Objective: The purpose of this study was to compare surgically treated clubfoot with typically developing (TD) children using plantar pressure, multi-segment-foot kinematic analysis, and multiple functional outcomes in comprehensive and long-term study. Methods: 26 patients with 45 clubfeet and 23 TD children with 45 normal feet were evaluated. Most clubfoot patients had a complete subtalar release and a few patients had a posterior medial-lateral release at the mean age of 5 years and 6 months. The mean age at follow-up for clubfoot was 12 years and 5 months. Subjects underwent physical and radiographic examination, plantar pressure analysis, multi-segment-foot motion analysis, AAOS Foot & Ankle Questionnaire (AAOS-FAQ), the Pediatric Outcomes Data Collection Instrument (PODCI), and the Child Behavior Checklist (CBCL). Results: Clubfoot patients scored significantly worse than TD on the AAOS-FAQ (90.9 vs.99.9 for pain and comfort), the CBCL Problems scale (23.1 vs.6.3), and several subscales of the PODCI (86.5 vs.96.7 for Sports and Physical Functioning) (P<0.05). Peak pressure at the lateral heel (25.6 vs.29.6 N/cm 2 ), contact area at the 1 st metatarsal head (1 st MT) (6.0 vs. 7.2 cm 2 ) and the pressure time integral at the 1 st MT (5.2 vs. 11.0 N/cm 2 * s) were significantly lower for the clubfoot group compared to the TD foot group (P<0.05). Maximum dorsiflexion of the 1 st metatarsal-hallux (1 st MT-Hal) (17.5 vs. 34.8 ) during stance phase (ST), supination of the 1 st MT-Hal during swing phase (SW) (4 vs. 7 ), maximum plantarflexion of the ankle during ST (-6.8 vs.-11.2 ), and maximum varus of the ankle during SW (4.4 vs. 6.9 ) were also lower for clubfoot except for maximum dorsiflexion of the navicular-1 st MT (P<0.05). Conclusion:This study supports evidence that surgically treated clubfoot continues to have residual deformity of forefoot, overcorrection of hindfoot, stiffness, and a decrease in physical functioning. This comprehensive study accurately portrays postsurgical clubfoot function with objective means through appropriate technologies. A plantar pressure redistributed and finite element analysis designed orthosis may be of importance in the improvement of the foot and ankle joint function for ambulatory children with a relapse of clubfoot deformity.
Objective Ultrasound (US) is an established imaging modality in adult sports medicine but is not commonly used in the diagnosis of pediatric sports conditions, such as Little League shoulder (LLS). This study was conducted to determine the reliability of US measurement of width of the physis at the proximal humerus in diagnosed LLS and to compare US to radiography (RA) in detecting a difference between the affected (dominant) (A) and unaffected (U) shoulders. Materials and Methods Ten male baseball players diagnosed with LLS were enrolled in the study. US images of the proximal humeral physis at the greater tuberosity of both shoulders were obtained by an US-trained sports medicine physician, and the physeal width was measured. Blinded to prior measurements, a separate physician performed measurements on the stored US images. Measurements were compared with RA on the anteroposterior (AP) view for both A and U at the time of the initial visit and for A at follow-up. Results The physeal width (mm) at A and U at the initial visit averaged 5.94 ± 1.69 and 4.36 ± 1.20 respectively on RA, and 4.15 ± 1.12 and 3.40 ± 0.85 on US. Median difference of averaged US measurements between A and U at initial evaluation was 0.75 mm (p = 0.00016). A linear model showed US measurements to be predictive of RA on A (R2 = 0.51) and U (R2 = 0.48). Conclusion US was able to reliably measure the width of the proximal humeral physis and detect a difference between A and U. US correlated well with RA (standard for LLS). US should be considered by the US-trained physician for the diagnosis of LLS.
Purpose: Formetric 4D dynamic system (F4D) is a radiation-free imaging system that can be used to detect static and dynamic back contour in children with adolescent idiopathic scoliosis (AIS). The aim of this paper is (1) to compare the F4D to other systems; (2) to review the correlation of spinal measurements taken by F4D with those taken by radiographs as well as the reproducibility of the F4D; (3) to present future clinical uses and suggest potential research studies utilizing F4D. Methods: MEDLINE (PubMed), ScienceDIRECT, SCOPUS, Cochrane, and Web of Science were queried for studies on AIS using surface topography. Papers were evaluated using PRISMA criteria. Results: Correlations between scoliosis angle as measured by F4D and Cobb angle by radiographs are from 0.7 to 0.872 in the thoracic spine and from 0.5 to 0.758 in the lumbar spine. The intraday reliability of F4D measurements by the same observer ranged from 0.65 to 0.996 across two studies. The study that evaluated reproducibility of F4D when segmented by patients with BMI below and above 24.99 kg/m2 found that the reproducibility was 0.990 and 0.995, respectively. There is potential for using F4D as a screening tool for scoliosis using an algorithm with 92% sensitivity and 74% specificity. Conclusions: F4D as a surface topography machine has great potential in screening and monitoring progression of the curvatures of AIS.
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