Flatfoot is one of the most common musculoskeletal conditions in the daily practice of pediatric orthopedists. Despite of numerous studies, diagnostic criteria and principles of management remain controversial. Flexible flatfoot - is visually detectable decrease in the height of the longitudinal arch of the foot, which can be spontaneously corrected by active or passive motion and not accompanied by any contracture of foot and ankle. Flexible flatfoot is a benign condition which is normal for childhood. But this term is also used to describe a painful deformity with marked limitation of dorsiflection and “not physiological” flatfoot with unfavorable course and prognosis. Despite of the awareness of the parents, flexible flatfoot does not lead to pain and should not be followed by any kind of treatment. Special shoe modifications and orthopedic insoles are useless in the attempt to improve the foot, but can influence negatively psychological condition and self-estimation. Proper diagnosis of flexible flatfoot is necessary in order to avoid unnecessary treatment and to reveal patients with adverse prognosis and rigid forms of flatfoot which need special approach.
Background. The visual assessment of flatfoot is the most commonly used method by pediatric orthopedists. It is necessary to confirm good consistency among specialists to justify its use as a standard. Aim. The aim of this study was to determine the consistency of visual assessment of flatfoot among orthopedists. Materials and methods. The first stage of this study included 187 primary school-aged children. The main methods used were clinical examination and computer plantography. Then, 130 images of the right foot were randomly selected in standard projections medial and posterior, which were provided to 32 orthopedists (ten of whom were experts). Specialists needed to note whether the foot presented for analysis was flat. We used the w-Kendall concordance coefficient and -Kendall correlation coefficient to determine the inter-rater reliability. After five months, the intra-rater reliability was determined, and the Cohen coefficient was calculated. Results. Our study demonstrated that the inter-rater reliability varied significantly depending on whether the orthopedist specialized in foot pathology. When calculating the concordance coefficient, an increase in the consistency among experts was noted after five months (0.58 and 0.76, respectively), compared with orthopedists who do not specialize in foot pathology. Although some heterogeneity was noted according to experts on the same foot, the overall correlation coefficient corresponded to a good and excellent level of consistency (0.650.84). Cohens coefficient among specialists corresponded to a good level of confidence (0.72), whereas among orthopedists who do not specialize in foot pathology, there was a low level of confidence (0.31). According to experts, the frequency of flatfoot was 24.6%, whereas according to orthopedists who do not specialize in foot pathology, it was 40.9% when they evaluated images of the same feet. Conclusion. Experts answers regarding which foot should be considered flat demonstrated a good and excellent level of consistency. Therefore, they can be used to determine reference values of anthropometric parameters of the medial foot arch.
Congenital clubfoot requires complete correction before the period of verticalization. Conservative methods are priority in treatment. The most effective method is Ponseti method that allows correcting all the deformations even in severe clubfoot. However, if clubfoot is accompanied with abnormal anatomy of foot or significant changes in functional ability of muscles, operative treatment is inevitable. The extent of surgical intervention depends on the severity of detected abnormalities and is determined individually. The use of ultasound, radiographic, and CT investigations, according to indications, contributes to the diagnostics. The indication for surgery is the lack of effect of conservative treatment after 10-12 cast correction in children over the age of 4 months. Diagnostic criteria for deciding in favor of surgery are: availability of fibrous coalition, the deformation of the talar or the sphenoid bone, the anomaly in the point of attachment of the tendon of the tibialis anterior muscle, lack of the repositioning of navicular bone on the talar head. Orthosis supply and rehabilitation treatment depend on the extent of surgical intervention.
Backgrоund. Osteoporosis is an important factor in the pathogenesis of orthopedic manifestations in children with cerebral palsy. It was previously demonstrated that children with cerebral palsy have specific changes in bone metabolism, which can cause changes in laboratory parameters compared with other orthopedic patients without neurological backgrounds. Aim. The aim of this study was to assess bone metabolism biomarkers in children with cerebral palsy, identifying distinguishing characteristic patterns in comparison with patients with orthopedic pathology without neurological backgrounds. Materials and methods. This study evaluated the concentrations of calcium, phosphorus, -cross laps, osteocalcin, vitamin D, CICP, and alkaline phosphatase in the blood serum of 50 children with cerebral palsy aged between 6 to 12 years with GMFCS levels IIII. The control group consisted of 50 patients with plano-valgus deformities of the feet. Results. The alkaline phosphatase activity in the group of children with cerebral palsy was 170.25 59.35 u/L, while in the control group it was 145.58 46.29 u/L; the CICP concentration in the study group was higher than in the control group (324.01 174.10 and 269.68 240.98, respectively). The concentration of -cross laps, osteocalcin, calcium, and vitamin D in the study group was lower than in children with flat feet. Conclusions. This study demonstrated multidirectional changes in the biomarkers of bone metabolism that are characteristic of walking children with cerebral palsy. These changes are characterized by a corresponding increase in the activity of osteoresorption and osteoreparation. This makes it possible to justify the combined use of metabolites and metabolic activators (calcium and vitamin D) and drugs that suppress osteoresorption (bisphosphonates) for the prevention and treatment of osteoporosis in children with cerebral palsy.
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