Modern Theory of the Development of Adult Acquired Flat Foot and an Updated Spring Ligament Classification System

Pasapula, Chandra; Cutts, Steven

doi:10.4172/2329-910x.1000247

Cited by 16 publications

(19 citation statements)

References 16 publications

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“…However, there has been controversy among researchers in many aspects. Johnson and Strom classification system does not take into consideration preexisting planovalgus 36 and overemphasized the role of PTTD to describe stages as a linear progression. It has been refuted whether stage I inevitably progresses to stage II, and at present it is generally understood that the disease progression is not linear starting from stage I to stage IV.…”

Section: Discussionmentioning

confidence: 99%

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity

et al. 2021

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Background: Historical concept of flatfoot as posterior tibial tendon dysfunction (PTTD) has been questioned. Recently, the consensus group published a new classification system and recommended renaming PTTD to Progressive Collapsing Foot Deformity (PCFD). The new PCFD classification could be effective in providing comprehensive information on the deformity. To date, there has been no study reporting intra- and interobserver reliability and the frequency of each class in PCFD classification. Methods: This was a single-center, retrospective study conducted from prospectively collected registry data. A consecutive cohort of PCFD patients evaluated from February 2015 to October 2020 was included, consisting of 92 feet in 84 patients. Classification of each patient was made using characteristic clinical and radiographic findings by 3 independent observers. Frequencies of each class and subclass were assessed. Intraobserver and inteobserver reliabilities were analyzed with Cohen kappa and Fleiss kappa, respectively. Results: Mean sample age was 54.4, 38% was male and 62% were female. 1ABC (25.4%) was the most common subclass, followed by 1AC (8.7%) and 1ABCD (6.9%). Only a small percentage of patients had isolated deformity. Class A was the most frequent component (89.5%), followed by C in 86.2% of the cases. Moderate interobserver reliability (Fleiss kappa = 0.561, P < .001, 95% CI 0.528-0.594) was found for overall classification. Very good intraobserver reliability was found (Cohen kappa = 0.851, P < .001, 95% CI 0.777-0.926). Conclusion: Almost half (49.3%) of patients had a presentation dominantly involving the hindfoot (A) with various combinations of midfoot and/or forefoot deformity (B), (C) with or without subtalar joint involvement (D). The new system may cover all possible combinations of the PCFD, providing a comprehensive description and guiding treatment in a systematic and individualized manner, but this initial study suggests an opportunity to improve overall interobserver reliability. Level of Evidence: Level III, retrospective diagnostic study.

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Section: Discussionmentioning

confidence: 99%

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity

et al. 2021

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“…35 Although it has been classically thought that PCFD occurs secondary to PTTD, 35,[38][39][40][41][42] it has also been hypothesized that PCFD triggered by the attenuation or rupture of the SL or DL leads to increased strain on the PTT and the progression of PTTD. 2,43,44 The current work provides support for both of these potential mechanisms because when one of the SL, DL, or PTT fails, the remaining ones will be overloaded, leading to degeneration and eventual failure over time. [6][7][8][9] In other words, PTTD could be either primary or secondary to collapsing foot deformity that is caused by ligament attenuation.…”

Section: Discussionmentioning

confidence: 74%

A computational model of force within the ligaments and tendons in progressive collapsing foot deformity

Malakoutikhah

Madenci

Latt

2022

Journal Orthopaedic Research

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Progressive collapsing foot deformity results from degeneration of the ligaments and posterior tibial tendon (PTT). Our understanding of the relationship between their failures remains incomplete. We sought to improve this understanding through computational modeling of the forces in these soft tissues. The impact of PTT and ligament failures on force changes in the remaining ligaments was investigated by quantifying ligament force changes during simulated ligament and tendon cutting in a validated finite element model of the foot. The ability of the PTT to restore foot alignment was also evaluated by increasing the PTT force in a foot with attenuated ligaments and comparing the alignment angles to the intact foot. We found that failure of any one of the ligaments led to overloading the remaining ligaments, except for the plantar naviculocuneiform, first plantar tarsometatarsal, and spring ligaments, where removing one led to unloading the other two. The combined attenuation of the plantar fascia, long plantar, short plantar, and spring ligaments significantly overloaded the deltoid and talocalcaneal ligaments. Isolated PTT rupture had no effect on foot alignment but did increase the force in the deltoid and spring ligaments. Moreover, increasing the force within the PTT to 30% of body weight was effective at restoring foot alignment during quiet stance, primarily through reducing hindfoot valgus and forefoot abduction as opposed to improving arch collapse. Our findings suggest that early intervention might be used to prevent the progression of deformity. Moreover, strengthening the PTT through therapeutic exercise might improve its ability to restore foot alignment.

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“…While primarily the tendon of TP has been implicated in the causation of PCFD, Pasapula et al 23 proposed an alternative hypothesis, suggesting involvement of spring ligament as a primary cause, and attenuation of TP tendon as secondary to that.…”

Section: Discussionmentioning

confidence: 99%

Revisiting the inferior supports of Chopart joint complex

Athavale,

Kotgirwar,

Lalwani

2024

Bone Jt Open

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AimsThe Chopart joint complex is a joint between the midfoot and hindfoot. The static and dynamic support system of the joint is critical for maintaining the medial longitudinal arch of the foot. Any dysfunction leads to progressive collapsing flatfoot deformity (PCFD). Often, the tibialis posterior is the primary cause; however, contrary views have also been expressed. The present investigation intends to explore the comprehensive anatomy of the support system of the Chopart joint complex to gain insight into the cause of PCFD.MethodsThe study was conducted on 40 adult embalmed cadaveric lower limbs. Chopart joint complexes were dissected, and the structures supporting the joint inferiorly were observed and noted.ResultsThe articulating bones exhibit features like a cuboid shelf and navicular beak, which appear to offer inferior support to the joint. The expanse of the spring ligament complex is more medial than inferior, while the superomedial part is more extensive than the intermediate and inferoplantar parts. The spring ligament is reinforced by the tendons in the superomedial part (the main tendon of tibialis posterior), the inferomedial part (the plantar slip of tibialis posterior), and the master knot of Henry positioned just inferior to the gap between the inferomedial and inferoplantar bundles.ConclusionThis study highlights that the medial aspect of the talonavicular articulation has more extensive reinforcement in the form of superomedial part of spring ligament and tibialis posterior tendon. The findings are expected to prompt further research in weightbearing settings on the pathogenesis of flatfoot.Cite this article: Bone Jt Open 2024;5(4):335–342.

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Modern Theory of the Development of Adult Acquired Flat Foot and an Updated Spring Ligament Classification System

Cited by 16 publications

References 16 publications

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity

A computational model of force within the ligaments and tendons in progressive collapsing foot deformity

Revisiting the inferior supports of Chopart joint complex

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