Osteotomía lateral de calcáneo en el tratamiento de la enfermedad de Müller-Weiss / Lateral osteotomy of the calcaneus in the treatment of Müller-Weiss disease

Resumen: Introducción: La afección deformante del hueso navicular conocida como enfermedad de Müller-Weiss (EMW) es una enfermedad rara. Los pacientes presentan dolor crónico en la articulación talonavicular y un pie plano paradójico con retropié varo. Objetivo: Analizar los resultados clínicos de la osteotomía valguizante de calcáneo aplicada a pacientes con EMW. Material y métodos: Estudio observacional, retrospectivo, realizado en dos centros hospitalarios. La serie consta de nueve casos en ocho pacientes, todos ellos con enfermedad de Müller-Weiss sintomática, fueron tratados mediante osteotomía valguizante de calcáneo entre 2012 y 2017, con un seguimiento medio de cuatro años (dos a seis). La edad media fue de 62 años (50-75). En todos los pacientes se midieron los ángulos de Costa-Bartani (CB), el ángulo de Kite y la inclinación calcánea (IC). Además, se utilizó la escala Manchester Oxford (MO) para medir la satisfacción postquirúrgica de los pacientes. Resultados: Todos los pacientes refieren haber mejorado en su dolor, obteniendo una puntuación postoperatoria media de 32.54 puntos (15.62-53.75) en la escala Manchester Oxford. En 66% de los pacientes el ángulo CB mejoró, al igual que en el ángulo de Kite en 89% y la IC en 33%. Conclusión: La mejoría en el dolor de los pacientes de nuestra serie no está acompañada por cambios radiológicos en la misma proporción, es una técnica sencilla y sin complicaciones en nuestro seguimiento.

Abstract: Introduction: The deforming condition of the navicular bone known as Müller-Weiss disease (MWD) is a rare disease. Patients present with chronic pain in the talonavicular joint and a paradoxical flat foot with a varo hindfoot. Objective: To analyze the clinical results of a lateral osteotomy of calcaneus applied to patients with MWD. Material and methods: Retrospective observational study carried out in two hospitals. The series consists of nine cases in eight patients, all of them with symptomatic Müller-Weiss disease, treated by lateral osteotomy of the calcaneus between 2012 and 2017, obtaining an average follow-up of 4 years (2-6). The mean age was 62 years (50-75). In all patients, Costa-Bartani angles (CB), Kite angle and Calcaneal Inclination (CI) were measured. In addition, the Manchester Oxford Scale (MO) to measure the post-surgical satisfaction of patients. Results: All patients report having improved their pain by obtaining a postoperative score on the mean Manchester Oxford scale of 32.54 points (15.62-53.75). In 66% of patients the CB angle improves, the Kite angle in 89% and the CI in 33%. Conclusion: The improvement in the pain of the patients in our series is not accompanied by radiological changes in the same proportion, it is a simple and uncomplicated technique in our follow-up.

An Intelligent Arch Diagnostic Method Based on Principal Component Analysis of Plantar Pressure Distribution / 医用生物力学

Objective According to clinical demand of quantification evaluation on flat foot and high arch, an intelligent and rapid method to diagnose arch shape based on principal component analysis (PCA) of plantar pressure is proposed, and its clinic validity is tested. Methods Volunteers diagnozed as abnormal arch and healthy arch were included in this study, and a portable intelligent arch test system was designed and developed. By adopting thin-firm piezoresistive sensor array with 44 rows, 52 columns of sensing units, the system could collect plantar pressure distribution data from the subjects under static standing. Foot axis could be fitted automatically by using the self-programmed PCA, so that foot diagnosis was completed with diagnostic report. The plantar pressure results from the system were compared with those from the existing plantar pressure acquisition device, so as to verify precision of collected data. The accuracy of the diagnosis algorithm for flat foot, high arch and healthy foot was verified through comparison with clinical diagnosis. Results The result of the system had a good correlation with that of the existing plantar pressure acquisition device, the deviation of contact area acquired by the system was smaller than 3.2%, and the angle deviation of the fitted foot axis with clinically defined angel was less than 1°. The system was capable of making diagnosis on arch shape that was 92.6% consistent with the clinical diagnosis. Conclusions PCA is introduced to automatically fit foot axis to achieve the purpose of fast and accurate extraction of foot arch information. The method can be used to assist clinical diagnosis of flat foot and high arch foot, and contribute to quantative analysis on foot arch deformity and its pathogenesis study.

Prevalence of Flat Foot using Plantar Arch Index among Young Adults of Delta State, Nigeria

@#Introduction: Traditionally, feet are classified as high, normal or low arched. Studies on flat foot (pes planus) have been conducted in different ethnic groups in Nigeria but none has been conducted among young Ika adults. This study is therefore aimed at determining the prevalence of flat foot using plantar arch index among young adults of Ika. Methods: A total of 384 subjects comprising 199 females and 185 males aged 18-37 years participated in the study. Foot prints of subjects were obtained using the simple ink and duplicating paper method. The Plantar Arch Index was calculated by dividing the foot prints in three equidistant regions excluding the toes. The index value was the ratio between the area of the mid foot and the total area of the foot print. Descriptive statistics for each variable included mean and standard deviation while statistical tools included independent sample t-tests and paired samples test respectively. Results: After data analyses, the total prevalence of flat foot was 8.6% while a total of 24(6.3%) males had flat foot on their right foot while 16(4.2%) had on their left. However, 14(3.6%) and 12(3.1%) females had flat foot on their right and left foot sides respectively. The prevalence of Pes planus was significantly higher among males (P< 0.05) than their female counterparts on both foot sides. Furthermore, there was a statistically significant difference between flat and normal foot on both foot sides while the difference between flat foot of the right side and that of the left was not statistically significant. Conclusion: Being the first of its kind in Ika, this study is therefore important to the Orthopaedist and Podiatrist in Nigeria for diagnosis and treatment choices of foot deformities amongst young adults of Ika.

Deformidades de los pies en niños / Foot deformities in children

Las alteraciones en los pies son una consulta frecuente en ortopedia pediátrica. La gran mayoría corresponde a condiciones que no constituyen patología y habitualmente no necesitan tratamiento, como el pie plano flexible. Por otro lado, existen deformidades patológicas que necesitarán un adecuado estudio y tratamiento. Según su morfología podemos clasificarlas en cavo-varo, plano-valgo y misceláneas. Su origen puede ser congénito o adquirido y de diversas etiologías, destacando el pie bot, metatarso varo, hallux valgus juvenil y aquellas secundarias a enfermedades neuromusculares, entre otras. Conocer la historia natural de cada deformidad nos permite decidir el momento más adecuado para cada tratamiento. Los antecedentes mórbidos y perinatales del paciente son muy importantes, así como el nivel de actividad física y/o deportiva. El examen físico debe incluir observar la marcha, extremidades inferiores, tobillo y pie. En el pie se debe analizar cada segmento por separado (antepié, mediopié y retropié) y las articulaciones respectivas. Es muy importante distinguir entre deformidades rígidas y flexibles. El tratamiento incluye la observación (condiciones benignas y autolimitadas), calzado adecuado, insertos plantares, órtesis, yesos correctores, cirugía de partes blandas y cirugía ósea; todo complementado por un adecuado programa de rehabilitación funcional y deportivo.

Foot disorders are a frequent cause of consultation in pediatric orthopaedics. The vast majority correspond to conditions that don't constitute pathology and usually don ́t need treatment, such as flexible flat foot. On the other hand, there are pathological deformities that will require a proper study and treatment. According to their morphology we can classify them in cavo-varus, plano-valgus and miscellaneous. Its origin can be congenital or acquired and due to various etiologies, highlighting clubfoot, metatarsus adductus, juvenile hallux valgus and those secondary to neuromuscular diseases, among others. Knowing the natural history of each deformity allows us to decide the most appropriate time for each treatment. Patient's morbility and perinatal history is very important, as well as their level of physical and/or sports activity. Physical exam should include gait obsevation, lower limbs, ankles and feet. In the foot, each segment should be analyzed separately (forefoot, midfoot and hindfoot) and their joints. It ́s very important to distinguish between rigid and flexible deformities. Treatments include observation (benign and self-limited conditions), adequate footwear, insoles, orthosis, corrective casting, soft tissue surgery and bone surgery; all complemented by an adequate functional and sports rehabilitation programs

Surface Electromyography Characteristics of Lower Extremities of Flat Feet Walking on Stairs / 中国康复理论与实践

Objective:To explore the characteristics of surface electromyography (sEMG) of flat foot in lower extremity muscles when walking flat and stairs. Methods:From March to June, 2019, 20 male subjects (10 with normal feet, 10 with flat feet) were recruited to use sEMG system of Noraxon to collect the average amplitude and integral electromyography of sEMG of tibialis anterio (TA), medialis gastrocnemius (MG), lateralis gastrocnemius (LG), rectus femoris (RF) and biceps femoris (BF) during the flat ground walking and the stair walking. Results:As ascending stairs, the average amplitudes of TA, RF and BF of flat feet were higher than that of normal feet (|t| > 2.461, P < 0.05); as descending stairs, the average amplitude of MG of flat feet was higher (t = -1.976, P < 0.05), and the average amplitude of BF of flat feet was lower than that of normal feet (t = 2.298, P < 0.05). Compared with ground walking, the average amplitudes of TA, RF and BF of flat feet increased when ascending stairs (|t| > 2.257, P < 0.05), and the average amplitudes of RF and BF increased when descending stairs (|t| > 2.630, P < 0.05). As ascending stairs, the integral electromyography of TA, MG, LG, RF and BF of flat feet was higher than that of normal feet (|t| > 2.492, P < 0.01); as descending stairs, the integral electromyography of MG of flat feet was higher (t = -5.271, P < 0.05), and the integral electromyography of BF was lower (t = 2.685, P < 0.05) than that of normal feet. Compared with ground walking, the integral electromyography of TA, MG, LG and BF increased when ascending stairs (|t| > 2.088, P < 0.05), and the integral electromyography of TA, LG and RF decreased when descending stairs (t > 2.059, P < 0.05). Conclusion:The lower extremities muscles of flat foot compensate for the excessive rotation of the joint when walking stairs.

Plantar pressure distribution evaluation in children with down syndrome from 2 to 5 years old / Avaliação da distribuição das pressões plantares em crianças com síndrome de down entre 2 e 5 anos / Evaluación de la distribución de las presiones plantares en niños con síndrome de down entre 2 y 5 años

Abstract Introduction: Some peculiar features of Down Syndrome (DS), such as ligament laxity, hypotonia, delay in gait acquisition, among others, may generate alterations in the distribution of plantar pressures, modifying the plantar support. Objective: To verify whether there are differences in the evaluation of plantar pressure distributions in standing posture between the measurement instruments (Baropodometer, SAPO, and Radiography). Method: This was a cross-sectional study, evaluating ten children with SD and ten children with normal development (ND), aged from two to five years old. Bio-photogrammetry, baropodometry, and foot radiography were used to assess the plantar pressure distribution. Kappa analysis was used to evaluate the agreement index between the different instruments. Results: Children with DS and ND had a higher prevalence of pronated feet in all three instruments, with poor to substantial agreement among the instruments. Conclusion: According to this study instruments, there was a greater prevalence of pronated feet in the two groups . Differences in the evaluation of the distribution of plantar pressures in the standing posture between the Baropodometer, SAPO, and radiography were observed. These instruments should be used in a complementary manner, as they propose to evaluate different aspects of the feet alignment.

Resumo Introdução: Algumas características peculiares da Síndrome de Down (SD), como a frouxidão ligamentar, hipotonia, atraso na aquisição da marcha, dentre outras, podem gerar alterações na distribuição das pressões plantares, modificando o apoio plantar. Objetivo: Verificar se existem diferenças na avaliação da distribuição das pressões plantares, na postura de pé, entre os instrumentos de mensuração Baropôdometro, SAPO e Radiografia. Método: Estudo transversal que avaliou dez crianças com SD e dez crianças com desenvolvimento normal (DN), com idade entre dois e cinco anos. Para avaliação da distribuição das pressões plantares foram utilizados a biofotogrametria, baropodometria e radiografia dos pés. Foi utilizado a análise Kappa para avaliar o índice de concordância entre os diferentes instrumentos. Resultados: As crianças com SD e DN apresentaram maior prevalência de pés pronados nos três instrumentos, havendo concordância de pobre a substancial entre os instrumentos. Conclusão: Houve maior prevalência de pés pronados nos dois grupos de acordo com os instrumentos utilizados neste estudo. Foram encontradas diferenças na avaliação da distribuição das pressões plantares na postura de pé entre o Baropôdometro, SAPO e Radiografia, devendo estes instrumentos serem usados de forma complementar, já que se propõem a avaliar aspectos distintos do alinhamento dos pés.

Resumen Introducción: Algunas características peculiares del Síndrome de Down (SD), como la flojedad ligada, hipotonía, retraso en la adquisición de la marcha, entre otras, pueden generar alteraciones en la distribución de las presiones plantares, modificando el apoyo plantar. Objetivo: Verificar si existen diferencias en la evaluación de la distribución de las presiones plantares, en la postura de pie, entre los instrumentos de medición Baropôdometro, SAPO y Radiografía. Método: Estudio transversal que evaluó diez niños con SD y diez niños con desarrollo normal (DN), con edad entre dos y cinco años. Para la evaluación de la distribución de las presiones plantares se utilizaron biofotogrametría, baropodometría y radiografía de los pies. Se utilizó el análisis Kappa para evaluar el índice de concordancia entre los diferentes instrumentos. Resultados: Los niños con SD y DN presentaron mayor prevalencia de pies pronados en los tres instrumentos, habiendo concordancia de pobre a sustancial entre los instrumentos. Conclusión: Hubo una mayor prevalencia de pies pronados en los dos grupos de acuerdo con los instrumentos utilizados en este estudio. Se encontraron diferencias en la evaluación de la distribución de las presiones plantares en la postura de pie entre el Baropôdometro, SAPO y Radiografía, debiendo estos instrumentos ser utilizados de forma complementaria, ya que se proponen a evaluar aspectos distintos de la alineación de los pies.

Análisis biomecánico a través de simulación numérica de la ruptura del tendón del tibial posterior en el pie plano valgo: estudio en cadáver / Biomechanical analysis through numerical simulation of rupture of the tibial posterior tendon in valgus flat foot: a cadeveric study

Resumen: La insuficiencia del tendón del tibial posterior es la causa adquirida de dolor más común relacionada con la deformidad de pie plano valgo en adultos. El pie plano adquirido por el adulto es una deformidad sintomática muy dolorosa que resulta de un estiramiento gradual (atenuación) del tendón del tibial posterior, así como de los ligamentos que sostienen el arco de la planta del pie. El dolor progresivo en el pie plano adquirido por el adulto afecta cuatro veces más a las mujeres que a los hombres. Algunos factores que contribuyen a incrementar el riesgo del pie plano adquirido en el adulto son la diabetes, la hipertensión y la obesidad. Se piensa que la combinación de los eventos siguientes es la causa del pie plano adquirido por el adulto. La clasificación de Johnson Strom modificada por Mayerson lo evalúa en cuatro estadios. Este estudio se dividió en tres etapas: etapa 1: disección y análisis tridimensional del tendón, etapa 2: aplicación de herramientas de bioingeniería para determinar las causas de ruptura del tendón del tibial posterior y etapa 3: evaluación de 24 pacientes con enfermedad de pie plano valgo para describir la deformidad.

Abstract: The insufficiency of the posterior tibial tendon is the most common acquired cause of pain related to valgus flatfoot deformity in adults. The acquired flatfoot adult is a very painful symptomatic deformity resulting from a gradual stretching (attenuation) of the posterior tibial tendon and ligaments that support the arch of the foot. The progressive pain acquired flatfoot adult affects four times more women than men. Some factors that contribute to increased risk of acquired flatfoot in adults, are diabetes, hypertension and obesity. It is thought that the combination of the following events is the cause of acquired flatfoot adult. Johnson Strom classification modified by Mayerson evaluates in 4 stages. This study was divided into 3 stages: Stage 1: Dissection and three-dimensional analysis of the tendon, Step 2: Application of tools bioengineering to determine the causes of rupture of the tibial tendon: Stage 3: Evaluation of 24 patients with flatfoot disease valgus for describe the deformity.

Caracterización morfológica del arco plantar longitudinal medial del pie en una población chilena / Morphological characterization of the medial plantar longitudinal arch foot in a Chilean population

El arco plantar longitudinal medial del pie (APLM) es el componente más importante en estática y dinámica de la bóveda plantar. Su altura define pies normales, planos y cavos, estos últimos son factores predisponentes de lesiones. El objetivo de este estudio fue describir y relacionar en una población de estudiantes universitarios chilenos la prevalencia de pies normales, cavos y planos según índice de masa corporal (IMC), sexo y actividad física (AF) semanal y la distribución de asimetrías entre pies. Se estudió a 209 sujetos (128 hombres y 81 mujeres), estudiantes universitarios, cuya edad, estatura, peso e IMC fue de 20,4 años (±3,4); 1,68 m (±0,09); 67,6 Kg (±12,4) y 23,77 (±3,0) respectivamente. Por medio de cuestionario se determinó los hábitos de AF de la muestra. La impresión plantar se obtuvo mediante fotopodoscopía, la cual fue evaluada empleando el Arch Index (AI) de Cavanagh y Rodgers. Los hombres presentan mayor prevalencia de pie plano (31,3 % contra 11,1 %). Hay correlación positiva estadísticamente significativa entre AI e IMC en ambos sexos. Se obtuvo mayor correlación entre AI izquierdo y AF en hombres y mujeres con significancia estadística. El 31,25 % de los hombres y el 37,04 % de las mujeres presentaron asimetrías en APLM. Hombres con IMC normal tienen 64,20 % de pies asimétricos. Las mujeres que practican entre 6 y 10 horas de AF a la semana presentan 50,98 % de pies asimétricos. El IMC se relaciona con una disminución de la altura del APLM, se sugiere el control de esta variable en sujetos con diagnóstico de pie plano flexible y pie plano valgo. La práctica de AF se relaciona con aumento de la altura del APLM en hombres y mujeres y se sabe que también contribuye a disminuir el IMC, actuando en concordancia hacia estas dos variables.

The (MPLA) is the most important component in statics and dynamics of the vault plant. Its height defines normal, flat and cavus feet, which are predisposing factors for injuries. The objective of this research was to describe and relate in a population of Chilean university students the prevalence of normal, cavus and flat feet according to body-mass index (BMI), sex, and weekly physical activity (PA) and the distribution of asymmetries between feet. 209 subject were studied (128 men and 81 women), university students, whose age, height, weight and BMI was of 20.4 years (±3.4); 1,68 m (±0.09); 67.6 kg (±12.4) and 23.77 (±3.0) respectively. The PAs habits of the sample were determined by means of questionnaire. The footprint is obtained by photo-podoscopy, which was evaluated by the Arch Index (AI) of Cavanagh and Rodgers. Men have higher prevalence of flat foot (31.3 % against 11.1 %). There are both statistically significant positive correlations between AI and BMI in both sexes. Greater correlation between left AI and PA in both men and women was obtained with statistical significance. The 31.25 % of men and 37.04 % of women presented asymmetries in MPLA. Men with normal BMI have 64.20 % of asymmetric feet. Women that practice between 6 and 10 hours of PA a week presented 50.98 % of asymmetric feet. The BMI is related to a decrease of the height of MPLA, suggesting the control of this variable in subjects with flexible flat foot and valgus flat foot diagnosis. The practice of PA is related to the height of the MPLA increased in men and women and it is known that it also helps to reduce BMI, acting in accordance to these two variables.

Relación entre hiperlaxitud articular, dismetría de miembros inferiores y control postural con los trastornos posturales / Relationship between joint hypermobility, lower limb asymmetry and postural control with postural abnormalities

Objetivos: Determinar si existe relación entre hiperlaxitud articular, dismetría de miembros inferiores y la estabilidad ocontrol postural en bipedestación con los trastornos posturales en adolescentes. Material y métodos: Estudio relacional transversal,realizado en el Instituto Nacional de Rehabilitación “Dra. Adriana Rebaza Flores” Amistad Perú-Japón,Chorrillos-Perú. Participaron todos los estudiantes del 5º año de secundaria de un colegio privado de la ciudad deLima. La hiperlaxitud articular (HA) se evaluó con el score de Beighton; la dismetría de miembros inferiores (DMI),con medición en ortoradiografía; el control postural (CP) con posturografía estática usando una plataforma ISTFOOTWORK; el apoyo plantar (pie plano y pie cavo) con baro-podometría; la escoliosis e hiperlordosis lumbar conmedición radiográfica del ángulo de COBB y de lordosis...

Objectives: To determine an association between joint hypermobility, lower limb asymmetry and postural control withpostural abnormalities in adolescents. Methods: Cross-sectional study conducted at the National Rehabilitation Institute“Dra. Adriana Rebaza Flores” Amistad Perú-Japón, Chorrillos-Perú. All students of the 5th year of a private secondaryschool in Lima participated in the study. Joint hypermobility (JH) was assessed with the Beighton´score; lower limbasymmetry (LLA) was evaluated with X-ray; postural control (PC) was evaluated with static posturography using ISTFOOTWORK platform; plantar surface (flat foot and cavus foot) was evaluated with baro-podometry; scoliosis andlumbar hyperlordosis were measured with X-ray measuring the COBB angle...

A Study on Prevalence of Flat Feet Among School Children in Kanchipuram Population.

Background: A flexible flatfoot is considered to be a variation of a normal foot. Any deviation from the anatomical plantigrade foot is a deformed foot. Some of the deformities of the foot are: Flat Foot. The normal concavity due to the medial longitudinal arch is absent. High Arch Foot - A normal foot has a medial longitudinal arch which is higher. Materials and Methods: A total population of 625, in age ranging from 5 year to 9 years in Kanchipuram district was chosen. Each individual was made to sit and the foot was brought in contact with the Foot Impression gaining Kit on white sheets in standing posture. Results: The flat feet and high arch feet evaluation was obtained by means of foot prints and the plantar arch index was established. The mean values of plantar arch index within the age group were stable and ranges from 0.72 to 0.73. With plantar arch indices greater than 1.15 was regarded as flatfeet and less than 0.10 was regarded as High arch feet. Discussion: In normal feet with presence of an arch, the stress will be distributed in an even manner so that the person will not experience any kind of pain. Under an abnormal condition that occurs due to lack of stretching of muscles, bones and tendons, there will be absence of arch among these people. In this condition, all the weight will be concentrated in smaller area on the feet and generates a lot more pain than normal. This condition might occur in both children and adults. In some people both feet will be flat and in some only one foot will be flat. Conclusion: Flat foot is highly prevalent in the ages between 5-9. The average values for plantar arch indices are stable and ranges from 0.72 to 0.73 in our sample regarded as Normal foot. Plantar arch index > 1.15 is regarded as Flat foot. Plantar arch index < 0.10 is regarded as High arch foot.

The impact of foot arch height on quality of life in 6-12 year olds / Impacto de la altura del arco del pie en la calidad de vida, de escolares entre 6-12 años

Objective: To determine whether arch height has an effect on the health-related quality of life of schoolchildren. Methods: One hundred and thirteen schoolchildren attended an out-patient centre where self-reported data were recorded, their feet were classified into one of three groups according to their arch index (high, normal or low) and the scores obtained from the Foot Health Status Questionnaire (FHSQ - Spanish version) were compared. Results: The groups with high, low and normal arch recorded lower scores in Section One for the general foot health and footwear domains and higher scores in foot pain and foot function. In Section Two they obtained lower scores in general health and higher scores in physical activity, social capacity and vigor. Conclusions: Comparison of the scores obtained reveals that arch height has a negative impact on quality of life. Given the limited extent of available evidence in respect of the aetiology and treatment of foot diseases and deformities, these findings reveal the need to implement programmes to promote foot health and carry out further research into this commonly occurring disabling condition.

Objetivo: Conocer si la altura del arco del pie tiene impacto en la calidad de vida relacionada con la salud en la etapa escolar. Métodos: Ciento trece escolares acudieron a un centro ambulatorio donde se registraron datos autoinformados, se clasificaron los pies en función de los valores del índice del arco en tres grupos (aumentado, disminuido y normal) y se compararon las puntuaciones obtenidas según el Foot Health Status Questionnaire (FHSQ) versión española. Resultados: Los grupos con arco del pie aumentado, disminuido y normal muestran puntuaciones más bajas en la primera sección en las dimensiones salud del pie y calzado y puntuaciones altas en dolor y función del pie. En la segunda sección obtuvieron menos puntuación en la dimensión salud general y puntuaciones altas en función física, función social y vitalidad. Conclusiones: La comparación de las puntuaciones obtenidas muestra que la altura del arco tiene un impacto negativo en la calidad de vida. Dado que la evidencia actual sobre la etiología y el tratamiento de las enfermedades y deformidades es limitada, estos resultados ponen de manifiesto la necesidad de implementar programas para promover la salud de los pies y seguir investigando en esta condición común e incapacitante.

Técnica calcáneo-stop con elongación de tendones peroneos en el pie plano de pacientes con parálisis cerebral infantil / Technique calcaneo-stop par élongation des tendons péroniers du pied plat chez les patients atteints de paralyse cérébrale infantile / Calcaneal-stop technique with lengthening of the peroneal tendons in the flat foot of infant cerebral palsy patients

Introducción: los pies planos del niño constituyen un motivo de gran preocupación por los padres, probablemente el más frecuente de consulta en ortopedia infantil. Objetivos: evaluar la técnica calcáneo-stop con elongación de los tendones peroneos en el tratamientodel pie plano paralítico de paciente con parálisis cerebral infantil. Métodos: se realizó un estudio de intervención, prospectivo y autopareado, que incluyó nueve pacientes con edad entre 4-14 años intervenidos quirúrgicamente, en el periodo comprendido entre el 1 de septiembre de 2011 y 31 de agosto de 2012, en el Complejo Científico Ortopédico Internacional Frank País. Resultados: predominaron los pacientes del sexo masculino (66,6 por ciento), entre 4-9 años (55,6 por ciento), color de la piel blanca (100,0 por ciento) y con ambos miembros afectados (100 por ciento). Todos los pacientes se caracterizaron por compromiso funcional, grado de afección III o IV del plantigrama y parámetros radiográficos de severidad. En el posoperatorio se obtuvo una reducción significativa del grado de afección (de 100 por ciento con grado III o IV a 66,7 por ciento con plantígrada normal y ninguno con grado III o IV; p< 0,001) y mejoría de los parámetros radiográficos (ángulo de Moreau-Costa-Bartani [MCB]: 146 ± 11(0) vs 129 ± 7(0); p< 0,001 y ángulo astrágalo-calcáneo: 33 ± 4(0) vs 24±4(0); p< 0,001). Las complicaciones fueron todas menores y en una pequeña proporción de los pacientes (n= 3; 33,4 por ciento). El grado de satisfacción de los padres y el buen resultado quirúrgico de la técnica fueron elevados. Conclusiones: la técnica calcáneo-stop con elongación de los tendones peroneos es una buena opción terapéutica en pacientes con parálisis cerebral infantil y pie plano, por sus escasas complicaciones y buenos resultados quirúrgicos(AU)

Introduction: flat foot of the child is a great concern for the parents and the most frequent reason to go to the pediatric orthopedist's. Objectives: to evaluate the calcaneal-stop technique with lengthening of the peroneal tendons in treating the flat foot of infant cerebral palsy patient. Methods: a prospective, self-paired and intervention study was conducted in nine patients aged 4 to 14 years, who were operated on in the period of September 1st 2011 through August 31st 2012 in Frank Pais international scientific orthopedic complex center. Results: males (66.6 percent), 4-9 years-olds (55.6 percent), Caucasians (100 percent) and both limbs affected (100 percent) prevailed. All the patients presented functional compromise, degree III or IV in the plantigram and radiographic indicators for severity. In the postoperative period, there was significant reduction of the degree of disease (from 100 percent with degree III or IV to 66.7 percent with normal plantigrade and none of them with grade III or IV p< 0.001) and better radiographic indicators (Moreau-Costa-Bartani angle (MCB): 146 ± 110 vs 129 ± 70; p< 0.001) and astragalus-calcaneal angle: 33 ± 40 vs 24 ± 40; p< 0,001). Minor complications were observed in a small portion of patients (n= 3 for 33.4 percent). The level of satisfaction of the parents was high and the surgical result of this procedure was very good. Conclusions: the calcaneal-stop technique with lengthening of the peroneal tendons is a good therapeutic choice for patients with infant cerebral palsy and flat foot because of minor complications and good surgical results(AU)

Introduction: le pied plat chez l'enfant constitue une préoccupation pour les parents, et c'est probablement l'affection la plus fréquemment traitée aux services d'orthopédie infantile. Objectifs: le but de cette étude est d'évaluer la technique calcaneo-stop par élongation des tendons péroniers dans le traitement du pied plat du patient atteint de paralyse cérébrale infantile. Méthodes: une étude interventionnelle, prospective et auto-comparée de neuf patients âgés de 4 à 14 ans, traités chirurgicalement entre le 1e septembre 2011 et le 31 août 2012 au Complexe scientifique international d'orthopédie Frank Pais, a été réalisée. Résultats: on a trouvé que les patients du sexe masculin (66.6 pourcent), blancs (100.0 pourcent), âgés de 4-9 ans (55.6 pourcent) et avec une affection bilatérale (100.0 pourcent) étaient en prédominance. Tous les patients ont montré un trouble du fonctionnement, grade III ou IV en plantigrade, et des paramètres radiographiques de sévérité. Dans l'étape postopératoire, il y a eu une réduction significative du grade de l'affection (100 de grade III ou IV à 66.7 pourcent en plantigrade normale, et 0 pourcent de grade III ou IV ; (p< 0.001), et une amélioration des paramètres radiographiques (angle de Moreau-Costa-Bartani (MCB): 146 ± 11° vs. 129 ± 7°; p< 0.001, et angle astragalo-calcanéen: 33 ± 4° vs. 24 ± 4° ; p< 0.001). Le taux de complications a été faible, et la proportion de patients affectés insignifiante (n= 3; 33.4 pourcent). Le degré de satisfaction des parents et les bons résultats de la technique chirurgicale ont été élevés. Conclusions: dû à son faible taux de complications et à ses très bons résultats chirurgicaux, la technique calcaneo-stop par élongation des tendons péroniers s'érige comme traitement de choix pour les patients atteints de paralyse cérébrale infantile et de pied plat(AU)

Comparação da distribuição de pressão plantar em sujeitos com pés normais e com pés planos durante a marcha / Comparison of plantar pressure distribution in subjects with normal and flat feet during gait

O objetivo do estudo/pesquisa foi verificar possíveis relações entre a queda do arco longitudinal medial, mensurada em situação estática pela altura do osso navicular e um conjunto de variáveis relacionadas à distribuição de pressão plantar, mensuradas em situação dinâmica. Participaram do estudo 11 (onze) sujeitos do gênero masculino, comidade média de 21 anos ± 3 anos, massa corporal 74 kg ± 10 kg e estatura 175 cm ± 4 cm. Para aquisição dos dados de Distribuição de Pressão Plantar (Pico de Pressão, Pressão Média, Área de Contato e Carga Relativa), foi utilizado o Novel Emed-AT System com uma taxa de amostragem de 50 Hz e para análise da Altura do Navicular para classificação dos sujeitos em grupos, foi utilizado o protocolo Navicular Drop Test proposto por Brody (1982). Os dados foram comparados a partir dos resultados da aplicação da estatística não paramétrica através do teste U de Mann-Whitney com p ? 0,05. Os resultados demonstraramque os grupos foram significativamente diferentes entre si, na região do mediopé, em todas as variáveis analisadas, sendo que foram encontrados os maiores valores médios no grupo dos indivíduos com os Pés Planos. Também apresentaram diferenças significativas na variável Área de Contato, Carga Relativa, Pico de Pressão Plantar e Pressão PlantarMédia quando comparados os grupos. Os resultados demonstram a importância que se deve dar aos sujeitos com pés planos, pois alterações na Distribuição de Pressão Plantar estão associadas ao surgimento de desconforto e também de lesões.

The aim of this study was to determine the possible relationship between loss of the normal medial longitudinal arch measured by the height of the navicular bone in a static situation and variables related to plantar pressure distribution measured in a dynamic situation. Eleven men (21 ± 3 years, 74 ± 10 kg and 175 ± 4 cm) participated in the study. The Novel Emed-AT System was used for the acquisition of plantar pressure distribution data (peak pressure, mean pressure, contact area, and relative load) at a sampling rate of 50 Hz. The navicular drop testproposed by Brody (1982) was used to assess the height of the navicular bone for classification of the subjects. The results were compared by the Mann-Whitney U test, with the level of significanceset at p ? 0.05. Differences were observed between the two groups in the mid-foot regionfor all variables studied, with the observation of higher mean values in subjects with flat feet. There were also significant differences in contact area, relative load, peak pressure, and mean pressure between groups. The present study demonstrates the importance of paying attentionto subjects with flat feet because changes in plantar pressure distribution are associated with discomfort and injuries.

The Effect of Medial Arch Support for Flexible Flat Foot of Children / 대한족부족관절학회지

PURPOSE: The author evaluated the clinical and radiological results after wearing the medial arch supports in children. MATERIALS AND METHODS: 103 patients who had symptomatic flat feet were evaluated from march, 2002 to may 2009. All patients wore the medial arch supports according to the symptoms. We measured parameters at weight-bearing radiographs before and after medial arch support were worn. We also evaluated the clinical scores using the AOFAS score. RESULTS: Mean age of patients was 97 months (11-204 months), all foot of patients involved bilaterally. Mean talo-first metatarsal angle of right foot was 17.7+/-9.4 and left foot was 19.96+/-9.5 degrees at AP radiograph in pre-wearing state. Mean calcaneal pitch angle of right foot was 12.0+/-5.3 and left foot was 11.9+/-5.8 degrees at lateral radiograph in pre-wearing state. Mean talo-first metatarsal angle of right foot was 14.4+/-8.05 and left foot was 13.1+/-8.77 degrees at AP radiograph in post-wearing state. Mean calcaneal pitch angle of right foot was 16.4+/-5.75 left foot was 16.5+/-5.6 degrees at lateral radiograph in post-wearing state. The radiographic angles between pre-wearing and post-wearing state were statistically significant (p<0.05). Mean pre-wearing AOFAS hindfoot score was 66.7+/-9.25, midfoot score was 60.0+/-9.34 forefoot score was 57.1+/-11.8. Mean post-wearing AOFAS hindfoot score was 73.2+/-9.73, midfoot score was 68.1+/-10.1, forefoot score was 67.2+/-11.4. The forefoot score was highest improving scores among the AOFAS scores. CONCLUSION: From our study, we concluded that medial arch support was effective for symptomatic flat feet of children in radiological and clinical results from our study.

Surgical Treatment of Symptomatic Accessory Navicular in Adolescent / 대한족부족관절학회지

PURPOSE: To investigate the results of surgical treatment of the symptomatic accessory navicular in adolescent. MATERIALS AND METHODS: 11 patients who were 11~16 years old with symptomatic accessory navicular were identified between 2001 and 2009. Six cases were diagnosed after trauma and 8 cases were diagnosed by accident with painful bony protrusion on medial aspect of foot. In cases after at least 3 months of ineffective conservative treatment, patients were treated by resection of accessory navicular and reattachment of tibialis posterior tendon to the apex of the medial longitudinal arch using periosteum and ligamentous soft tissue without transposition of its course. And then short leg cast was applied for correction of the flat foot (if it is combined) which was molded into the longitudinal arch with the talonavicular joint released and foot inverted during about 6 weeks. RESULTS: All were type II accessory navicular without tibialis posterior tendon lesions. In most cases pain was improved, results were excellent in seven and good in four. Calcaneal pitch angle and talus-first metatarsal angle was improved about 4.64degrees and 5.79degrees in average. CONCLUSION: Symptomatic accessory navicular in adolescent might not be associated with the tibialis posterior tendon lesions. The surgical treatment composed of excision of the accessory navicular with simple replication of the tibialis posterior tendon without altering its course led to good results in most cases. The procedure has a low rate of complications. And it is easy to be performed with a good satisfaction.

Surgical Treatment of Symptomatic Accessory Navicular in Adolescent / 대한족부족관절학회지

PURPOSE: To investigate the results of surgical treatment of the symptomatic accessory navicular in adolescent. MATERIALS AND METHODS: 11 patients who were 11~16 years old with symptomatic accessory navicular were identified between 2001 and 2009. Six cases were diagnosed after trauma and 8 cases were diagnosed by accident with painful bony protrusion on medial aspect of foot. In cases after at least 3 months of ineffective conservative treatment, patients were treated by resection of accessory navicular and reattachment of tibialis posterior tendon to the apex of the medial longitudinal arch using periosteum and ligamentous soft tissue without transposition of its course. And then short leg cast was applied for correction of the flat foot (if it is combined) which was molded into the longitudinal arch with the talonavicular joint released and foot inverted during about 6 weeks. RESULTS: All were type II accessory navicular without tibialis posterior tendon lesions. In most cases pain was improved, results were excellent in seven and good in four. Calcaneal pitch angle and talus-first metatarsal angle was improved about 4.64degrees and 5.79degrees in average. CONCLUSION: Symptomatic accessory navicular in adolescent might not be associated with the tibialis posterior tendon lesions. The surgical treatment composed of excision of the accessory navicular with simple replication of the tibialis posterior tendon without altering its course led to good results in most cases. The procedure has a low rate of complications. And it is easy to be performed with a good satisfaction.

Hálux valgo e pés planos: as forças plantares são iguais? / Hallux valgus and flat feet: are plantar forces equal?

OBJETIVO: Este trabalho teve como objetivo estimar as forças plantares nos dedos dos pés de mulheres com hálux valgo e/ou pés planos. MÉTODOS: Trata-se de um estudo transversal envolvendo mulheres com hálux valgo e/ou pés planos confirmado através de análise radiográfica. Mediram-se as forças plantares, utilizando plataformas de forças. Coletaram-se estas forças com as mulheres descalças e em posição ereta, por três medidas sendo obtida uma média. Os dados foram adquiridos através da ponte amplificadora Spider 8 da HBM e analisados através do programa Catman®. Obtiveram-se as medidas de forças dos dedos de ambos os pés e as médias foram comparadas pelo teste t de Student segundo a presença de hálux valgo e pés planos; a associação entre essas deformidades foi estimada pelo teste exato de Fischer bicaudal, a significância estatística adotada foi alfa = 5 por cento. RESULTADOS: Foram incluídas no estudo, vinte mulheres com presença ou não de hálux valgo. As forças médias encontradas mostraram-se maiores no 5º dedo em relação ao 1º dedo de ambos os pés (p< 0,05) em ambas as situações. CONCLUSÃO: Neste estudo encontraram-se, ao contrário de outros trabalhos, forças no 5º dedo maiores que no 1º em ambos os pés.

OBJECTIVE: to measure the plantar forces above the toes of women with hallux valgus and/or flat feet. METHODS: This study involved women with hallux valgus and/or flat feet confirmed by X-ray images. The plantar forces were measured utilizing force plates. Force was measured three times, which were taken with the women on barefoot and at upright position, recording the average for the three measurements. Data were acquired from Spider 8 system (HBM) and analyzed by using a Catman® software. The measurements for both feet's toes force were reported and the averages were compared by the Student's t-test according to the presence of hallux valgus and flat feet; the association between these deformities was estimated by using the two-tailed Fischer's exact test, the statistical significance adopted was alpha = 5 percent. RESULTS: For this study, 20 women with or without hallux valgus were included. The mean force values found showed to be higher on the fifth toe compared to first toe of both feet (p < 0.05) in both situations. CONCLUSION: in this study, we found strong forces on the fifth toe than on the first toe, contradicting some studies in literature.

Cálculo do índice do arco plantar de staheli e a prevalência de pés planos: estudo em 100 crianças entre 5 e 9 anos de idade / Calculation of staheli's plantar arch index and prevalence of flat feet: a study with 100 children aged 5-9 years

Os autores avaliam 100 crianças normais da população geral de ambos os sexos entre 5 e 9 anos de idade com o objetivo de verificar e avaliar o chamado índice do arco plantar e a ocorrência de pé plano. A avaliação do pé plano o foi feita através da obtenção da impressão plantar e do cálculo do índice do arco plantar (IP) que estabelece a relação entre a região central e posterior dessa impressão, determinando-se um IP médio e um limite para esse tipo de pé. Concluem que o índice do arco plantar é facilmente obtido a partir da impressão plantar, não existirem diferenças entre os sexos e faixas etárias, que os valores médios do índice do arco plantar nessa faixa etária são estáveis e estão entre 0,61 e 0,67 e que índices do arco plantar acima de 1,15 devem ser considerados como indicativos de pé plano.

The authors studied 100 normal children from the general population of both genders with ages ranging from 5 to 9 years old in order to evaluate the plantar arch index and the flat-feet prevalence. The flat-feet evaluation was obtained by means of the footprint and the plantar arch index (IP), which establishes the ratio between central and posterior regions of this footprint, determining a mean IP and a limit to the flat-foot. They conclude that the plantar arch index is easy to obtain from footprints and that there are no differences in terms of gender or age. The mean values of the plantar arch index within this age group are stable and range from 0.61 to 0.67, with plantar arch indexes greater than 1.15 being regarded as flat feet.

Radiology study on foot in rheumatiod arthritis / 中国矫形外科杂志

[Objective]To study the foot radiographs of rheumatoid arthritis(RA),evaluate the relationship between foot deformity and disease duration,the relationship between flat foot and forefoot deformities in RA,thus to improve understanding of the progression of deformity and provide more appropriate treatment. [Method]Anteroposterior and lateral weight-bearing radiographs were obtained for 112 feet of patients with RA and 104 feet of patients without RA.The hallux valgus angle,the first intermetatarsals angle,the top angle of the medial longitudinal arch,the anterior angle of the medial longitudinal arch,the relative height of the talus were measured.One-Way ANOVA were used to evaluate the difference between two groups,and partial correlations were used to analyze the relationship between the foot deformities and disease duration by control the age,the relationship between flat foot and forefoot deformity by control the age was also analyzed.[Result]The hallux valgus angle was 24.2?14.3 in RA group and 13.2?5.3 in control group,the first intermetatarsals angle was 9.6?5.9 in RA group and was 7.6?4.4 in control group,the top angle of the medial longitudinal arch was 129.4?6.6 in RA group and 124.4?5.2 in control group,the anterior angle of the medial longitudinal arch was14.5?3.0 in RA group and 16.2?4.5 in control group,the relative height of the talus was 0.184?0.024 in RA group and was 0.191?0.032 in control group,there was significant difference between two groups except the anterior angle of the medial longitudinal arch.With the increase of disease duration,the top angle of the medial longitudinal arch,increased in RA group(P