Correlation of Postoperative Midfoot Position With Outcome Following Reconstruction of the Stage II Adult Acquired Flatfoot Deformity

Abstract

Background No studies investigating the effect of midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from AP radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). Methods Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors’ institution that underwent flatfoot reconstruction for stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo-first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with two or more measurements in the abduction category were classified as the abduction group (n=30); those with one or fewer measurements in the abduction category were placed in the adduction group (n=25). Preoperative FAOS and postoperative FAOS with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests. Results Patients corrected to a position of adduction showed a significantly lower improvement in the FAOS daily activities (p=0.012) and quality of life subscales (p=0.046). Mean improvement in subscale score for the adducted group was lower for pain (p=0.052) and sports activities (p=0.085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (p=0.372) between groups was found. Conclusions Correction of the talonavicular joint to a position of adduction following stage II AAFD is associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in the reconstruction of stage II AAFD. Level of Evidence Therapeutic Level III

Assessment of foot function in patients with pes planus deformity treated with the authors’ own exercise programme – a preliminary report

“…W uzyskanych wynikach badania pedobarograficznego widoczna jest tendencja do spadku wartości nacisku maksymalnego i średniego oraz wzrostu powierzchni całkowitej po terapii. Nacisk maksymalny i śred-ni prawie u wszystkich badanych (oprócz dwóch osób) zmniejszył się po terapii, maksymalna różni-ca w zmianie nacisku maksymalnego wyniosła aż 187 g/cm 2 , a nacisku średniego 55g/cm 2 . Wartości p-value w teście t-Studenta wynoszą odpowiednio dla parametrów: nacisk maksymalny (p=0,018), nacisk średni (p=0,002), powierzchnia cał-kowita (p=0,005) oraz naciski maksymalne w strefach H (p=0,018), FF2 (p=0,048) i FF3 (p=0,041) dla stopy lewej i H (p=0,018), M (p=0,049) dla stopy prawej, dlatego przyjmujemy, że dla tych parametrów różnice są istotne statystycznie.…”

“…For this reason, investigating the causes of flat foot as well as treatment methods is still an open issue. Borrelli is convinced of a multifactorial etiology of this complex foot pathology [1]; however, according to a number of authors, it results from the muscle and ligament system weakening (including tibialis posterior muscle) [2][3][4].…”

“…Z tego też powodu poszukiwanie zarówno przyczyn jak i możliwości leczenia płaskostopia niezmiennie pozostaje aktualne. Borrelli wyraża przekonanie o wieloczynnikowej etiologii tej złożonej patologii stóp [1], jednak zdaniem wielu autorów jest ono wynikiem osłabienia aparatu więzadłowo-mięśniowego, w tym mięśnia piszczelowego tylnego [2][3][4].…”

“…W zależności od stopnia zaawansowania zmian morfologicznych oraz nasilenia bólu najczęściej proponowanymi metodami leczenia są: zabiegi chirurgiczne [2,4,5], stosowanie zaopatrzenia ortopedycznego [6] oraz fizjoterapia. W dostępnej literaturze dominują prace uwzględniające ćwiczenia stosowane u dzieci [7,8].…”

“…The primary goal of pes planus treatment is to improve the function of the feet. Depending on the level of morphological changes as well as pain intensity, the most common treatment procedures include surgeries [2,4,5], the use of orthotic devices [6] and physiotherapy. The available literature mainly consists of works that focus on exercises performed by children [7,8].…”