The role of medial ligaments and tibialis posterior in stabilising the medial longitudinal foot arch: a cadaveric gait simulator study

Acquired adult flatfoot is a three-dimensional deformation, which consists of hindfoot valgus, collapse of the longitudinal arch of the foot and adduction of the forefoot. The aim of the work is to present problems related to etiology, biomechanics, clinical diagnostics and treatment principles of acquired flatfoot. The most common cause in adults is the dysfunction of the tibialis posterior muscle, leading to the lack of blocking of the transverse tarsal joint during heel elevation. Loading the unblocked joints consequently leads to ligament failure. The clinical image is dominated by pain in the foot and tibiotarsal joint. The physical examination of the flat feet consists of: inspection, palpation, motion range assessment and dynamic force assessment. The comparable attention should be paid to the height of the foot arch, the occurrence of “too many toes” sign, evaluate the heel- rise test and correction of the flatfoot, exclude Achilles tendon contracture. The diagnosis also uses imaging tests. In elastic deformations with symptoms of posterior tibial tendonitis, non-steroidal anti-inflammatory drugs, short-term immobilization, orthotics stabilizing the medial arch of the foot are used. In rehabilitation, active exercises of the shin muscles and the feet, especially the eccentric exercises of the posterior tibial muscle, are intentional. The physiotherapy and balneotherapy treatments, in particular hydrotherapy, electrotherapy and laser therapy, are used as a support. In advanced lesions, surgical treatment may be necessary, including plastic surgery of soft tissues, tendons, as well as osteotomy procedures.

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Role of Tendoscopy in Treating Stage II Posterior Tibial Tendon Dysfunction

Foot & Ankle International ◽

10.1177/1071100717746192 ◽

2018 ◽

Vol 39 (4) ◽

pp. 433-442 ◽

Cited By ~ 8

Author(s):

Alessio Bernasconi ◽

Francesco Sadile ◽

Matthew Welck ◽

Nazim Mehdi ◽

Julien Laborde ◽

...

Keyword(s):

Invasive Surgery ◽

Stage Ii ◽

Preoperative Imaging ◽

Tibialis Posterior ◽

Posterior Tibial Tendon ◽

Posterior Tibial ◽

Spring Ligament ◽

Sf 36

Background: Stage II tibialis posterior tendon dysfunction (PTTD) resistant to conservative therapies is usually treated with invasive surgery. Posterior tibial tendoscopy is a novel technique being used in the assessment and treatment of posterior tibial pathology. The aims of this study were (1) to clarify the role of posterior tibial tendon tendoscopy in treating stage II PTTD, (2) to arthroscopically classify spring ligament lesions, and (3) to compare the arthroscopic assessment of spring ligament lesions with magnetic resonance imaging (MRI) and ultrasonographic (US) data. Methods: We reviewed prospectively collected data on 16 patients affected by stage II PTTD and treated by tendoscopy. We report the reoperation rate and functional outcomes evaluated by comparing pre- and postoperative visual analogic scale for pain (VAS-pain) and the Short-Form Health Survey (SF-36; with its physical [PCS] and mental [MCS] components). Postoperative satisfaction was assessed using a VAS-satisfaction scale. One patient was lost to follow-up. Spring ligament lesions were arthroscopically classified in 3 stages. Discrepancies between preoperative imaging and intraoperative findings were evaluated. Results: At a mean of 25.6 months’ follow-up, VAS-pain ( P < .001), SF-36 PCS ( P = .039), and SF-36 MCS ( P < .001) significantly improved. The mean VAS-satisfaction score was 75.3/100. Patients were relieved from symptoms in 80% of cases, while 3 patients required further surgery. MRI and US were in agreement with intraoperative data in 92% and 67%, respectively, for the tendon assessment and in 78% and 42%, respectively, for the spring ligament. Conclusions: Tendoscopy may be considered a valid therapeutic tool in the treatment of stage II PTTD resistant to conservative treatment. It provided objective and subjective encouraging results that could allow continued conservative therapy while avoiding more invasive surgery in most cases. MRI and US were proven more useful in detecting PT lesions than spring ligament tears. Further studies on PT could use this tendoscopic classification to standardize its description. Level of Evidence: Level IV, therapeutic study, case series.

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Ultrasound assessment of the meniscus complex formation in health children and with the 1st stage of longitudinal platypodia ones

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0014.6947 ◽

2013 ◽

Vol 14 (SUPPLEMENT 1) ◽

pp. 1-5

Author(s):

Alexei Ivantsov ◽

Daria Vorobyeva

Keyword(s):

Joint Space ◽

Healthy Children ◽

Old Patients ◽

Shock Absorbers ◽

Keywords Meniscus ◽

Foot Arch ◽

Ultrasound Assessment ◽

Transformation Processes ◽

Ultrasound Investigation

Objectives: Foot arch reduces the exposure of weight and buf load due to its bufer function. in longitudinal platypodia foot looses this function and articular menisci have to take the role of the bufers (shock absorbers). Materials and Methods: Ultrasound assessment of meniscus thickness was performed on the joint space level. Results: varus type (43.4%) of the meniscus complex adaptation was dominant in 5-7 years old patients with the 1st stage longitudinal platypodia; symmetric type (51.9%) – in 8-12 years old patients; valgus type (56%) – in 13-17 years old ones. Healthy children showed the valgus type in all age periods. Conclusions: in our opinion the dominance of the varus type of the meniscus complex in 5-7 aged children and its further conversion into the valgus type in case of the 1st stage longitudinal platypodia refects the reduction of the lower extremities transformation processes from the varus into the most functional convenient valgus position at the age of 13-17. Keywords: meniscus, children, ultrasound investigation.

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POS1333 ANKLE ARTHRITIS IN JUVENILE IDIOPATHIC ARTHRITIS: DON’T MISS TENOSYNOVITIS. CLINICAL AND SONOGRAPHIC FEATURES OF ANKLE TENOSYNOVITIS IN JIA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4272 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 948.3-949

Author(s):

S. Pastore ◽

S. Della Paolera ◽

A. Zabotti ◽

A. Tommasini ◽

A. Taddio

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Clinical Characteristics ◽

Color Doppler ◽

Tendon Sheath ◽

Response To Treatment ◽

Tibialis Posterior ◽

Ultrasound Guided ◽

Sonographic Examination

Background:Tenosynovitis can occur in patients with Juvenile Idiopathic Arthritis (JIA) and may be clinically difficult to distinguish from joint synovitis. The role of musculoskeletal ultrasound (msk-US) is still discussed in the management of JIA but recent studies supported the utility of msk-US especially in detection of tenosynovitis. There is no consensus treatment for tenosynovitis in children with JIA and almost all studies focused on tendon sheath injection with glucocorticoids.Objectives:The aims of the study were: i) to define the prevalence of tenosynovitis of the ankle in JIA patients and ankle swelling; ii) to describe the clinical characteristics of patient with tenosynovitis and to analyze different response to treatment.Methods:We conducted an observational cross-sectional study of a group of patients with JIA followed at the Rheumatology Service of the Maternal and Child Institute “Burlo Garofolo” of Trieste. We enrolled all the patients who reported a swelling of the ankle at least once during the follow-up period and, among these patients, we included only those who underwent msk-US. Based on both clinical and sonographic examination, we identified patients with tenosynovitis and we described their demographical and clinical characteristics as well as the therapeutic approach undertaken in this group of patients.Results:On December 31st 2019, 56 swollen ankles of 48 patients were assessed with msk-US: 22 ankles showed sonographic signs of synovitis (39%), 16 ankles of both synovitis and tenosynovitis (28%), 14 ankles of tenosynovitis only (25%). Overall, tenosynovitis was detected on twenty-seven (56%) out of 48 children with at least a swollen ankle. The majority of patient were females (70%) and the most affected tendon was the tibialis posterior (66%). Twenty-five patients with tenosynovitis (92%) achieved clinical and radiological remission: seven out of 26 patients (26%) treated with methotrexate achieved clinical and radiological remission without the addition of other therapies; fifteen out of seventeen patients (88%) treated with a biological drug responded to the therapy, of which eleven (73%) were in combination therapy with methotrexate.Conclusion:We observed that more than 50% of the patients with a swelling of the ankle presented a tenosynovitis and among these patients about 50% did not show sonographic sign of synovitis. Msk-US was decisive in order to identify tenosynovitis and to characterize ankle swelling in JIA patients. Among patients with tenosynovitis biological therapy alone or in association with immunomodulating therapy showed effectiveness in inducing disease remission.References:[1]Peters SE, Laxer RM et al. Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study. Pediatr Rheumatol Online J. 2017 Apr 11;15(1):22.[2]Lanni S, Bovis F et al. Delineating the Application of Ultrasound in Detecting Synovial Abnormalities of the Subtalar Joint in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken). 2016 Sep;68(9):1346-53.[3]Cimaz R, Giani T et al. What is the real role of ultrasound in the management of juvenile idiopathic arthritis? Ann Rheum Dis. 2020 Apr;79(4):437-439. doi: 10.1136/annrheumdis-2019-216358[4]Lanni S, Marafon DP et al. Comparison between clinical and ultrasound assessment of the ankle region in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2020 Apr 27.[5]Laurell L, Court-Payen M et al. Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study. Pediatr Rheumatol Online J. 2011 Jan 29;9(1):4.Disclosure of Interests:None declared

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The Role of Death Anxiety on Marksmanship Performance: A Virtual Reality Simulator Study

Ergonomics ◽

10.1080/00140139.2021.1965222 ◽

2021 ◽

pp. 1-35

Author(s):

Xyle Ku ◽

Seungju Hyun ◽

Byounghwak Lee

Keyword(s):

Virtual Reality ◽

Death Anxiety ◽

Virtual Reality Simulator ◽

Simulator Study

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The role of self-regulation in the context of driver distraction: A simulator study

Traffic Injury Prevention ◽

10.1080/15389588.2015.1102231 ◽

2016 ◽

Vol 17 (5) ◽

pp. 472-479 ◽

Cited By ~ 24

Author(s):

Bernhard Wandtner ◽

Markus Schumacher ◽

Eike A. Schmidt

Keyword(s):

Self Regulation ◽

Driver Distraction ◽

Simulator Study

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Kidner Procedure for Symptomatic Accessory Navicular and Its Relation to Pes Planus

Foot & Ankle International ◽

10.1177/107110079501600807 ◽

1995 ◽

Vol 16 (8) ◽

pp. 500-503 ◽

Cited By ~ 44

Author(s):

Somchai Prichasuk ◽

Opas Sinphurmsukskul

Keyword(s):

Pitch Angle ◽

Normal Subjects ◽

Tibialis Posterior ◽

Medial Longitudinal Arch ◽

Pes Planus ◽

Tibialis Posterior Tendon ◽

Accessory Navicular ◽

Tendon Insertion

The role of relocation of tibialis posterior tendon insertion in the treatment of symptomatic accessory navicular and its relation to the pes planus was studied in 28 patients with symptomatic accessory navicular. Two hundred non-affected individuals were used as control. The calcaneal pitch angle measured radiographically, was used as an indicator of pes planus. All patients had had an excision of the accessory navicular and relocation of the tibialis posterior tendon insertion (Kidner procedure). The average follow-up was 3.2 years. The results were good in 27 patients, and fair in 1 patient, and there were no poor results. Most of the patients demonstrated that the pain and the fatigue signs of the foot and the leg have been improved. Only 3 of 25 patients clinically showed an improvement of the medial longitudinal arch. The calcaneal pitch angle in patients with symptomatic accessory navicular was significantly (14.8°) lower than that in normal subjects (21.4°). An association of pes planus and symptomatic accessory navicular was shown. The Kidner procedure gave good results in the relief of pain and fatigue in patients with symptomatic accessory navicular. The procedure did not significantly restore the height of the medial arch.

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Combined Effect of Foot Arch Structure and an Orthotic Device on Stress Fractures

Foot & Ankle ◽

10.1177/107110078901000105 ◽

1989 ◽

Vol 10 (1) ◽

pp. 25-29 ◽

Cited By ~ 165

Author(s):

Ariel Simkin ◽

Isaac Leichter ◽

Michael Giladi ◽

Michael Stein ◽

Charles Milgrom

Keyword(s):

Stress Fractures ◽

Lower Limbs ◽

Orthotic Device ◽

Military Recruits ◽

Longitudinal Arch ◽

Metatarsal Fractures ◽

Foot Arch ◽

Military Stress ◽

A Prospective Study

In a prospective study, quantitative measures of the structure of the longitudinal arch of the foot were established and related to the incidence of stress fractures in the bones of the lower limbs of military recruits. In addition, the role of a semirigid orthotic device (Langer military stress orthotic) in preventing stress fractures was evaluated as a function of the structure of the longitudinal arch. Femoral and tibial stress fractures were found to be more prevalent in the presence of feet with high arches, whereas the incidence of metatarsal fractures was higher in feet with low arches. The use of an orthotic device reduced the incidence of femoral stress fractures only in the presence of feet with high arches and the incidence of metatarsal fractures only among feet with low arches. The findings suggest that the normal foot with a low arch acts as a better shock absorber than the normal foot with a high arch, and that an orthotic device may improve the shock absorbing capacity of the arch.

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