Increasing Values of the Lateral Talar-First Metatarsal Angle Preoperatively Predict Spring Ligament Attenuation in Adult Acquired Flat Foot Deformity

Pate, Matthew; Hall, Jacob; Albright, Patrick; Bohay, Donald R.; Anderson, John G.; Roberts, Justin

doi:10.1177/2473011419s00338

Cited by 4 publications

(4 citation statements)

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“…Using a cadaver model, Jennings created deformities associated with AAFD in a 3-dimensional custom-loaded frame [29]. Significant rotational changes of the talus, navicular, and calcaneus occurred after SL sectioning that the loaded TP tendon could not restore, despite its incremental tensioning [30]. A functioning PF [4] acts as a tie beam for the medial longitudinal arch, and an intact superficial deltoid suspends the SL from the fixed medial malleolus.…”

Section: -Evidence For Sequential/progressive Instabilities In Aafdmentioning

confidence: 99%

“…Deep deltoid rupture in ankle fractures demonstrates SL weakening [34] and Type 1 FRI (secondary to SL laxity, not hallux valgus [31]) that develops within six months post-injury [31]. Radiographic change in Meary's axis of 30 degrees has a high (100%) sensitivity for predicting intraoperative SL tears [30].…”

Section: -First Ray Instability and Its Classificationmentioning

confidence: 99%

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Review of Classification Systems for AAFD/PCFD and the Triple Classification Delinking Instability/Deformity and Foot Type

Pasapula,

Choudkhuri,

Monzó

et al. 2023

Preprint

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Classifications of AAFD/PCFD have evolved with an increased understanding of the pathology involved. A review of classification systems helps identify deficiencies and respective contributions to the evolution in understanding the classification of AAFD. Using multiple electronic database searches (Medline, PubMed) and Google search, original papers classifying AAFD were identified. Nine original articles were identified that met the inclusion criteria. Johnson's original classification and multiple variants provided a significant leap in understanding and communicating the pathology but remained tibialis posterior tendon focussed. Drawbacks of these classifications include the implication of causality, linearity of progression through stages, an over-simplification of stage 2 deformity and a failure to understand multiple tendons react, not just tibialis posterior. Later classifications, such as the PCFD classification, are deformity-centric. Early instability in non-cavus feet and all stages of cavus feet can present pain and instability with minor/no deformity. These may not be captured in deformity-based classifications biased to planus feet.' The authors developed the 'Triple Classification' (TC) understanding that primary pathology is a progressive ligament failure/instability that presents as tendon reactivity, deformity, and painful impingement. There is a variable manifestation dependent on starting foot morphology. This review has identified deficiencies within classification systems used in AAFD/PCFD and, as a result, was used to help develop a more comprehensive 'Triple classification'. Advantages of the TC include representing foot types with no deformity, defining complex secondary instabilities, delinking of foot types, tendon reactivity/ligament instability and deformity to represent these independently in a more comprehensive classification system.

show abstract

Section: -Evidence For Sequential/progressive Instabilities In Aafdmentioning

confidence: 99%

Section: -First Ray Instability and Its Classificationmentioning

confidence: 99%

Review of Classification Systems for AAFD/PCFD and the Triple Classification Delinking Instability/Deformity and Foot Type

Pasapula,

Choudkhuri,

Monzó

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Using a cadaver model, Jennings created deformities associated with AAFD in a 3-dimensional custom-loaded frame [31]. Significant rotational changes of the talus, navicular, and calcaneus occurred after SL sectioning, which the loaded TP tendon could not restore, despite incremental tensioning [32]. A functioning PF [14] acts as a tie beam for the medial longitudinal arch, and an intact superficial deltoid suspends the SL from the fixed medial malleolus.…”

mentioning

confidence: 99%

“…Deep deltoid rupture in ankle fractures demonstrates SL weakening [37] and Type 1 FRI (secondary to SL laxity, not hallux valgus) that develops within six months post-injury. Radiographic change in Meary's axis of 30 degrees has a high (100%) sensitivity for predicting intraoperative SL tears [32].…”

mentioning

confidence: 99%

Review of Classification Systems for Adult Acquired Flatfoot Deformity/Progressive Collapsing Foot Deformity and the Novel Development of the Triple Classification Delinking Instability/Deformity/Reactivity and Foot Type

Pasapula,

Choudkhuri,

Monzó

et al. 2024

JCM

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Background: Classifications of AAFD/PCFD have evolved with an increased understanding of the pathology involved. A review of classification systems helps identify deficiencies and respective contributions to the evolution in understanding the classification of AAFD/PCFD. Methods: Using multiple electronic database searches (Medline, PubMed) and Google search, original papers classifying AAFD/PCFD were identified. Nine original papers were identified that met the inclusion criteria. Results: Johnson’s original classification and multiple variants provided a significant leap in understanding and communicating the pathology but remained tibialis posterior tendon-focused. Drawbacks of these classifications include the implication of causality, linearity of progression through stages, an oversimplification of stage 2 deformity, and a failure to understand that multiple tendons react, not just tibialis posterior. Later classifications, such as the PCFD classification, are deformity-centric. Early ligament laxity/instability in normal attitude feet and all stages of cavus feet can present with pain and instability with minor/no deformity. These may not be captured in deformity-based classifications. The authors developed the ‘Triple Classification’ (TC) understanding that primary pathology is a progressive ligament failure/laxity that presents as tendon reactivity, deformity, and painful impingement, variably manifested depending on starting foot morphology. In this classification, starting foot morphology is typed, ligament laxities are staged, and deformity is zoned. Conclusions: This review has used identified deficiencies within classification systems for AAFD/PCFD to delink ligament laxity, deformity, and foot type and develop the ‘Triple classification’. Advantages of the TC may include representing foot types with no deformity, defining complex secondary instabilities, delinking foot types, tendon reactivity/ligament instability, and deformity to represent these independently in a new classification system. Level of Evidence: Level V.

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Spring ligament insufficiency and hallux valgus as an independent risk factors for first ray instability

et al. 2021

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Increasing Values of the Lateral Talar-First Metatarsal Angle Preoperatively Predict Spring Ligament Attenuation in Adult Acquired Flat Foot Deformity

Cited by 4 publications

References 0 publications

Review of Classification Systems for AAFD/PCFD and the Triple Classification Delinking Instability/Deformity and Foot Type

Review of Classification Systems for AAFD/PCFD and the Triple Classification Delinking Instability/Deformity and Foot Type

Review of Classification Systems for Adult Acquired Flatfoot Deformity/Progressive Collapsing Foot Deformity and the Novel Development of the Triple Classification Delinking Instability/Deformity/Reactivity and Foot Type

Spring ligament insufficiency and hallux valgus as an independent risk factors for first ray instability

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