Biomechanical Evaluation of the Efficacy of External Stabilizers in the Conservative Treatment of Acquired Flatfoot Deformity

Imhauser, Carl W.; Abidi, Nicholas A.; Frankel, David Z.; Gavin, Kenneth; Siegler, Sorin

doi:10.1177/107110070202300809

Cited by 53 publications

(45 citation statements)

References 38 publications

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“…2,5,6,9,30 The magnitudes of bony changes were small, on the order of 18 to 78. Compared with data from other cadaveric flatfoot studies (Table 8), the changes seen in our model were smaller than in models using complete ligament sectioning 6,13,15 and larger than a model that used ligament attenuation. 16 The exception is calcaneal eversion, in which we saw a 4.08change, similar to what has been reported in ligament sectioning models.…”

Section: Discussionmentioning

confidence: 71%

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Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Blackman

Blevins

Sangeorzan

et al. 2009

Journal Orthopaedic Research

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Flatfoot deformity is characterized by loss of the medial longitudinal arch, forefoot abduction, hindfoot eversion, and often Achilles tendon contracture. Our objectives were to validate a cadaveric flatfoot model that involves selective ligament attenuation and to determine if Achilles tendon overpull is associated with increased pes planus severity. We measured the three-dimensional (3D) orientation of the bones of interest in the unloaded, loaded, and Achilles tendon overpull conditions. A flatfoot model was created by attenuating ligaments involved in the pes planus deformity followed by cyclic axial loading, and bone orientations were acquired in the three conditions. Significant differences seen between normal feet and flat feet were consistent with those seen with the pes planus deformity. The first metatarsal dorsiflexed and abducted relative to the talus. The navicular abducted relative to the talus. The calcaneus everted relative to the tibia. The talus plantar flexed and adducted. Achilles overpull resulted in first metatarsal-to-talus dorsiflexion and navicular-to-talus abduction. Thus, selective ligament attenuation followed by cyclic axial loading can create a cadaveric flatfoot model consistent with the in vivo deformity. Longitudinal arch depression, hindfoot eversion, talonavicular joint abduction, forefoot abduction, and talar plantar flexion were seen. Simulated Achilles tendon contracture increased the severity of the deformity, particularly in arch depression and forefoot abduction.

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Section: Discussionmentioning

confidence: 71%

“…12 Much research has been devoted to creating and testing cadaveric flatfoot models. 5,6,[13][14][15][16] However, we are unaware of any models that have examined the effects of Achilles tendon contracture. Furthermore, many cadaveric models utilize substantial sectioning of ligaments and tendons to create the deformity.…”

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confidence: 99%

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Blackman

Blevins

Sangeorzan

et al. 2009

Journal Orthopaedic Research

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“…19 However, others report significant improvement in radiographic measurements after the use of customised flexible orthosis. 20,21 Thus, we evaluated correlations between various foot angles and their respective American Orthopaedic Foot and Ankle Society (AOFAS) scores for pain, and the effectiveness of a medial arch orthosis.…”

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confidence: 99%

Medial Arch Orthosis for Paediatric Flatfoot

Sinha¹,

Song²,

Kim³

et al. 2013

J Orthop Surg (Hong Kong)

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purpose. To evaluate any correlation between various foot angles and their respective American Orthopaedic Foot and Ankle Society (AOFAS) scores for pain, and the effectiveness of a medial arch orthosis. Methods. 81 children with bilateral symptomatic flatfoot were randomised into orthosis (n=55) and control (n=26) groups. The orthosis group consisted of 33 male and 22 female patients aged 36 to 204 (mean, 99) months and they were given a medial arch support. The control group consisted of 15 male and 11 female patients aged 36 to 192 (mean, 100) months and they were managed with analgesics. Foot angles including anteroposterior (AP) and lateral talocalcaneal (TC) angles, AP and lateral talofirst metatarsal (TFM) angles, calcaneal pitch angle (in lateral plane), and talonavicular (TN) angle were measured, as were AOFAS scores for pain for the forefoot, midfoot, and hindfoot. improved significantly. In the controls, all AOFAS scores (except for the midfoot score) and only the AP-TFM angle improved significantly. In the orthosis group, the AOFAS hindfoot score correlated positively with the lateral TC angle of the left foot (r=0.345, p=0.010) and negatively with the calcaneal pitch angle of the right foot (r=-0.33, p=0.015). In the control group, the lateral TFM angle of the left foot correlated negatively with the AOFAS forefoot (r=-0.566, p=0.003) and midfoot scores (r=-0.497, p=0.001), whereas the calcaneal pitch angle of the left foot correlated positively with the AOFAS forefoot score (r=0.497, p=0.010). conclusion. Medial arch support orthosis significantly improved AOFAS scores and foot angles. Calcaneal pitch angle and lateral TC angle correlated well with AOFAS hindfoot scores.

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“…Although the rearfoot has been primarily implicated in kinematic alterations found in subjects with PTTD, 17,18,30 there is evidence to suggest even greater influence on forefoot function with tendon attenuation. Using a multisegment foot model applied to a single case of a subject with PTTD and a longstanding lacerated tendon, Rattanaprasert et al 31 found that rearfoot eversion/inversion was surprisingly similar to a group of 10 healthy controls.…”

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confidence: 99%

Comparison of Foot Kinematics Between Subjects With Posterior Tibialis Tendon Dysfunction and Healthy Controls

Tome

Nawoczenski²,

Flemister³

et al. 2006

J Orthop Sports Phys Ther

157

178

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Study Design: A 2 × 4 mixed-design ANOVA with a fixed factor of group (posterior tibialis tendon dysfunction [PTTD] and asymptomatic controls), and a repeated factor of phase of stance (loading response, midstance, terminal stance, and preswing). Objective: To compare 3-dimensional stance period kinematics (rearfoot eversion/inversion, medial longitudinal arch [MLA] angle, and forefoot abduction) of subjects with stage II PTTD to asymptomatic controls. Background: Abnormal foot postures in subjects with stage II PTTD are clinical indicators of disease progression, yet dynamic investigations of forefoot, midfoot, and rearfoot kinematic deviations in this population are lacking. Methods: Fourteen subjects with stage II PTTD were compared to 10 control subjects with normal arch index values. Subjects were matched for age, gender, and body mass index. A 5-segment, kinematic model of the leg and foot was tracked using an Optotrak Motion Analysis System. The dependent kinematic variables were rearfoot inversion/eversion, forefoot abduction/adduction, and the MLA angle. An ANOVA model was used to compare kinematic variables between groups across 4 phases of stance.Results: Subjects with PTTD demonstrated significantly greater rearfoot eversion (P = .042), MLA angle (P = .008) and forefoot abduction angles (PϽ.005) during specific phases of stance. Subjects with PTTD demonstrated significantly greater rearfoot eversion (PϽ.004) and MLA angles (PϽ.009) by 6.2°and 8.0°, respectively, during loading response when compared to controls. During preswing, the subjects with PTTD demonstrated a significantly greater MLA angle (PϽ.002) and a forefoot abduction angle (PϽ.001) which exceeded that of the controls by 10.0°. Conclusions: The abnormal kinematics observed at the rearfoot, midfoot, and forefoot across all phases of stance implicate a failure of compensatory muscle and secondary ligamentous support to control foot kinematics in subjects with stage II PTTD.

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Biomechanical Evaluation of the Efficacy of External Stabilizers in the Conservative Treatment of Acquired Flatfoot Deformity

Cited by 53 publications

References 38 publications

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Medial Arch Orthosis for Paediatric Flatfoot

Comparison of Foot Kinematics Between Subjects With Posterior Tibialis Tendon Dysfunction and Healthy Controls

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