Flatfoot over the centuries: the background of current conservative and operative treatments

Biz, Carlo; Cerchiaro, Mariachiara; Mori, Fabiana; Rossin, Alessandro; Ponticiello, Mattia; Crimì, Alberto; Ruggieri, Pietro

doi:10.1007/s00264-023-05837-3

Cited by 5 publications

(4 citation statements)

References 57 publications

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“…Regarding the distribution of the diagnoses (Figure 8) that led to the indication of arthrodesis, almost half of the subjects had clubfoot (52). The second most common diagnosis was pes planovalgus (29), followed by pes cavus (23), pes calcaneus (6), skewfoot (6) and hallux valgus (1).…”

Section: Resultsmentioning

confidence: 99%

“…Many foot deformities affect children and adolescents, such as clubfoot, pes planovalgus, pes cavus, pes equinus, pes calcaneus and hallux valgus [1]. The incidence of clubfoot in Central Europe, for example, is 1-2/1000 [2]; symptomatic pes plano-valgus in juveniles is reported to have an incidence of 0.1/1000 [3], and juvenile hallux valgus has an incidence of 2-4% [4].…”

Section: Introductionmentioning

confidence: 99%

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K-Wire Osteosynthesis for Arthrodesis of the Paediatric Foot Is a Good and Valid Procedure

Kreher,

Putz,

Fackler

et al. 2023

JCM

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Background: Foot deformities in children are common, and the majority can be treated conservatively. Nevertheless, there are deformities that require surgical treatment. These include rigid clubfeet, severe forms of pes planovalgus, pes cavus and several more. We retrospectively analysed the pseudarthrosis rate of surgical treatment of foot deformities with transcutaneous K-wire osteosynthesis in neurologically healthy children and adolescents. The aim of the study was to show that the results with K-wires are comparable to those with other osteosynthesis methods in the literature. Methods: A total of 46 paediatric patients aged 6 to 17 years treated between January 2010 and December 2015 met the inclusion criteria. Depending on the diagnosis, different surgical interventions were necessary. In clubfoot and pes planovalgus, representing n = 81, 70% of the whole collective triple arthrodesis with fusion of the talonavicular, calcaneocuboid and subtalar joints or Evans osteotomy was usually performed. Radiographs were taken at least 6 months post-surgery, and bony consolidation of the subtalar, talonavicular (TN), and calcaneocuboidal (CC) joints and the metatarsal I (MT I) osteotomy were assessed. If there was no evidence of fusion at this time, it was considered non-union. Results: In total, 117 arthrodesis procedures with K-wires were performed. Overall, 110 of the arthrodesis (94%) healed, and only 7 joints (6%) showed non-union (subtalar 0%, TN 7.7%, CC 6.5% and MT I 6.7%). All non-unions occurred in subjects with clubfoot deformities. No significant risk factors were observed. Conclusion: This study replicated the good consolidation rates reported in the literature with screws, plates, intramedullary nails or staples in arthrodesis of the adolescent foot in neurologically healthy subjects and confirmed the efficacy of K-wires. The main advantages of transcutaneous K-wire treatment are easy metal removal, lower osteosynthesis material costs and less concomitant damage. Further studies, especially randomised controlled trials, are needed to further investigate this topic.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

K-Wire Osteosynthesis for Arthrodesis of the Paediatric Foot Is a Good and Valid Procedure

Kreher,

Putz,

Fackler

et al. 2023

JCM

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“…Thus, many authors refer to flatfeet as "normal anatomic variants" [3], as long as no disability or pain is present. Furthermore, variance in the assessment of the MLA during a static or a dynamic position has been shown to change the result significantly, with muscle activity during gait resulting in an increased chance of finding a normal MLA [4].…”

Section: Introductionmentioning

confidence: 99%

Pediatric Flatfoot: Is There a Need for Surgical Referral?

Luna

Khal

Milliken

et al. 2023

JCM

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Pediatric foot deformities are a common finding, concerning up to 44% of preschool aged children. The absence of accepted international guidelines, as well as heterogeneity in definitions and measurements, makes management of pediatric flatfoot a challenge, and decisions surrounding specialized care referral confusing and biased. The objective of this narrative review is to provide guidance to primary care physicians treating these patients. A non-systematic review of the literature regarding the development, etiology, and clinical and radiographic assessment of flatfeet using the PubMed and Cochrane Library databases was performed. The exclusion criteria for the review were adult populations, papers detailing the outcome of a specific surgical procedure, and publications prior to 2001. The included articles showed great heterogeneity in definition and proposed management, which makes the study of pediatric flatfoot challenging. Flatfoot is a common finding in children under 10 years old, and should not be considered pathological unless stiffness or functional limitation are present. Surgical referral should be reserved to children with stiff or painful flatfoot, while simple observation is indicated for flexible, asymptomatic flatfeet.

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“…Considering the complex structural basis of the MLA and flatfoot condition 33 , this study aims to evaluate hominid navicular morphology and to assess its anatomical correlates with the MLA (Fig. 1).…”

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confidence: 99%

Morphological and evolutionary insights into the keystone element of the human foot’s medial longitudinal arch

Sorrentino,

Carlson,

Orr

et al. 2023

Commun Biol

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The evolution of the medial longitudinal arch (MLA) is one of the most impactful adaptations in the hominin foot that emerged with bipedalism. When and how it evolved in the human lineage is still unresolved. Complicating the issue, clinical definitions of flatfoot in living Homo sapiens have not reached a consensus. Here we digitally investigate the navicular morphology of H. sapiens (living, archaeological, and fossil), great apes, and fossil hominins and its correlation with the MLA. A distinctive navicular shape characterises living H. sapiens with adult acquired flexible flatfoot, while the congenital flexible flatfoot exhibits a ‘normal’ navicular shape. All H. sapiens groups differentiate from great apes independently from variations in the MLA, likely because of bipedalism. Most australopith, H. naledi, and H. floresiensis navicular shapes are closer to those of great apes, which is inconsistent with a human-like MLA and instead might suggest a certain degree of arboreality. Navicular shape of OH 8 and fossil H. sapiens falls within the normal living H. sapiens spectrum of variation of the MLA (including congenital flexible flatfoot and individuals with a well-developed MLA). At the same time, H. neanderthalensis seem to be characterised by a different expression of the MLA.

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Flatfoot over the centuries: the background of current conservative and operative treatments

Cited by 5 publications

References 57 publications

K-Wire Osteosynthesis for Arthrodesis of the Paediatric Foot Is a Good and Valid Procedure

K-Wire Osteosynthesis for Arthrodesis of the Paediatric Foot Is a Good and Valid Procedure

Pediatric Flatfoot: Is There a Need for Surgical Referral?

Morphological and evolutionary insights into the keystone element of the human foot’s medial longitudinal arch

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