scholarly journals Osteotomies combined with soft tissue procedures for symptomatic flexible flatfoot deformity in children

2020 ◽  
Author(s):  
Xiaodong WEN ◽  
Guanghua Nie ◽  
Hongmou Zhao ◽  
Jun Lu ◽  
Xiaojun Liang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Pitch Angle ◽  
Functional Outcomes ◽  
Lateral View ◽  
Foot And Ankle ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Flexible Flatfoot ◽  
Surgery Timing ◽  
American Orthopaedic

Abstract Background: The indications for surgery, timing, and procedure in children with flexible flatfoot deformity remain controversial. For marked deformities, combined procedures are preferred to correct multiple plane deformities. Thus, this study aimed to evaluate the outcomes of osteotomies combined with soft tissue procedures in children with flexible flatfoot aged 9-14 years.Methods: From July 2014 to October 2017, 28 children (47 feet) with flexible flatfoot with an average age of 11.7±2.1 (range 9-14) years underwent osteotomy combined with soft tissue surgery. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Foot and Ankle Outcome Score (FAOS) were used to evaluate the preoperative and postoperative clinical outcomes. The talo-navicular coverage angle (TNCA) and talar–first metatarsal angle (T1MA) on the foot anteroposterior view, calcaneal pitch angle and Meary’s angle on the foot lateral view, and calcaneus valgus angle (CVA) on the Saltzman view were also observed.Results: All patients were followed up for an average duration of 29.7±8.6 months. Mean AOFAS and FAOS significantly improved from 56.6±8.0 and 47.4±9.5 preoperatively to 88.4±3.9 and 83.2±6.8 at final follow-up (P<0.001). respectively. There were statistically significant differences between preoperative and postoperative scores in all FAOS subscales (P<0.001). Radiographic parameters, such as TNCA (P<0.001) and T1MT (P<0.001) on foot AP views, calcaneal pitch angle (P=0.014) and Meary,s angle (P<0.001) on foot lateral views, and CVA (P<0.001) on Saltzman views, were significantly improved. All patients and their parents were satisfied with the functional outcomes.Conclusion: Osteotomies combined with soft tissue procedures are an effective strategy for flexible flatfoot deformity in children, as it results in favorable radiographic and functional outcomes.

scholarly journals Analysis of Short-Term Outcome of Osteotomy Combining with Soft Tissue Surgery in the Treatment of Symptomatic Children with Flexible Flatfoot

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0050
Author(s):  
Li Yi ◽  
Liang Xiaojun ◽  
Zhao Hong-Mou
Keyword(s):  
Patient Satisfaction ◽  
Soft Tissue ◽  
Pitch Angle ◽  
Weight Bearing ◽  
Short Term ◽  
Metatarsal Angle ◽  
Flexible Flatfoot ◽  
Anteroposterior View ◽  
Soft Tissue Surgery

Category: Hindfoot; Other Introduction/Purpose: To evaluate the short-term curative effect of clinical results and imaging of osteotomy and soft tissue surgery for the treatment of children with flexible flatfoot. Methods: From July 2014 to October 2016, 28 patients (47 feet) with flexible flatfoot were treated with osteotomy combining with soft tissue surgery, included 16 males (26 feet) and 12 females (21 feet) with the average age of (11.7+-2.1) years old ranging from 9 to 14 years old. The VAS score, American Orthopaedic Foot & Ankle Society ankle-hindfoot score, Maryland score were evaluated before and after the operation to study the clinical effect. Patient satisfaction was also investigated at the end of the follow-up. The talo-navicular coverage angle (TNCA), the talo-1st metatarsal angle (T1MA), the talo-2nd metatarsal angle (T2MA) in the weight-bearing anteroposterior view and the calcaneal inclination angle (Pitch angle), the talo-1st metatarsal angle (Meary’s angle), the talo-calcaneal angle (Kite angle) and final follow-up time to study the imaging data. Results: Superficial tissue infection occurred in 2 cases (3 feet) after surgery, wound healing was achieved through debridement and short-term oral antibiotics. The average VAS score of the final follow-up was significantly lower than that before surgery (P < 0.01). The average AOFAS score and the average Maryland score were significantly higher than pre-operation (P < 0.01). Patient satisfaction at the last follow-up: very satisfaction 20 (71.43%), satisfaction 7 (25%), general 1 (3.57%). The the talo-navicular coverage angle (TCA) ,the talo-1st metatarsal angle (T1MA), the talo-2nd metatarsal angle (T2MA) in the weight-bearing anteroposterior view of the final follow-up were significantly improved compared with preoperation (P＜0.01), the Pitch Angle, Meary’s Angle and Kite Angle in the weight-bearing lateral view ere significantly improved compared with preoperation (P＜0.05). Conclusion: Osteotomy combined with soft tissue surgery has good short-term effect on children’s flexible flatfoot, and the effect of correction of malformation is obvious, but the medium-term and long-term effects need to be further studied.

scholarly journals Preliminary Results of Subtalar Arthroereisis with Vulpius Procedure for Symptomatic Flatfoot in Patients with Type I Osteogenesis Imperfecta

2020 ◽  
Vol 18 (1) ◽  
pp. 67
Author(s):  
Cheng-Min Hsu ◽  
Sheng-Chieh Lin ◽  
Kuan-Wen Wu ◽  
Ting-Ming Wang ◽  
Jia-Feng Chang ◽  
...  
Keyword(s):  
Osteogenesis Imperfecta ◽  
Weight Bearing ◽  
Life Quality ◽  
Type I ◽  
Foot And Ankle ◽  
Flexible Flatfoot ◽  
Subtalar Arthroereisis ◽  
Viable Approach ◽  
American Orthopaedic

In this retrospective study, we aim to assess the safety and feasibility of adapting subtalar arthroereisis (SA) for type I osteogenesis imperfecta (OI) patients with symptomatic flatfoot. From December 2013 to January 2018, six type I OI patients (five girls and one boy, 12 feet) with symptomatic flexible flatfoot were treated with SA and the Vulpius procedure. All the patients were ambulatory and skeletally immature with failed conservative treatment and unsatisfactory life quality. The median age at the time of surgery was 10 years (range 5–11), and the median follow-up period was 55 months (range 33–83). All functional and radiographic parameters improved (p < 0.05) after the procedure at the latest follow-up. The median American Orthopaedic Foot and Ankle Society ankle-hindfoot scale improved from 68 (range 38–80) to 95 (range 71–97). All of the patients ambulated well without significant complications. The weight-bearing radiographs showed maintained correction of the tarsal bone alignment with intact bony surfaces adjacent to implants during the post-operative follow-up period. This is the very first study on symptomatic flatfoot in pediatric patients with type I OI. Our data suggest that SA is a potentially viable approach, as functional improvements and maintained radiographic correction without significant complication were observed.

Foot and ankle functions and deformities focus on posterior tibial tendon dysfunction using magnetic resonance imaging in patients with rheumatoid arthritis

2021 ◽  
Author(s):  
Takeshi Mochizuki ◽  
Yuki Nasu ◽  
Koichiro Yano ◽  
Katsunori Ikari ◽  
Ryo Hiroshima ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pitch Angle ◽  
Posterior Tibial Tendon ◽  
Foot And Ankle ◽  
Resonance Imaging ◽  
Posterior Tibial Tendon Dysfunction ◽  
First Metatarsal ◽  
Posterior Tibial ◽  
Metatarsal Angle

ABSTRACT Objectives Posterior tibial tendon dysfunction (PTTD) affects the support of the medial longitudinal arch and stability of the hindfoot. The purpose of this study was to assess the relationships of PTTD with foot and ankle functions and foot deformities in patients with rheumatoid arthritis (RA). Methods A total of 129 patients (258 feet) who underwent magnetic plain and contrast-enhanced magnetic resonance imaging were enrolled in this study. Positive magnetic resonance imaging findings were defined as tenosynovitis and incomplete and complete rupture of the posterior tibial tendon. Foot and ankle functions were assessed using the Japanese Society for Surgery of the Foot standard rating system for the RA foot and ankle scale (JSSF-RA) and self-administered foot evaluation questionnaire. Plain radiographs were examined for the hallux valgus angle, first metatarsal and second metatarsal angle, lateral talo-first metatarsal angle, and calcaneal pitch angle. Results PTTD was associated with motion in the JSSF-RA (p = .024), activities of daily living in JSSF-RA (p = .017), and pain and pain-related factors in the self-administered foot evaluation questionnaire (p = .001). The calcaneal pitch angle was significantly lower in the feet with PTTD than in those without PTTD (median: 16.2° vs. 18.0°; p = .007). Conclusions The present study shows that PTTD was associated with foot and ankle functions and flatfoot deformity. Thus, a better understanding of PTTD in patients with RA is important for the management of foot and ankle disorders in clinical practice.

scholarly journals Evaluation of functional outcome following ORIF of bimalleolar fractures of the ankle-A prospective study of 30 patients

2020 ◽  
Vol 11 (4) ◽  
pp. 6051-6055
Author(s):  
Yeshwanth subash ◽  
Vishnu S ◽  
Damodharan
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Surgical Intervention ◽  
Early Mobilization ◽  
Foot And Ankle ◽  
The Mean ◽  
American Orthopaedic ◽  
A Prospective Study ◽  
Mean Time

Bimalleolar fractures are common injuries, and stable fracture patterns can be treated conservatively, while complicated, unstable fractures would require surgical intervention. This study aimed to evaluate the functional outcome following ORIF (Open reduction and internal fixation) of these fractures. This was a study of 30 patients with bimalleolar fractures who presented between January 2013 to January 2016 treated with ORIF with a follow-up period of 3 years. Functional outcome was performed with the AOFAS (American Orthopaedic Foot and ankle society) score. The mean age of the patients was 41.6 years. There was a female preponderance seen in our study with the left side being more commonly affected. The mean time to fracture union was 12.13 weeks, and we had excellent outcomes in 18 patients, good in 10, while two patients had a fair result. We did not lose any of our patients to follow up. All of our patients were happy with the functional outcome achieved. No significant complications were seen in our study. ORIF in bimalleolar fractures enables restoration of the ankle mortise to an anatomical position and facilitates early mobilization of the ankle resulting in good functional outcomes.

scholarly journals Classical Mitchell's osteotomy in the management of symptomatic hallux vulgus

2016 ◽  
Vol 2 (4) ◽  
pp. 366
Author(s):  
Naveed B. Wani ◽  
Abdul R. Badoo
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Major Complication ◽  
Osteotomy Site ◽  
Metatarsal Osteotomy ◽  
Foot And Ankle ◽  
Non Union ◽  
First Metatarsal ◽  
Distal Metatarsal Osteotomy ◽  
American Orthopaedic

<p class="abstract"><strong>Background:</strong> Hallux vulgus is common deformity of fore foot frequently resulting in pain at first metatarso phalyngeal joint and cosmetic problems. Hallux vulgus is particularly more common in shoe wearing populations. Ours being a sub Himalayan region with harsh and prolonged winters where shoe wearing is a must this condition is very common. Various surgical procedures have been described for its management. These range from soft tissue procedures to arthodesis of first metatarso phalyngeal joint. Distal first metatarsal osteotomy (Mitchell’s osteotomy) is a time tested procedure in its management<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Forty adult patients (56 feet) with symptomatic hallux vulgus, who did not respond to conservative treatment, were managed with Mitchell’s osteotomy.<strong></strong></p><p class="abstract"><strong>Results:</strong> Results were assessed as per American Orthopaedic Foot and Ankle Society grading. More than ninety percent of our patients were fully satisfied with their pain relief and foot cosmetics while others were satisfied with some reservations. There was no major complication or non-union at osteotomy site<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Management of hallux vulgus is conservative to begin with, measures like life style modifications, broad toed shoes, toe spacers and physical therapy are tried first. Surgical intervention is indicated if conservative measures fail to relieve symptoms. More than 130 surgical procedures have been described for hallux vulgus ranging from soft tissue procedures like MacBride’s to arthodesis of first metatarso phalyngeal joint. Distal metatarsal osteotomy was first described by Hawkins in 1945 but was named after Mitchell who published his work in 1958. From our study we conclude that this is a time tested procedure for symptomatic cases of Hallux Vulgus not responding to conservative measures<span lang="EN-IN">.</span></p>

Radiographic Prognostic Factors for Selective Soft Tissue Release After Ponseti Failure in Young Pediatric Clubfoot Patients

2018 ◽  
Vol 39 (6) ◽  
pp. 712-719
Author(s):  
Michael Seungcheol Kang ◽  
Il-Yeong Hwang ◽  
Soo-Sung Park
Keyword(s):  
Prognostic Factors ◽  
Soft Tissue ◽  
Lateral View ◽  
Soft Tissue Release ◽  
Tibialis Posterior ◽  
Idiopathic Clubfoot ◽  
Abductor Hallucis ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Metatarsal Angle

Background: Selective soft tissue release (SSTR), which includes a combination of abductor hallucis, tibialis posterior, and Achilles lengthening, has been used in patients with recurrent clubfoot deformity after Ponseti treatment. The aim of this study was to investigate the prognostic factors for recurrence of clubfoot deformity after SSTR. Methods: Consecutive patients with idiopathic clubfoot and residual or recurrent deformity after Ponseti treatment underwent SSTR between 2005 and 2013. The clinical and radiologic characteristics before and after SSTR were analyzed. The ability of radiologic factors to predict recurrence of clubfoot deformity was assessed using multivariate analysis. Rigid deformities of forefoot adduction, and hindfoot varus, and equinus were examined separately. Forty-three patients with 64 clubfeet were included. Results: Postoperative improvement in the talo–first metatarsal angle on the anteroposterior view, the talocalcaneal angle on the lateral view, and the tibiocalcaneal angle on the lateral view independently predicted recurrence after SSTR. Additionally, the preoperative talocalcaneal angles on the anteroposterior and lateral views were also significant predictors, but these angles did not significantly improve after SSTR. Conclusions: SSTR seems to be an effective surgical modality only in milder deformities. Among patients with poor talocalcaneal angles, a high percentage required further surgery. The present results may be useful for the choice of SSTR or more extensive surgery. Level of Evidence: Level III, retrospective case-control study.

scholarly journals Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Sofia Carlucci ◽  
Nelly Carrasco ◽  
Maria Santini-Araujo ◽  
Ana Parise ◽  
Leonardo Conti ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Deformity Correction ◽  
Hallux Valgus Angle ◽  
Chevron Osteotomy ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Akin Osteotomy ◽  
American Orthopaedic

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The use of minimally invasive techniques for hallux valgus may provide complete deformity correction with minor soft tissue damage, which reduces morbidity and shortens recovery. In this way, some open osteotomies were adapted to percutaneous approaches, with good outcomes reported. The minimally invasive chevron-Akin (MICA) described by Vernois and Redfern in 2011, combines benefits of percutaneous approaches with a stable internal fixation. Since 2015 we have adapted this technique, by adding a percutaneous adductor tenotomy to dispense with the Akin osteotomy. The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a minimally invasive chevron osteotomy and a percutaneous adductor tendon release. Methods: This was a prospective cohort study. A total of 38 feet with moderate hallux valgus underwent the procedure and were followed up for a minimum 12 months (SD 1.10). The median age was 58 years (IQR 52 - 65), 36 women and 2 men. Radiological parameters were compared at preoperatory and at the last follow-up and included: Hallux Valgus Angle (HVA), Inter- Metatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and first metatarsal shortening. Time to consolidation was also assessed. For clinical evaluation the American Orthopaedic Foot & Ankle Society score (AOFAS) was evaluated. Complications during the follow up were reported. Patients in which another procedure in the hallux was performed, with previous surgeries or not completed 1 year follow-up were excluded. Results: Radiologic postoperative parameters demonstrated to achieved correction. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and distal metatarsal articular angle. Shortening of the first metatarsus was a mean 7.02 mm (IQR 1.24 - 10,27). The mean AOFAS score increased from 58.23 (SD 9.02) pre-operatively to 97.15 (SD 4.72) post-operatively (p< 0.001). Complications reported were 2 superficial infections, 1 broken screw, 1 screw extraction. Five patients referred metatarsalgia after surgery and 1 presented a fourth metatarsal stress fracture. Only one patient presented lost of correction in the first postoperative week and needed a second surgery. Conclusion: Our series of hallux valgus correction with a minimally invasive chevron osteotomy combined with the adductor tendon release shows good clinical and radiological outcomes, and results are comparable to series with the additional Akin osteotomy. Comparative studies are needed for major evidence.

Biplanar Chevron Osteotomy

1998 ◽  
Vol 19 (9) ◽  
pp. 579-584 ◽  
Author(s):  
Loretta B. Chou ◽  
Roger A. Mann ◽  
Mark M. Casillas
Keyword(s):  
Hallux Valgus ◽  
Foot And Ankle ◽  
Hallux Valgus Angle ◽  
Rating Score ◽  
Intermetatarsal Angle ◽  
Clinical Rating ◽  
Chevron Osteotomy ◽  
Valgus Angle ◽  
American Orthopaedic

We retrospectively reviewed the results of using a biplanar chevron osteotomy performed on patients who presented with hallux valgus deformities with an increased distal metatarsal articular angle (DMAA). The study included 17 feet (14 patients) of 12 women and 2 men. The average follow-up was 33 months. The average American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-lnterphalangeal Clinical Rating Score was 91. Ten of the 14 patients (13 of 17 feet) stated that they would choose to undergo the procedure again. The hallux valgus angle was improved from an average of 22° to 18°, the intermetatarsal angle from 11° to 9°, and the DMAA from 16° to 9°. We have demonstrated this procedure to be useful in the treatment of symptomatic bunion deformities with an increased DMAA.

scholarly journals Functional evaluation of patients undergoing endoscopic calcaneoplasty for Haglund deformity

2021 ◽  
Vol 15 (2) ◽  
pp. 155-160
Author(s):  
Hallan Douglas Bertelli ◽  
Bruno Arvatti Michelin ◽  
Isabela Ferreira Perucci ◽  
Mário Sérgio Paulillo de Cillo ◽  
Carlos Daniel Candido Castro Filho ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Functional Outcomes ◽  
Case Series ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
The Mean ◽  
Haglund Deformity ◽  
American Orthopaedic ◽  
Preoperative Score

Objective: To analyze the functional outcomes of patients undergoing endoscopic calcaneoplasty for the treatment of Haglund deformity. Methods: This study consists of a case series of patients undergoing endoscopic calcaneoplasty. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, was used to evaluate patients before and 12 months after the procedure, providing preoperative and postoperative scores. Results: Nineteen patients were evaluated for a total of 24 endoscopic calcaneoplasties. The American Orthopaedic Foot and Ankle Society scale provided a mean preoperative score of 31.4 and a mean postoperative score of 93.3, which shows a significantly increased score after surgery. The mean patient age was 52 years, and the youngest patient was 25 years old and the oldest patient was 73 years old. However, no significant relationship was found between age and change in the American Orthopaedic Foot and Ankle Society score. No complications were observed in the immediate or late postoperative periods. Conclusion: Arthroscopic resection is efficient in the treatment of Haglund deformity given the significant improvement in the American Orthopaedic Foot and Ankle Society score observed after the procedure. Also, no postoperative complications were seen in patients who underwent endoscopic calcaneoplasty. Level of Evidence: IV; Therapeutic Studies; Case series.

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