Developmental Foot Deformities in Patients with Connective Tissue Disorders

Mir, Basit; Gaber, Karim; Ghali, Daniel; Merabia, Bouchra Ghania; Lin, Celina; Kishta, Waleed

doi:10.2106/jbjs.rvw.22.00219

Cited by 3 publications

(2 citation statements)

References 67 publications

(168 reference statements)

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“…Previous litterature suggest that in patients with connective tissues disorders, such as Ehlers Danlos syndrome, Downs syndrome, and OI, foot orthoses may improve pain and fatigue [ 14 ], as well as stability [ 15 ]. Arch supporting foot orthoses have been shown to decrease the external ankle evertor moment in children with flexible flat foot deformity [ 16 ], and to reduce variability in spatiotemporal gait parameters in children with joint hypermobility syndrome [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of foot orthoses on gait in children with Osteogenesis Imperfecta type I, III and IV – a cross-sectional study

Naili,

Åström,

Löwing

et al. 2024

BMC Musculoskelet Disord

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Background For children with Osteogenesis Imperfecta (OI), a rare genetic bone disease, walking can be difficult to carry out due to a combination of bone fragility and deformity, muscle weakness, joint hypermobility, and pain. Bisphosphonate treatment has facilitated more children being able to walk, but for many, foot and ankle hypermobility is a limiting factor. Current evidence on foot orthoses in children with OI is sparse. This study aimed to evaluate gait characteristics in children with OI walking barefoot as compared to walking with foot orthoses. Methods Twenty-three children with OI and hypermobility (mean age 8.3 ± 3.0 years) were included in this cross-sectional study. Children conducted three-dimensional gait analysis barefoot, and with foot orthoses and appropriate foot wear (stable yet light-weight), respectively. Walking speed, step length, lower limb kinematics and kinetics were collected. Differences in gait characteristics between test conditions were evaluated using paired sample t-tests. Results When walking with foot orthoses, the external foot progression angle was reduced, peak ankle dorsiflexion angle increased, and peak plantarflexion moment increased as compared to barefoot. No difference was found in walking speed between test conditions, however, children with OI walked with longer steps with foot orthoses as compared to barefoot. Conclusion The observed gait alterations suggest that foot orthoses, aiming to support the foot and ankle joint, contributed to reduced overall foot rotation as measured by external foot progression, increased peak plantarflexion moment, and increased step length. In a wider perspective, the ability to walk provides the opportunity to be physically active, and thereby increase skeletal loading and prevent fractures, thus, foot orthoses may be an important treatment option to consider in children with OI. Level of evidence III.

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Section: Introductionmentioning

confidence: 99%

The impact of foot orthoses on gait in children with Osteogenesis Imperfecta type I, III and IV – a cross-sectional study

Naili,

Åström,

Löwing

et al. 2024

BMC Musculoskelet Disord

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“…The management of hallux abductus in patients with Down syndrome poses unique challenges due to hypotonia and ligamentous laxity associated with the condition [ 6 ]. Traditional surgical approaches may be insufficient in providing long-term correction, and the risk of complications is also heightened [ 7 ]. In fact, Down syndrome patients who are increasingly active need faster diagnosis and intervention to prevent severe disability.…”

Section: Introductionmentioning

confidence: 99%

A 28-Year-Old Woman with Down Syndrome, Congenital Heart Disease, and a History of Knee Surgery and Plantar Fasciitis, with Hallux Abducto Valgus (Bunion) and Lapiplasty Three-Dimensional Correction Surgery

Simón-Pérez,

Jiménez-Martín,

Cicchinelli

et al. 2023

Am J Case Rep

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Patient: Female, 28-year-old Final Diagnosis: Congenital heart disease • Down’s syndrome • flat foot • hallux valgus Symptoms: Foot pain • knee joint pain • low back and hip pain, gait changes, proximal muscle weakness Clinical Procedure: — Specialty: Podiatry • Surgery Objective: Congenital defects/diseases Background: Tarsometatarsal joint (TMJ) arthrodesis is common method used for correcting hallux abductus valgus (HAV). Its popularity has grown due to studies revealing HAV’s triplanar deformity with frontal plane rotation. This case report presents a 28-year-old woman with Down syndrome, congenital heart disease, and a history of knee surgery and plantar fasciitis, with severe HAV deformity and flexible valgus flatfoot associated with ligamentous hyperlaxity. Case Report: Examination revealed severe foot deformities, and radiographic studies confirmed the condition. A surgical intervention was planned, and the patient’s cardiologist confirmed she was fit for the procedure. The modified Lapidus technique with frontal plane rotational correction included realigning the metatarsal joint, resecting spurs, osteosynthesis material, and arthrosis in the sinus tarsi. After surgery, the patient underwent a recovery period without support for 8 weeks and received appropriate medical care. Radiographs showed successful alignment, and the patient gradually resumed her daily activities. The patient had an uneventful recovery, and postoperative radiographs showed good alignment in all planes. Conclusions: The hyperlaxity associated with Down syndrome makes the incidence of HAV more frequent, and TMJ fusion is preferable to correction by osteotomy. The modified Lapidus technique with frontal plane rotational correction could be a good technique to achieve satisfactory correction in patients with severe HAV deformity and flexible valgus flatfoot associated with ligamentous hyperlaxity. TMJ fusion is indicated when severe or recurrent rotational component is observed in X-rays.

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Outcomes of orthopaedic surgery in Ehlers-Danlos syndromes: a scoping review

Schubart,

Mills,

Rodeo

et al. 2024

BMC Musculoskelet Disord

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Background Patients with Ehlers-Danlos syndromes (EDS) often experience high rates of joint subluxations and dislocations, and associated pain that may require surgical interventions. Orthopaedic surgical management is challenging in this population, and patients will often undergo multiple unsuccessful surgeries. Outcomes data specific to patients with EDS are sparse in the orthopaedic surgery literature. We conducted a scoping review to evaluate the evidence and outcomes for orthopaedic surgery specifically for the EDS population. Methods PubMed MEDLINE, Embase, The Cochrane Library, Cochrane Controlled Register of Trials (CENTRAL), CINHL, and Scopus from their inception to February 28, 2024 for all studies that reported outcomes for orthopaedic surgery in patients with EDS. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The studies in this scoping review include Level III (retrospective cohort and case control) and Level IV (case series) evidence. Results The literature search yielded a total of 71 citations published between 1990 and 2023. All were primary studies. 38 were single case studies, 14 were case series, and 19 were retrospective cohort studies. No randomized clinical studies or systematic reviews were identified. Overall, the reported findings for the various anatomical sites and procedures indicated that surgery outcomes were inconsistent. Our review highlights the need for future research to determine whether currently established surgical approaches for various orthopaedic conditions offer long-term clinical benefit in patients with EDS. This is clearly a challenging diagnosis, and more rigorous clinical studies are required to identify optimal treatment approaches. Conclusions Our review found little evidence-based research to guide optimal surgical treatment in EDS. Established surgical techniques that have been shown to be successful in the wider orthopaedic population should be studied to determine their efficacy in the EDS population. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-024-07937-6.

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Developmental Foot Deformities in Patients with Connective Tissue Disorders

Cited by 3 publications

References 67 publications

The impact of foot orthoses on gait in children with Osteogenesis Imperfecta type I, III and IV – a cross-sectional study

The impact of foot orthoses on gait in children with Osteogenesis Imperfecta type I, III and IV – a cross-sectional study

A 28-Year-Old Woman with Down Syndrome, Congenital Heart Disease, and a History of Knee Surgery and Plantar Fasciitis, with Hallux Abducto Valgus (Bunion) and Lapiplasty Three-Dimensional Correction Surgery

Outcomes of orthopaedic surgery in Ehlers-Danlos syndromes: a scoping review

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