Diagnosis and treatment of adult flatfoot

Lee, Michael S.; Vanore, John V.; Thomas, James L.; Catanzariti, Alan R.; Kogler, Géza F.; Kravitz, Steven R.; Miller, Stephen J.; Gassen, Susan Couture

doi:10.1053/j.jfas.2004.12.001

Cited by 186 publications

(134 citation statements)

References 172 publications

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“…The clinical classification of PTTD, as originally defined by Johnson and Strom, 19 continues to be modified as new studies are completed. 25 The inclusion criteria of an arch index equal to or greater than 1 standard deviation of a published study 45 excluded subjects with a low MLA from the asymptomatic control group. Other foot posture measures, such as navicular height, may also be useful in categorizing subjects with PTTD.…”

Section: Discussionmentioning

confidence: 99%

“…13,26,29,35 Persons most commonly affected by PTTD are white females, 45 to 65 years of age, that are over weight and hypertensive. 11,25,28 Although PTTD is viewed as an overuse injury, the exact cause of PTTD is unknown. 11,23,43 Avascularity of the tendon and metabolic disease associated with diabetes have been correlated to tendon dysfunction and may contribute to PTTD.…”

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confidence: 99%

“…14,30,31 Persisting abnormal foot postures may also contribute to breakdown of secondary ligamentous supports (eg, spring ligament, plantar fascia, and deltoid ligament), 2,12 further magnifying the flatfoot deformity. 23,25,28,43 These deviations point to the importance of early recognition and management of adult acquired flatfoot deformity in preventing disease progression and protecting secondary ligamentous supports. 25 In vitro studies attempting to simulate gait mechanics suggest that the posterior tibialis muscle may play a key role in preventing collapse of the medial longitudinal arch (MLA), contribute to rearfoot inversion, and adduct the forefoot.…”

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confidence: 99%

“…23,25,28,43 These deviations point to the importance of early recognition and management of adult acquired flatfoot deformity in preventing disease progression and protecting secondary ligamentous supports. 25 In vitro studies attempting to simulate gait mechanics suggest that the posterior tibialis muscle may play a key role in preventing collapse of the medial longitudinal arch (MLA), contribute to rearfoot inversion, and adduct the forefoot. 30,31,37 Despite EMG analysis suggesting inconsistent activation patterns in the posterior tibialis muscle during gait, 32 the muscle is thought to play a significant role in support of the MLA after foot flat and rearfoot inversion after heel off.…”

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confidence: 99%

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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

155

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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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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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

155

178

View full text Add to dashboard Cite

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“…A number of studies have suggested that foot abnormalities are related to the habit of wearing shoes and the beginning of wearing shoes. [29] In addition, a number of studies have claimed that obesity or body weight should also be considered in the course of this abnormality [20,21]. Of course, Stathit Undam and Joseph studied the relationship between flat foot and BMI, which is indicative of obesity, using the foot role International Journal of Applied Exercise Physiology www.ijaep.com…”

Section: Discussionmentioning

confidence: 99%

The relationship between flat feet and cavus foot with body mass index in girl students

Hajirezaei

Mirzaei

Khezri

2017

Int J Appl Exerc Physiol

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Radiographic measurements of the talus and calcaneus in the adult pes planus foot type

Agoada

Kramer

2020

American J Phys Anthropol

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Objective A distinctive feature of the modern human foot is the presence of a medial longitudinal arch when weight‐bearing. Although the talus and calcaneus play a major role in the structure and function of the human foot, the association between the morphology of these bones and longitudinal arch height has not been fully investigated. A better understanding of this relationship may assist in the interpretation of pedal remains of fossil hominins, where features of the foot and ankle morphology have been described as providing evidence for the presence of a longitudinal arch. Methods For this study, weight‐bearing radiographs of 103 patients from an urban US Level 1 trauma center, taken as part of a clinical examination for medical evaluation, were selected. These radiographs were classified as to foot type by arch height as defined using the calcaneal inclination angle. From this group, 68 radiographs were suitable for linear and angular measurements of the talus and 74 of the calcaneus. The relationships between these measurements and arch height were explored using least squared linear regression analysis. Results The results demonstrate that angular measurements of the calcaneus (particularly those that reflect the relationship of the talar articular facets to each other and the tilt of the calcaneocuboid joint to the longitudinal axis of the calcaneus) are predictive of arch height (r2 = .29–.44 p ≤ .001). All angular measurements of the talus and all examined linear measurements of both the talus and calcaneus were not predictive of arch height. Discussion These results suggest that certain angular measurements of the calcaneus are associated with arch height in the modern human foot. While this information is useful in the interpretation of hominin pedal remains, the relationship of the morphology of these bones, as well as other bones of the foot, to arch height is complex, requiring further investigation.

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Diagnosis and treatment of adult flatfoot

Cited by 186 publications

References 172 publications

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

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

The relationship between flat feet and cavus foot with body mass index in girl students

Radiographic measurements of the talus and calcaneus in the adult pes planus foot type

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