Self-perceived foot function and pain in children and adolescents with flexible flatfeet – Relationship between dynamic pedobarography and the foot function index

Hösl, Matthias; Böhm, Harald; Oestreich, Claudia; Dussa, Chakravarthy U.; Schäfer, Christel; Döderlein, Leonhard; Nader, Sean; Fenner, Verena

doi:10.1016/j.gaitpost.2020.01.014

Cited by 12 publications

(12 citation statements)

References 25 publications

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“…This study provides new insights in diagnostical approaches by using pedobarography which helps to dynamically assess foot alignment. In addition to clinical examination pedobarography improves the three-dimensional understanding of FFF and its treatment [ 3 , 4 , 5 ]. Comparable studies to discuss the observation in the context of actual literature are rare.…”

Section: Discussionmentioning

confidence: 99%

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Subtalar Arthroereisis for Flexible Flatfoot in Children—Clinical, Radiographic and Pedobarographic Outcome Comparing Three Different Methods

et al. 2021

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Subtalar arthroereises (STA) is a minimally invasive and reversible surgery to correct symptomatic flexible flatfoot (FFF) in children. Various techniques were described either applying expandable sinus tarsi implants or lateral calcaneus stop screws. Studies comparing the outcome of STA with different devices are rare. This retrospective single-center cohort study analyzes the results of STA using three different implants. 113 STA were performed in 73 consecutive patients (28 females). Mean age at surgery was 10.8 years (range 5–16). Mean follow-up was 29.0 months (range 1–111). In 21 feet the non-absorbable Kalix® endorthesis and in 56 feet the absorbable Giannini endorthesis were applied. Subtalar extraarticular screw arthroereises (SESA) was conducted in 36 feet. Clinical, radiographic and pedobarographic parameters were analyzed. No intraoperative complications were observed. All three procedures achieved comparable improvements of the clinical, radiographic and pedobarographic parameters. The mean foot function index (FFI) improved from 36.4 (range 12–63) to 22.8 (range 2–55). The mean preoperative calcaneal inclination angle and the lateral talocalcaneal angle improved from 9.5° (range 0–22) and 42.3° (range 21–62) to 12.8° (range 0–26) and 37.6° (range 15–56), respectively. Pedobarographically determined values of the arch index, the medial midfoot contact area and the medial forefoot peak pressure decreased. In contrast to SESA (1/36, 3%), a higher incidence of implant-related complications was observed using Kalix® (6/21, 29%) and Giannini (10/56, 8%) sinus tarsi implants. Peroneal muscle contractures only occurred in the SESA group (4/36, 11%). Premature removal due to treatment-related complications was necessary in 6/21 Kalix® implants (29%), 4/56 Giannini implants (7%) and 4/36 SESA implants (11%). Implant choice for treatment of painful FFF in children with STA seems to play a subordinate role. Clinical, radiographic and pedobarographic outcomes are comparable between the applied implants. Surgeons and patients should be aware of the different spectrum of implant-related complications. Treatment can be reliably monitored by radiation-free pedobarography providing dynamic information about the deformity.

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Section: Discussionmentioning

confidence: 99%

“…Standard assessment includes clinical and radiological examination. Modern technology such as digital pedobarography has helped to improve understanding and treatment of the deformity [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Subtalar Arthroereisis for Flexible Flatfoot in Children—Clinical, Radiographic and Pedobarographic Outcome Comparing Three Different Methods

et al. 2021

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“…Dynamic pedobarography evaluates these variables at specific moments in gait phases. Additionally, it provides the foot contact pattern, plantar pressure distribution such as peak pressure time or pressure-time integrals, and the center of pressure (CoP) trajectories [4,38]. Hellstrom et al [39] have proposed a division into the spatiotemporal variables (step and stride length, stride width, step time, speed, ground contact duration, and cadence) and the force and pressure variables (peak forces and pressures, mean plantar pressure, CoP, speed of CoP shift, contact region, force-time integral, arch index, and the foot posture).…”

Section: Pedobarographic Measurementsmentioning

confidence: 99%

“…Although often neglected as being of little medical importance, foot disorders may be crippling at any age, adversely affect the quality of life, and hinder the musculoskeletal development and socioemotional development of children [1,2]. Examples are the flat foot or platypodia, one of the commonest disorders [3,4], and more serious conditions such as a discrepancy in leg length, causing a differential overload of both legs, which destabilize posture and may lead to disability [5]. The diagnostic methods for foot disorders are not standardized or unified, appear uncertain and troublesome, and are often guided empirically or by healers' experience rather than being evidence-based.…”

Section: Introductionmentioning

confidence: 99%

Pedobarography: A Review on Methods and Practical Use in Foot Disorders

2021

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Pedobarographic examination is a non-invasive method that enables the quantitative and qualitative evaluation of plantar pressure distribution, notably the plantar pressure distribution, referring to the function of the entire musculoskeletal system. This is a scoping review that aims to update knowledge on the practical use of pedobarography in foot disorders. We also attempted to systematize the methodological principles of conducting the pedobarographic examination. We searched Medline/PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews for the articles on the methodology of pedobarography. The search encompassed clinical trials, randomized controlled trials, meta-analyses, and reviews published in English between January 1982 and February 2021. The literature distinguishes three different types of examinations: static, postural, and dynamic. The rationale for each is presented. The review pointedly shows the unique use of pedobarography for the quantitative and qualitative evaluations of the plantar pressure distribution. It also points to the need for enhancing the awareness among medical professionals of the method and advantages it provides for patient management. Shortcomings of the method are discussed of which the difficulty in establishing the cause-and-effect relationship of foot disorders is the most disturbing as it limits the comparative verification of results of different studies. There also appears a need for developing standardized algorithmic protocols and recommendations to seamlessly perform pedobarography in clinical settings, which would help make wider use of this valuable tool.

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“…Footprint analysis and FPI-6 are the most widely used clinical methods for assessment of static foot posture, 10 , 14 however, disagreement persists over whether footprint analysis can evaluate foot posture. Some studies even doubt whether a footprint can accurately represent MLA, 22 , 23 however, several investigations have shown that footprint indices correlate with radiographic measures. Kanatli et al 24 reported that footprint analysis is as accurate as radiologic measurements, Villarroya et al 25 found a significant correlation between CA and Chippaux-Smirak index (CSI) methods and radiography-based talus–first metatarsal (T1MA) and calcaneal inclination angles.…”

Section: Introductionmentioning

confidence: 99%

Comparing Validity and Diagnostic Accuracy of Clarke’s Angle and Foot Posture Index-6 to Determine Flexible Flatfoot in Adolescents: A Cross-Sectional Investigation

Hegazy¹,

Aboelnasr²,

Abuzaid³

et al. 2021

JMDH

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Objective Clinically, the foot posture index-6 (FPI-6) and Clarke’s angle (CA) are widely utilized to assess static foot posture; however, due to scarcity of scientific evidence, clinicians continue to debate the validity and diagnostic accuracy of these measures in children and adolescents. This study aimed to evaluate and compare the validity and diagnostic accuracy of the FPI-6 and CA in determining adolescents’ flexible flatfoot between ages of 12 and 18 years, considering radiographic investigation as a reference standard measure. Design Cross-sectional study. Setting Governmental hospitals. Participants and Methods A sample of 460 people (920 feet) with flexible flatfoot between the ages of 12 and 18 (15.23 ± 0.84 years) was enrolled in the study. The findings of the investigated measures were compared to the reference standard radiographic measure and plotted on the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was determined as a measure of FPI-6 and CA diagnostic accuracy. Intra-rater reliability, sensitivity, specificity, predictive values, and likelihood ratios of FPI-6 and CA were calculated and compared. The post-test probability of flatfoot was determined using the Fagan nomogram. Results CA had a substantially higher intra-rater reliability (ICC=0.99) than the FPI-6 (ICC=0.96), with p-value of 0.001. CA has greater sensitivity (98%) than FPI-6, as well as a superior specificity (99%), positive predictive value (98%), negative predictive value (98.9%), positive likelihood ratio (97), and a lower negative likelihood ratio (0.02). CA had such an area under ROC curve of 0.98 with a 95% confidence interval of 0.95–1.00, while FPI-6 had an area under ROC curve of 0.80 with a 95% confidence interval of (0.77–0.85). Conclusion FPI-6 and Clarke’s angle are both valid and diagnostically accurate clinical tests for flatfoot detection, with Clarke’s angle outperforming FPI-6 in adolescents aged 12 to 18 years with a normal BMI.

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Self-perceived foot function and pain in children and adolescents with flexible flatfeet – Relationship between dynamic pedobarography and the foot function index

Cited by 12 publications

References 25 publications

Subtalar Arthroereisis for Flexible Flatfoot in Children—Clinical, Radiographic and Pedobarographic Outcome Comparing Three Different Methods

Subtalar Arthroereisis for Flexible Flatfoot in Children—Clinical, Radiographic and Pedobarographic Outcome Comparing Three Different Methods

Pedobarography: A Review on Methods and Practical Use in Foot Disorders

Comparing Validity and Diagnostic Accuracy of Clarke’s Angle and Foot Posture Index-6 to Determine Flexible Flatfoot in Adolescents: A Cross-Sectional Investigation

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