Foot pressure and radiographic outcome measures of lateral column lengthening for pes planovalgus deformity

The purpose of this study was to establish and characterize the relationship between foot pressure analysis and radiographic measurements in children that underwent a lateral column lengthening procedure for pes planovalgus (PPV). Eight children (13 feet) with PPV that had failed non-operative treatment underwent a lateral column lengthening procedure. Pre-operative and post-operative standing AP and lateral radiographs and foot pressure data were obtained. The relationships between the radiographic and foot pressure measurements were investigated. The findings from this study demonstrated strong relationships between these parameters. The relationships seen in this study indicate that the addition of foot pressure analysis provides objective documentation of the improvement in foot pressure distribution following a lateral column lengthening. Also, there is a direct, positive relationship between the key radiographic and foot pressure measurements.     

The effects of foot orthosis and low-dye tape on lower limb joint angles and moments during running in individuals with pes planus

BackgroundPes Planus or Flat feet is one of the most common lower limb abnormalities. When runners with this abnormality participate in recreational running, interventional therapies could help in pain alleviation and enhance performance. To determine the most effective treatment, however, a biomechanical examination of the effects of each treatment modality is required.Research questionThe aim of the present study was to investigate the effects of Foot Orthoses (FOs) and Low-Dye Tape (LDT) on lower limb joint angles and moments during running in individuals with pes planus.Methodskinematic and kinetic data of 20 young people with pes planus were measured during running in three conditions: (1) SHOD (2) with shoes and FOs (3) with shoes and LDT. One-way repeated measure ANOVA was used to investigate the impacts of the FOs and LDT on the lower limb joint angles and moments throughout the stance phase of the running cycle.ResultsThe results showed that FOs reduced ankle eversion compared to SHOD and LDT (P < 0.001) and decreased the dorsiflexion angle (P = 0.005) and the plantarflexor moment compared to the SHOD (P < 0.001). FOs increased knee adduction angle (P = 0.021) and knee external rotator moment (P < 0.001) compared to both conditions and increased knee extensor and abductor moments compared to SHOD (P < 0.001). At the hip joint, FOs only increased hip external rotation compared with the LDT condition (P = 0.031); and LDT increased hip extensor moment compared to SHOD and FOs (P = 0.037) and also increased hip adduction angle compared to SHOD (P = 0.037).SignificanceFOs with a medial wedge appears to increase the external knee adduction moment and knee adduction angles, which are risk factors for the development and progression of knee osteoarthritis. Further, usage of FOs seems to reduce the ankle joint role in propulsion as it impacts the ankle sagittal angles and moments.     

Common disorders of the adult foot and ankle

Intricate bony and soft tissue anatomy associated with complex biomechanics can provide a significant challenge when considering the pathologies affecting the adult foot and ankle. The aim of this article is to introduce some of the clinical features and treatments for more common foot and ankle conditions.     

The Treatment of Posterior Tibial Tendon Insufficiency Using the Double Heel Osteotomy and Soft Tissue Reconstruction: The “All-American Procedure”

BackgroundMultiple treatment options have been proposed for the treatment of flexible (stage II) flatfoot with posterior tibial tendon insufficiency (PTTI). This article describes the rationale and technique of our joint-sparing approach to this problem with a combination of osteotomies and soft tissue reconstruction.MethodsLengthening of the lateral column (LCL) through the anterior calcaneal process diminishes the abduction of the forefoot related to the hindfoot, plantarflexes the first ray by tightening the peroneus longus tendon, and causes the arch to rise. Hindfoot valgus is addressed with a medializing calcaneal osteotomy (MCO). Additional soft tissue procedures include transfer of the flexor digitorum longus tendon (FDL), substituting for the diseased posterior tibial tendon and a percutaneous heel cord lengthening (HCL).Results and ConclusionsThe combination of a double heel osteotomy (LCL and MCO) and a soft tissue reconstruction (FDL transfer and HCL) has proven to be an excellent operation for supple PTTI in our practice for 25 years in approximately 1000 patients. Paying careful attention to the described details of the LCL portion of the procedure improves the results of the reconstruction. Removal of the LCL screw and any remaining osteophytes at the calcaneocuboid joint seems to solve the problem of lateral column pain and some overcorrection after the initial procedure.     

Arthroereisis and Pes planovalgus. Tool of the devil or novel implant?

BackgroundThe primary aim of surgical flatfoot management is to correct deformity, provide dynamic support to the medial longitudinal arch and stabilise the hindfoot to allow normal heelstrike and propulsion for toe off. The correction aims to place the calcaneal tuberosity in line with the midsagittal tibia and reduce the talonavicular joint.Materials and MethodsThe standard procedure involves a heel cord lengthening or calf release if indicated. Bony correction involves a varising calcaneal osteotomy. The medial soft tissue correction involves repair of the tibialis posterior tendon and augmentation with a flexor digitorum longus tendon transfer. The arthroereisis implant is inserted into the sinus tarsi via a 2 cm skin incision over a guide wire. The primary role of the arthroereisis is to block the non-physiologic eversion of the subtalar joint by limiting pronation. Thus, the implant acts as an internal arch support, protecting the medial soft tissue repair.ResultsThe senior author has reviewed 84 feet over 7 years of late stage tibialis posterior dysfunction treated in the above technique. No infections were recorded and 30% of implants were removed after 6 months for subtalar discomfort. Less favourable outcome was associated with over- or undersizing of the implant.ConclusionArthroereisis allows for a good correction adult onset pes planovalgus. It provides an additional tool in the armamentarium of the foot and ankle surgeon for the management of a difficult condition