The Assessment of First Metatarsal Rotation in the Normal Adult Population Using Weightbearing Computed Tomography

Background: The importance of the rotational profile of the first metatarsal is increasingly recognized in the surgical planning of hallux valgus. However, rotation in the normal population has only been measured in small series. We aimed to identify the normal range of first metatarsal rotation in a large series using weightbearing computed tomography (WBCT). Methods: WBCT scans were retrospectively analyzed for 182 normal feet (91 patients). Hallux valgus angle, intermetatarsal angle, anteroposterior/lateral talus–first metatarsal angle, calcaneal pitch, and hindfoot alignment angle were measured using digitally reconstructed radiographs. Patients with abnormal values for any of these measures and those with concomitant pathology, previous surgery, or hallux rigidus were excluded. Final assessment was performed on 126 feet. Metatarsal pronation (MPA) and α angles were measured on standardized coronal computed tomography slices. Pronation was recorded as positive. Intraobserver and interobserver reliability were assessed using intraclass correlation coefficients (ICCs). Results: Mean MPA was 5.5 ± 5.1 (range, –6 to 25) degrees, and mean α angle was 6.9 ± 5.5 (range, –5 to 22) degrees. When considering the normal range as within 2 standard deviations of the mean, the normal range identified was −5 to 16 degrees for MPA and −4 to 18 degrees for α angle. Interobserver and intraobserver reliability were excellent for both MPA (ICC = 0.80 and 0.97, respectively) and α angle (ICC = 0.83 and 0.95, respectively). There was a moderate positive correlation between MPA and α angle (Pearson coefficient 0.68, P < .001). Conclusion: Metatarsal rotation is variable in normal feet. Normal MPA can be defined as less than 16 degrees, and normal α angle can be defined as less than 18 degrees. Both MPA and α angle are reproducible methods for assessing rotation. Further work is needed to evaluate these angles in patients with deformity and to determine their significance when planning surgical correction of hallux valgus. Level of Evidence: Level III, retrospective comparative study.

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Radiographic Assessment of Foot Alignment in Juvenile Hallux Valgus and Its Relationship to Flatfoot

Foot & Ankle International ◽

10.1177/1071100719850148 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1079-1086

Author(s):

Hyun Woo Kim ◽

Kun Bo Park ◽

Yoon Hae Kwak ◽

Seokhwan Jin ◽

Hoon Park

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Hallux Valgus Angle ◽

Hindfoot Alignment ◽

First Metatarsal ◽

Metatarsal Angle ◽

Valgus Angle ◽

Significant Difference ◽

Metatarsus Adductus ◽

Foot Alignment

Background: The relationship between juvenile hallux valgus (JHV) and flatfoot has not been clearly established. The aim of this study was to assess radiographic measurements in feet with JHV compared with matched controls and to investigate whether the foot alignment of JHV is related to flatfoot. Methods: We retrospectively reviewed 163 patients with JHV as defined as hallux valgus angle greater than 20 degrees and intermetatarsal greater than angle than 10 degrees. Patients with open physes of the feet and who had weight-bearing radiographs of the feet were included. Another 55 normal participants served as controls. Patients with JHV were divided into 2 subgroups: Group 1 included patients with asymptomatic JHV and group 2 consisted of those treated with correctional surgery for painful JHV. Twelve radiographic indices were analyzed, including calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, lateral talo–first metatarsal angle, anteroposterior talo–first metatarsal angle, metatarsus adductus angle, hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and first metatarsal cuneiform angle. The groups were compared by age, gender, and the above radiographic parameters. Results: There was no significant difference in hindfoot alignment of patients with JHV and controls. Naviculocuboid overlap ( P <.001), lateral talo–first metatarsal angle ( P = .002), and metatarsus adductus angle ( P = .004) were significantly greater in patients with JHV than in controls, whereas the anteroposterior talo–first metatarsal angle ( P = .026) was significantly less. Symptomatic and asymptomatic JHV patient subsets showed no significant radiologic differences. Conclusion: Radiographic profiles in patients with JHV were inconsistent with regard to features of flatfoot, and foot alignment was unrelated to the presence of symptoms or degree of deformity in JHV. Level of Evidence: Level III, retrospective comparative series.

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Assessing the Rotation of the First Metatarsal on Computed Tomography Scans: A Systematic Literature Review

Foot & Ankle International ◽

10.1177/10711007211020676 ◽

2021 ◽

pp. 107110072110206

Author(s):

Ali-Asgar Najefi ◽

Karan Malhotra ◽

Shelain Patel ◽

Nicholas Cullen ◽

Matthew Welck

Keyword(s):

Computed Tomography ◽

Literature Review ◽

Hallux Valgus ◽

Systematic Literature Review ◽

3D Modeling ◽

Multiple Methods ◽

Recurrence Rates ◽

Level Of Evidence ◽

First Metatarsal ◽

Α Angle

Background: Hallux valgus is a multiplanar deformity that is often treated on the basis of 2-dimensional (2D) parameters and radiographs. Recurrence rates after surgical correction remain high, and failure to correct pronation of the metatarsal is increasingly stipulated as being part of the problem. Multiple methods of assessing metatarsal pronation have been proposed. Methods: We performed a systematic literature review identifying studies that measured metatarsal pronation and torsion on computed tomography (CT) scans. Specific methodology, patient groups, results, and reliability assessments were all reported. Results: We identified 14 studies that fulfilled the inclusion criteria. Eleven studies measured 2D values on CT scan, and 3 studies used computer-based 3-dimensional (3D) modeling and artificial intelligence systems to help calculate pronation. Metatarsal pronation angle, α angle, sesamoid rotation angle, and measurements for torsion were the most commonly used methods. All angles and measurements were performed as 2D measurements, but the metatarsal pronation angle was also performed with 3D modeling. Reliability and reproducibility of the α angle and metatarsal pronation angle were excellent, despite being performed on studies with small numbers. Conclusion: Multiple methods have been reported to demonstrate first metatarsal pronation on CT, of which the α angle and the metatarsal pronation angle are the most pragmatic and useful in a clinical setting. Further work is needed to further validate the reliability of these measurements in larger series and to identify normal pronation and metatarsal torsion on weightbearing imaging. Further work is required to determine whether addressing pronation reduces recurrence rates and improves outcomes in surgery for hallux valgus. Level of Evidence: Level III

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First Metatarsal Pronation Stratified by Tibial Sesamoid Position on Coronal Plane: A Study Based on Weight-Bearing Computed Tomography

10.21203/rs.3.rs-770160/v1 ◽

2021 ◽

Author(s):

Zhi Wang ◽

HE huijing ◽

ZHANG Shu ◽

SUN Chao ◽

WANG Xianjun ◽

...

Keyword(s):

Computed Tomography ◽

Hallux Valgus ◽

Linear Regression Analysis ◽

Coronal Plane ◽

Control Group ◽

Study Group ◽

First Metatarsal ◽

The Mean ◽

Coronal Rotation ◽

Α Angle

Abstract Backgrounds: Few studies analyzed the coronal rotation of first metatarsal in hallux valgus patients with weightbearing computed tomography (WBCT). The purpose of this study is to investigate the association between hallux valgus parameters and first metatarsal head rotation in the coronal plane.Methods: Retrospective review of full standing WBCT scans were taken by PedCAT. A group of 123 patients with 216 feet, that intermetatarsal angle (IMA) >9 degrees and hallux valgus angle (HVA) >15 degrees, were included. 27 feet of 17 female included in control group. Measurements of forefoot hallux valgus parameters included IMA, HVA, distal metatarsal abduction angle (DMAA), metatarsal adduction angle (MAA), first metatarsal coronal rotation angle (α-angle), tibial sesamoid position (TSP) on dorsoplantar view, and sesamoid grading in the coronal plane. The differences of HVA, IMA, MAA, DMAA and α-angle in control and study group were compared by Wilcoxon rank test and student t test. Spearman correlation test was performed between α-angle and other parameters. General linear regression analysis was used to predict relationship parameters and α-angle.Results: The mean α-angle in the control group was 11.33±6.16 (range ,0-20) degrees, with the 95% confidence interval (CI) for the mean from 8.90 degrees to 13.77 degrees. The mean of α-angle in the study group was 23.75±6.32 (range,9-39) degrees, with the 95% CI from 22.90 degrees to 24.59 degrees. In the hallux valgus group, there were positive correlations between α-angle and IMA (Spearman’s correlation coefficient (rs) 0.137, P=0.044), DMAA (rs=0.176, P=.010) and TSP (rs=0.218, P=0.001). General linear regression analysis showed that α-angle was correlated with TSP (P<0.001). 208 hallux valgus feet (96.3%) had more pronation than the control group, whereas 8 feet (3.7%) had no or less pronation. Comparing the control and study subjects with the same TSP, means of α-angle showed significant difference, P=0.005.Conclusion: A large portion of hallux valgus patients had the first metatarsal pronation, which was positive correlated to TSP, IMA, and DMAA, and did not correlated to HVA and Smith grading. TSP is a useful predicting factor to α-angle changing. Level of Evidence: Level Ⅲ，Retrospective Cohort study

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Instability of the First Ray and Hallux Valgus in Patients with Adult Acquired Flatfoot Deformity (AAFD)

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00102 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0010 ◽

Cited By ~ 3

Author(s):

Andrew Roney ◽

Cesar de Cesar Netto ◽

Carolyn Sofka ◽

Daniel Sturnick ◽

Lauren Roberts ◽

...

Keyword(s):

Hallux Valgus ◽

Interobserver Reliability ◽

Foot And Ankle ◽

Moment Arm ◽

Hindfoot Alignment ◽

First Metatarsal ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

First Ray ◽

Adult Acquired Flatfoot Deformity

Category: Bunion Introduction/Purpose: Longitudinal arch collapse and first ray instability represent landmarks for adult acquired flatfoot deformity (AAFD), and have been linked to the development and progression of hallux valgus (HV). Radiographic evaluation of first ray instability is usually marked by increased angulation between the first and second metatarsals. The 1-2 intermetatarsal angle (IMA) is also an important aspect in the staging of HV deformity. Weightbearing CT imaging (WBCT) provides three-dimensional evaluation of dynamic deformities such as AAFD and HV. The purpose of this study was to assess the correlation between hallux valgus severity and foot collapse indicators using WBCT measurements, in patients with AAFD. We hypothesized that a flattening of the longitudinal arch, increased hindfoot valgus and forefoot abduction would correlate with greater IMA and HV angles. Methods: In this retrospective comparative study, 108 patients with stage II AAFD, 36 men and 72 women, with a mean age of 54.4 (range, 20-78) years, had their WBCTs evaluated by 2 blinded and independent board-certified foot and ankle orthopedic surgeons. The readers assessed multiple variables related to the severity of the hallux valgus and flatfoot deformities including: 1-2 intermetarsal angle, hallux valgus angle, talocalcaneal angle in the axial plane, talus-first metatarsal angle in the axial and sagittal planes, hindfoot alignment angle, hindfoot moment arm, navicular- and medial cuneiform-floor distance and the talonavicular uncoverage angle. Intra- and interobserver reliability were calculated by Pearson or Spearman’s correlation and intraclass correlation coefficient, respectively. A multiple regression analysis was used to evaluate the correlation between the variables indicative of AAFD and the severity of HV. P-values less than 0.05 were considered significant. Results: The intra- and interobserver reliability ranged from (0.65-0.99). Means and standard deviations for IM and HV angles were 11.3°±3.7° and 17.6°±13.4°, respectively. These angles significantly correlated with each other (p<0.0001). Most of the AAFD measurements evaluated were significantly associated with either increased IM or HV angles. IM angle correlated with increased talocalcaneal (26.0°±10.3°, p<0.0001), talus-first metatarsal (19.0°±13.6°, p=0.0001), and hindfoot alignment angles (22.3°±12.9°, p= 0.0049). HV angle correlated with medial cuneiform-floor distance (15.1mm±5.5 mm, p=0.0183), talus-first metatarsal angle in the axial plane (p=0.0004) and sagittal plane (15.7°±8.8°, p=0.0351), talonavicular uncoverage angle (17.8°±13.9°, p=0.0035). Hindfoot moment arm and navicular-floor distance were the only AAFD measurements that did not correlate with IM or HV angles. Conclusion: To the best of our knowledge this is the first study to confirm the association between AAFD, first ray instability and hallux valgus deformity using WBCT images. Our study results demonstrated that stage II flatfoot patients indeed have increased intermetatarsal and hallux valgus angles. Measurements traditionally used for staging the severity of AAFD showed significant positive correlation with increased IM or HV angles. Even though cause and effect cannot be determined with certainty, foot and ankle surgeons should consider these findings during evaluation and surgical planning of patients with AAFD.

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Correlation of Different Methods of Measuring Pronation of the First Metatarsal on Weightbearing CT Scans

Foot & Ankle International ◽

10.1177/10711007211003090 ◽

2021 ◽

pp. 107110072110030

Author(s):

Matthew S. Conti ◽

Tamanna J. Patel ◽

Kristin C. Caolo ◽

Joseph M. Amadio ◽

Mark C. Miller ◽

...

Keyword(s):

Hallux Valgus ◽

Computer Aided Design ◽

Foot And Ankle ◽

Level Of Evidence ◽

3 Dimensional ◽

3D Cad ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Second Metatarsal ◽

Α Angle

Background: There is no consensus in the foot and ankle literature regarding how to measure pronation of the first metatarsal in patients with hallux valgus. The primary purpose of this study was to compare 2 previously published methods for measuring pronation of the first metatarsal and a novel 3-dimensional measurement of pronation to determine if different measurements of pronation are associated with each other. Methods: Thirty patients who underwent a modified Lapidus procedure for their hallux valgus deformity were included in this study. Pronation of the first metatarsal was measured on weightbearing computed tomography (WBCT) scans using the α angle with reference to the floor, a 3-dimensional computer-aided design (3D CAD) calculation with reference to the second metatarsal, and a novel method, called the triplanar angle of pronation (TAP), that included references to both the floor (floor TAP) and base of the second metatarsal (second TAP). Pearson’s correlation coefficients were used to determine if the 3 calculated angles of pronation correlated to each other. Results: Preoperative and postoperative α angle and 3D CAD had no correlation with each other ( r = 0.094, P = .626 and r = 0.076, P = .694, respectively). Preoperative and postoperative second TAP and 3D CAD also had no correlation ( r = 0.095, P = .624 and r = 0.320, P = .09, respectively). However, preoperative and postoperative floor TAP and α angle were found to have moderate correlations ( r = 0.595, P = .001 and r = 0.501, P = .005, respectively). Conclusion: The calculation of first metatarsal pronation is affected by the reference and technique used, and further work is needed to establish a consistent measurement for the foot and ankle community. Level of Evidence: Level III, retrospective cohort study.

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First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/24730114211008514 ◽

2021 ◽

Vol 6 (2) ◽

pp. 247301142110085

Author(s):

Christopher Traynor ◽

James Jastifer

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Retrospective Case ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

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Effect of Proximal Dome and Distal Chevron Osteotomies on Plantar Pressures and Radiographic and Functional Outcomes in Hallux Valgus Surgery: A Retrospective Analysis

Journal of the American Podiatric Medical Association ◽

10.7547/20-016 ◽

2021 ◽

Vol 111 (3) ◽

Author(s):

Kadir Ilker Yildiz ◽

Abdulhamit Misir ◽

Turan Bilge Kizkapan ◽

Mustafa Cukurlu ◽

Canan Gonen Aydin

Keyword(s):

Hallux Valgus ◽

Inclination Angle ◽

Plantar Pressure ◽

Functional Outcomes ◽

First Metatarsal ◽

Pressure Point ◽

Radiographic Outcomes ◽

Metatarsal Angle ◽

Dome Osteotomy ◽

Pressure Changes

Background No detailed comparative studies have been performed regarding plantar pressure changes between proximal dome and distal chevron osteotomies. This study aimed to compare radiographic and plantar pressure changes after distal chevron and proximal dome osteotomies and to investigate the effect of radiographic and plantar pressure changes on clinical outcomes. Methods This study included 26 and 22 patients who underwent distal chevron and proximal dome osteotomies, respectively. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scores were used to evaluate pain and functional outcomes. Hallux valgus angle, intermetatarsal angle, talar–first metatarsal angle, and calcaneal inclination angle were measured in the evaluation of radiographic outcomes. Preoperative and postoperative plantar pressure changes were evaluated. Results There were no statistically significant differences between the two groups in age, body mass index, or AOFAS forefoot and VAS scores. In the proximal dome group, the pressure measurement showed significant lateralization of the maximal anterior pressure point in the forefoot (P < .001). In addition, the postoperative calcaneal inclination angle was significantly lower (P = .004) and the talar–first metatarsal angle was significantly higher (P < .001) in the proximal dome group. Postoperative transfer metatarsalgia was observed in one patient (3.8%) in the distal chevron group and five (22.7%) in the proximal dome group (P < .05). Conclusions Proximal dome osteotomy led to more lateralization of the maximum anterior pressure point, decreased calcaneal inclination angle and first metatarsal elevation, and related higher transfer metatarsalgia.

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Reliability and Relevance of Radiographic Measures of Metatarsus Primus Elevatus and Arch Alignment in Individuals with Midfoot Arthritis and Controls

Journal of the American Podiatric Medical Association ◽

10.7547/1030347 ◽

2013 ◽

Vol 103 (5) ◽

pp. 347-354 ◽

Cited By ~ 5

Author(s):

Smita Rao ◽

Katie Bell

Keyword(s):

Inclination Angle ◽

Intraclass Correlation ◽

Positive Association ◽

Group Differences ◽

Control Group ◽

Arch Height ◽

First Metatarsal ◽

Compressive Stresses ◽

Metatarsal Angle ◽

The Relationship

Background: Low arch alignment and metatarsus primus elevatus (MPE) have been postulated to increase dorsal compressive stresses in the joints of the medial column of the foot and to contribute to the development of degenerative changes. The primary purposes of this study were 1) to examine the relationship between radiographic measures of arch alignment and MPE and 2) to assess arch alignment and MPE in individuals with midfoot arthritis and in asymptomatic controls. The secondary aim was to examine the reliability of radiographic measures of arch alignment and MPE. Methods: Radiographic measures of arch height and MPE were quantified on 28 individuals with midfoot arthritis and 22 individuals in a control group. Reliability was assessed using the intraclass correlation coefficient (ICC). The Pearson product moment correlation (r) was used to assess the relationship between arch alignment and MPE. Between-group differences were assessed using a two-sample t test (α = 0.05). Results: Good to excellent reliability was noted for measures of arch height (ICC[2,3] = 0.919–0.994) as well as MPE (ICC[2,3] = 0.891–0.882). A modest positive association was noted between normalized cortical elevation and normalized navicular height (r = 0.274, P = .030) and calcaneal inclination angle (r = 0.263, P = .035). Individuals with midfoot arthritis demonstrated lower arch alignment, reflected in a significantly higher calcaneal–first metatarsal angle (P = .002), lower calcaneal inclination angle (P = .004), and lower normalized navicular height (P < .001) compared with controls. No evidence was found to support between-group differences in lateral intermetatarsal angle (P = .495) and normalized cortical elevation (P = .146). Conclusions: These findings provide objective data establishing the reliability of measures of MPE and arch alignment and their potential clinical significance. (J Am Podiatr Med Assoc 103(5): 347–354, 2013)

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3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

Foot & Ankle International ◽

10.1177/1071100719835492 ◽

2019 ◽

Vol 40 (6) ◽

pp. 720-726 ◽

Cited By ~ 24

Author(s):

Jian Zhong Zhang ◽

François Lintz ◽

Alessio Bernasconi ◽

Shu Zhang ◽

Keyword(s):

Computed Tomography ◽

Comparative Study ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Level Of Evidence ◽

Hindfoot Alignment ◽

Mean Values ◽

Intraclass Correlation Coefficients ◽

Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

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Structural Effect of Long-Term Use of Medial Arch Support Insole on Children with Pediatric Flexible Flatfoot

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00143 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0014

Author(s):

Jun Young Choi ◽

Min Jin Kim ◽

Jin Soo Suh

Keyword(s):

Structural Effect ◽

Hindfoot Alignment ◽

First Metatarsal ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Flexible Flatfoot ◽

Arch Support ◽

Group 2 ◽

Physeal Closure ◽

Group 1

Category: Midfoot/Forefoot Introduction/Purpose: This prospective study aimed to rule out the effect of the normal physiologic maturation in applying medial arch support insole for patients with pediatric flexible flatfoot (PFFF). Methods: From January 2005 to June 2015, 18 patients (34 feet) in group 1 (insole was continuously applied) and 16 patients (32 feet) in group 2 (untreated group) were enrolled. A medial arch support insole was applied from age 10-11 years until radiographic physeal closure. Results: In group 1, the talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, and medial cuneiform height were significantly changed at final follow-up, although all values were still within the abnormal range. Moreover, no significant differences were found in any of the increments of the radiographic parameters between groups 1 and 2. Conclusion: Radiographic improvements were found in both medial arch support insole-treated and untreated groups even if all radiographic values were still within the abnormal range. This means that PFFF could be somehow improved with heel stretching exercise until the physes were closed. Further, hindfoot alignment remained unchanged regardless of the medial arch support insole application.

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