen feet in 11 patients were the subject of this study. The period of follow-up ranged from 8 to 42 months. The results were assessed according to the relief of foot strain and calf pains, improvement in shoewear, general activity, and foot shape. To evaluate foot shape, reconstruction of the medial arch and heel posture were assessed. The children and parents were satisfied with the final results in 17 feet (89.5%). Improvement of the radiological measurements was evident and was statistically significant.

Adolescent↗
PubMed2001

Treatment of stage 3 adult acquired flatfoot.

Stage 3 adult acquired flatfoot occurs when chronic posterior tibial tendon insufficiency results in fixed hindfoot valgus or fixed forefoot abduction and supination. Nonoperative management results in limited success. Corrective fusion is the treatment of choice. Although a variety of arthrodeses have been employed, triple arthrodesis remains the gold standard.

Adult↗
PubMed2001

Treatment of stage 4 adult acquired flatfoot.

Stage 4 PTT dysfunction is a rare anatomic condition in which fixed hindfoot valgus is associated with valgus tilting of the talus within the ankle mortise. Success with nonoperative management is the exception rather than the rule. The surgical options are a tibiotalocalcaneal fusion or a pantalar fusion; however, there are few results reported in the adult acquired flatfoot population. Valgus talar tilting after triple arthrodesis may be the challenge of the future.

Adult↗
PubMed2001

Complications of surgical treatments for adult flatfoot deformities.

Numerous surgical procedures have been proposed for reconstructing and correcting adult flatfoot deformity. Most procedures include lengthening of the tight Achilles tendon and transferring the FDL tendon to substitute for a dysfunctional PTT. These procedures commonly are combined with a bone procedure to stabilize the correction and correct the pathologic anatomy. All of these procedures have the potential for a range of complications, many of them serious. In general, the clinician should perform the least invasive procedure that decreases pain and improves function. The effects of each procedure and the associated morbidity and complications must be considered.

Adult↗
PubMed1999

Talonavicular arthrodesis for the acquired flatfoot in the adult.

The acquired painful flatfoot in the adult is a syndrome that commonly is disabling and progressive. Patients should benefit from a surgical technique that can provide correction of the major deformities and lasting stability with limited surgical morbidity. Twenty-nine patients treated with a talonavicular arthrodesis for this disorder were followed up a minimum of 12 months and an average of 26 months. Twenty-five patients (86%) were satisfied with no or minor reservations and achieved good or excellent results. A talonavicular arthrodesis, by addressing the instability at its focal point, appears to achieve these goals with one surgical procedure.

Adult↗
PubMed2003

Measurement of forefoot varus angle by laser technology in people with flexible flatfoot.

OBJECTIVE: The purpose of this study was to measure the forefoot varus angles in subjects with and without flexible flatfoot (FF) by using laser foot-scanning technology. DESIGN: In the rehabilitation laboratory of a tertiary medical center, 70 subjects with FF, ranging in age from 10 to 50 yr, were recruited. The control group consisted of 30 volunteers without clinical evidence of FF. A total of 100 positive casts were obtained by having their subtalar joints kept in a neutral position. The plantar surface of the positive cast was scanned by a Yeti 3D Foot Scanner. A straight line was drawn between the first and fifth metatarsophalangeal joints. The forefoot varus angle was measured from this line in relation to the line parallel to the ground. RESULTS: The mean forefoot varus angle was calculated to be 5.01 +/- 4.51 degrees in our FF subjects, and 1.23 +/- 1.96 degrees in the control group. Significant statistical difference in forefoot varus angle was noted between these two groups. CONCLUSIONS: The laser foot-scanning technique offers fast and accurate measurement of the forefoot varus angles. An average forefoot varus angle of approximately 5 degrees was observed in subjects with FF, which was significantly greater than the subjects without FF. Therefore, we recommend the concept of incorporating adequate forefoot posting at the medial forefoot area of an insole in treating people with FF.

Adolescent↗
PubMedDate not supplied

Association of slipped upper femoral epiphysis and peroneal spastic flatfoot.

A significant association between slipped upper femoral epiphysis (SCFE) and subtalar arthritis causes peroneal spastic flatfoot. Three patients with this association were observed in 136 cases of SCFE, an incidence of 2.3%; the anticipated incidence would be 0.4%. We postulate that both conditions reflect an underlying immunologic disorder.

Adolescent↗