The reliability of measurements taken from radiographs in the assessment of paediatric flat foot deformity

Paediatric flat feet are a serious therapeutic problem. During the child’s development, the foot is subject to the processes of anatomical and physiological modifications. In small children, the flat foot is a physiological variant. The assessment of the flat foot deformity is based on clinical examination, a podoscope examination and possibly radiological evaluation. Only from the age of about 3 years is it possible to consider the implementation of treatment, initially conservative with rehabilitation and possibly orthotics. Some patients require treatment with analgesics, anti-inflammatory drugs or physiotherapy due to the pain they experience, especially in the hindfoot. The lack of progress in conservative treatment requires consideration of surgical treatment, which must be individually adjusted. Arthroereisis, possibly combined with the elongation of the Achilles tendon, is the most commonly used treatment. In fixed deformities or congenital flat feet, corrective bone procedures are also performed, usually combined with soft tissue procedures.

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Association Between Subtalar Articular Surface Typing and Flat Foot Deformity: Which Type is More Likely to Cause Flat Foot Deformity

10.21203/rs.3.rs-762843/v1 ◽

2021 ◽

Author(s):

Lei Zhang ◽

Xiaoyao Peng ◽

Siyuan He ◽

Xin Zhou ◽

Gang Yi ◽

...

Keyword(s):

Articular Surface ◽

Type I ◽

Type Ii ◽

Foot Deformity ◽

Imaging Data ◽

Level Of Evidence ◽

Flat Foot ◽

Wide Range ◽

Retrospective Comparative Study ◽

Böhler’S Angle

Abstract Background Previous studies have shown a wide range of anatomical classifications of the subtalar joint (STJ) in the population and this is related to the different force line structures of the foot. Different subtalar articular surface morphology may affect the occurrence and development of flat foot deformity, and there are fewer studies in this area. The main objective of our study was to determine the association of different subtalar articular surface with the occurrence and severity of flat foot deformity. Methods We analyzed the imaging data of 289 cases of STJ. The articular surface area, Gissane's angle and Bohler's angle of subtalar articular surface of different types were counted. The occurrence and severity of flat foot deformity in different subtalar articular surface were judged by measuring the Meary angle of foot. Results We classified 289 cases of subtalar articular surface into five types according to the morphology. According to Meary angle, the flat foot deformity of Type Ⅰ and Type Ⅳ are significantly severer than Type Ⅱ (P < 0.05). Type II (7.65 ± 1.38 cm2) was significantly smaller than Type I (8.40 ± 1.79 cm2) in the total joint facet area(P < 0.05). Type III (9.15 ± 1.92 cm2) was smaller than Type I (8.40 ± 1.79 cm2), II(7.65 ± 1.38 cm2) and Ⅳ(7.81 ± 1.74 cm2 ) (P < 0.05).Type II (28.81 ± 7.44∘) was significantly smaller than Type I (30.80 ± 4.61 degrees), and IV (32.25 ± 5.02 degrees) in the Bohler’s angle (P < 0.05). Type II (128.49 ± 6.74 degrees) was smaller than Type I (131.58 ± 7.32 degrees), and IV (131.94 ± 5.80 degrees) in the Gissane’s angle (P < 0.05). Conclusions After being compared and analyzed the measurement of morphological parameters, joint facet area and fusion of subtalar articular surface were closely related to the severity of flat foot deformity and Type I and IV were more likely to develop severer flat foot deformity. Level of evidence: Level III, retrospective comparative study.

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Anterior talofibular ligament lesion is associated with increased flat foot deformity but does not affect correction by lateral calcaneal lengthening

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2827-2 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Stephan H. Wirth ◽

Arnd F. Viehöfer ◽

Sarvpreet Singh ◽

Stefan M. Zimmermann ◽

Tobias Götschi ◽

...

Keyword(s):

Lateral Ligament ◽

Anterior Talofibular Ligament ◽

Foot Deformity ◽

Mri Findings ◽

Flat Foot ◽

Postoperative Result ◽

Operative Correction ◽

Significant Difference ◽

Adult Acquired Flatfoot Deformity ◽

Calcaneal Lengthening

Abstract Background Several risk factors for adult acquired flatfoot deformity (AAFD) have been identified in literature. To this date, little attention has been paid to the lateral ligament complex and its influence on AAFD, although its anatomic course and anatomic studies suggest a restriction to flatfoot deformity. The aim of this study was to assess the influence of the anterior talofibular ligament (ATFL) on AAFD and on radiologic outcome following common operative correction by lateral calcaneal lengthening. Methods We reviewed all patients that underwent lateral calcaneal lengthening for correction of AAFD between January 2008 and July 2018 at our clinic. Patients were grouped according to the preoperative MRI findings into those with an intact ATFL and those with an injured ATFL. Two independent readers assessed common radiographic flatfoot parameters on preoperative and postoperative radiographs. Results Sixty-four flatfoot corrections in 63 patients were included, whereby the ATFL was intact in 29 cases, and in 35 cases the ligament was injured. An ATFL lesion was overall radiologically associated with increased flatfoot deformity with a statistically significant difference between the two groups for preoperative talometatarsal-angle (p = 0.002), talocalcaneal-angle (p = 0.000) and talonavicular uncoverage-angle (p = 0.005). No difference between the two groups could be observed regarding the success of operative correction or operative consistency after lateral calcaneal lengthening. Conclusion The ATFL seems to influence the extent of AAFD. In patients undergoing lateral calcaneal lengthening, the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.

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