Conceptos actuales sobre el tratamiento ortésico en el método Ponseti / Current concepts on bracing in the Ponseti method

El método Ponseti se ha convertido en el patrón de referencia para el tratamiento del pie bot, con excelentes resultados funcionales en el seguimiento a largo plazo. El cumplimiento del protocolo de férula es fundamental para mantener la corrección obtenida y el éxito terapéutico a largo plazo. Existen múltiples férulas para mantener la corrección y prevenir la recurrencia. En este artículo, proporcionamos una revisión de las férulas utilizadas para el pie bot, y analizamos sus ventajas y desventajas, así como la evi-dencia sobre cada una. Nivel de evidencia: V

The Ponseti method has become the gold standard for the treatment of clubfoot, with excellent long-term functional outcomes. Adherence to the bracing protocol is essential for the long-term success of the treatment. Currently, there are multiple braces that can be used to prevent relapse. In this article, we provide a review of clubfoot braces, discussing their advantages and disadvantages, as well as the current evidence on each of them. Level of Evidence: V

Current Concepts in the Management of Patellofemoral Pain Syndrome / Conceptos Actuales en el Manejo del Síndrome de Dolor Patelofemoral

Introduction Patellofemoral pain syndrome (PFPS) is one of the leading causes of knee pain, manifesting itself during daily life activities. This study presents a review on PFPS treatment modalities. Materials and methods State of the art review on the treatment of PFPS with grades of recommendation. Active and passive conservative interventions are reviewed, as well as surgical alternatives. Results Hip and lower-limb muscle strengthening and stretching are active interventions that provide long-lasting benefits. Passive interventions include patellofemoral joint bracing, kinesiotaping and foot orthoses, and are considered useful coadjuvants to active interventions, with quick relief for patients but usually in the short term. Surgical treatment is only recommended in a small subset of patients with specific anatomic abnormalities in the patellofemoral joint. Discussion Conservative treatment remains as the mainstream in the management of patellofemoral pain syndrome.

Introducción El síndrome de dolor patelofemoral (SDPF) es una de las principales causas de dolor de rodilla y se presenta con actividades diarias de la vida cotidiana. Este estudio presenta una revisión de la literatura acerca de las modalidades de tratamiento actual para el SDPF. Materiales y métodos Revisión estado del arte acerca del tratamiento del SDPF con grados de recomendación según la evidencia. Se revisan las intervenciones conservadoras activas y pasivas, así mismo las alternativas quirúrgicas. Resultados El fortalecimiento de los músculos de la cadera y del miembro inferior, así como el estiramiento, son intervenciones activas que ofrecen beneficios en el largo plazo para el SDPF. Las intervenciones pasivas como las rodilleras, el kinesiotaping y las ortesis para los pies, ofrecen alivio rápido pero de corta duración. El tratamiento quirúrgico solamente se recomienda en un subgrupo de pacientes que no han respondido a otros tratamientos y que tienen ciertas anormalidades anatómicas específicas que alteran la articulación patelofemoral. Discusión El tratamiento conservador continúa siendo la piedra angular en el tratamiento del síndrome de dolor patelofemoral

Long-Term Effect of Rigid Foot Orthosis in Children Older Than Six Years With Flexible Flat Foot

OBJECTIVE: To evaluate the long-term effect of a custom-made rigid foot orthosis (RFO) in children older than 6 years with pes planus (flat foot). METHODS: Medical records of 42 children diagnosed with flexible pes planus who were fitted with RFOs based on the inverted technique and underwent more than four consecutive radiological studies were reviewed. Resting calcaneal stance position (RCSP), anteroposterior talocalcaneal angle, lateral talocalcaneal angle, lateral talometatarsal angle, and calcaneal pitch were initially measured in both feet to evaluate alignment. Followup clinical and radiological evaluations were then performed at 12–18, 24–30, 36–42, and ≥48 months after RFO application. Repeated measures analysis of variance was used to evaluate significant differences. RESULTS: Significant improvements in all radiological indicators and significant progression of RCSP toward the corrective direction were observed after RFO application relative to baseline measurements. CONCLUSION: According to our findings, RFO can induce significant improvements in calcaneus-related radiographic indices and subsequently improve talus-related radiologic indices.

Forefoot disorders and conservative treatment / 영남의대학술지

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

Current Situation of Assistive Devices and Appliances Provision for Persons with Cerebral Palsy in Korea / 보건행정학회지

BACKGROUND: The aim of this study was to investigate the current state of the assistive devices and appliances provision system for cerebral palsy patients registered with brain disability. METHODS: From 2003 to 2013, we analyzed the records of cerebral palsy patients who had assistive devices and appliances provisioned at least once in their lives based on National Health Information Database. Patients with cerebral palsy were divided into three groups: infants and toddlers, school age and adolescence, and adults. RESULTS: Data on short leg plastic orthoses, ankle joint orthoses, and wheelchair were mainly analyzed. The types of ankle joint orthoses divided into three categories: limited, 90° limited, and Klenzac. Limited ankle joint orthoses was most frequently supported of the three in all age groups. Powered wheelchair and scooter were most supported to adult patients. When the re-supply duration was evaluated, the duration was suitable to the duration on guideline of regulation of re-supplement according to the related laws in adult patients but not in infants/toddlers and school age/adolescence as the actual re-supplement duration was much shorter than the reference value. CONCLUSION: This study confirmed the pattern of assistive devices and appliances supply differed depending on the age of cerebral palsy patients.

Long Term Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children with Symptomatic Flexible Flat Feet

OBJECTIVE: To evaluate the long termeffect of custom-molded foot orthoses on foot pain and balance ability in children with symptomatic flexible flat feet after 1 year.METHOD: A total of 35 children over 6 year-old with flexible flat feet and foot pain for at least 6 months were recruited. Individual custom-molded rigid foot orthoses fabricated with the inverted orthotic technique was prescribed. Pain related parameters (pain sites, degree, and frequency) were obtained through questionnaires. Pain assessment was performed prior to application of the foot orthoses, and 1, 3, 6, 12 months after applying the orthoses. Balance ability was tested by computerized posturography. Such measures were evaluated prior to, 3 months, and 12 months after applying the foot orthoses. Additionally, the difference inbalance ability between barefoot and withfoot orthosesat 12 months was assessed to estimate carryover effect.RESULTS: 17 out of 35 children completed the study. Significant improvements were noted upto 12 months in pain parameters and balance ability. The carry over effect of the orthoses was confirmed.CONCLUSION: There were significant improvements offoot pain and balance ability in children with symptomatic flexible flat foot after wearing foot orthoses fabricated with the inverted orthotic technique over 1year period.

The Effect of Protective Socks with Functional Insoles on Plantar Foot Pressure in Diabetes Patients

PURPOSE: The most common cause of plantar ulceration is an excessive plantar pressure in patients with peripheral neuropathy. Foot orthosis and therapeutic footwear have been used to decrease the plantar pressure and prevent the plantar ulceration in in diabetes patients. We investigated whether protective sock with functional insoles reduce plantar pressure while walking in 17 diabetes patients. METHODS: An in-shoe measurement device was used to measure the peak plantar pressure while walking. Peak plantar pressure data were collected while walking under two conditions: 1) wearing diabetic sock and 2) wearing the protective sock with functional insoles. Each subject walked 3 times in 10-m corridor under three conditions, and data were collected in 3 steps in the middle of corridor with in right and left feet, respectively. Pared t-test was used to compare the peak plantar pressures in three plantar areas under these two conditions. RESULTS: The protective sock with functional insoles significantly reduced the peak plantar pressure on the lateral rearfoot, but significantly increased the peak plantar pressure on the middle forefoot, and medial midfoot (p 0.05). CONCLUSION: The protective sock with functional insoles reduced plantar pressures in the rearfoot and supported the medial longitudinal arch. However, it is necessary to change the position of metatarsal pad in the insole design of forefoot area to prevent diabetic foot ulceration.

Functional Improvement Following Revision Surgery in a Patient with the Dual Disability of a Complicated Residual Limb and Contralateral Hemiplegia: A Case Report

The number of reported cases with dual disability is increasing for the past few decades. Currently, dual disability of lower limb amputation and motor weakness after stroke became a strong issue in public concern. The functional levels of patients have shown in the wide range from independent community ambulation to non-ambulation. Thus, it indicates that favorable outcomes for dual disability may depend upon adopted rehabilitative strategies. We present the case of a man with left below-knee amputation and severe right-sided weakness following a huge putaminal hemorrhage. He had suffered from extreme pain and misfit of the prosthetic socket and the complicated residual limb for three years prior to the stroke. Forty days post-stroke, we performed a revision surgery to resolve the complications of bony overgrowth, verrucous hyperplasia, and neuroma and applied an ankle foot orthosis (AFO). Two years post-stroke, he was able to ambulate outside his home and negotiate stairs using a cane. This is the first case with the dual disability of lower limb amputation and contralateral hemiplegia to undergo revision surgery. The results suggest that an early revision surgery and use of an AFO are crucial for achieving a higher level of mobility in such cases.

A novel hinged ankle foot orthosis for gait performance in chronic hemiplegic stroke survivors: a feasibility study

Stroke survivors with gait disturbances may use ankle foot orthoses (AFOs). However, most AFOs come in one-piece styles, which make it difficult for spasticity-affected stroke survivors to don. AFOs are also limited since they do not properly prevent ankle joint for foot drop by itself. Therefore, the present study developed a novel hinged AFO by adding a locking device to a hinged joint. We then tested its feasibility in 9 hemiplegic stroke survivors by investigating temporal–spatial gait parameters using the GAITRite in the following 3 conditions: no AFO, traditional AFO, and novel hinged AFO. There was no significant difference in spatiotemporal gait parameters among the different conditions. There were greater decreases in gait velocity, cadence, step length, and stride length in the novel hinged AFO group than in the no AFO and traditional AFO groups. This novel hinged AFO was developed to prevent foot drop. However, the AFO did not show significant differences in gait parameters because it consists of metal with extra weight and volume. Functionally, it prevented foot drop. It also improved convenience by its releasable design. Thus, further studies are needed to develop an AFO that improves gait and is convenient to use for hemiplegic stroke survivors.

Correlation of Radiographic and Patient Assessment of Spine Following Correction of Nonstructural Component in Juvenile Idiopathic Scoliosis

OBJECTIVE: To evaluate the association between progression of curvature of scoliosis, and correction for functional component in patients with juvenile idiopathic scoliosis (JIS). METHODS: We retrospectively reviewed medical data of patients prescribed custom molded foot orthosis (FO) to correct inequality of RCSPA (resting calcaneal stance position angle), and chose 52 patients (26 females, 26 males) with Cobb angle ≥10° in radiology and uneven pelvic level at iliac crest by different RCSPA (≥3°) as a factor of functional scoliosis. They had different hump angle ≥5° in forward bending test, for idiopathic scoliosis component. Their mean age and mean period of wearing FO were 79.5±10.6 months and 18.6±0.70 months. RESULTS: Cobb angle was reduced from 22.03°±4.39° initially to 18.86°±7.53° after wearing FO. Pelvis height difference and RCSPA difference, were reduced from 1.07±0.25 cm initially to 0.60±0.36, and from 4.25°±0.71° initially to 1.71°±0.75° (p < 0.01). Cobb angle improved most in 9 months. However, there was no significant improvement for those with more than 25° of Cobb angle initially. Mean Cobb angle improved in all age groups, but patients less than 6 years had clinically significant improvement of more than 5°. CONCLUSION: JIS can have functional components, which should be identified and managed. Foot orthosis is useful in correcting functional factors, in the case of pelvic inequality caused by different RCSPA, for patients with juvenile idiopathic scoliosis.

Eficacia del tratamiento ortopédico en pie plano flexible pediátrico: revisión sistemática / Eficacy of orthopediac treatment of flexible flatfoot in pediatrics: A systematic review

Introducción: El pie plano flexible es una de las entidades ortopédicas más frecuentes en Pediatría. Algunos autores lo consideran una variante anatómica. La incertidumbre en cuanto a su evolución y pronóstico, sumado a la preocupación y demanda por parte de los padres, hace que en muchas ocasiones se indique tratamiento ortésico. Metodología: se realizó una búsqueda sistemática en Medline, Lilacs, Cochrane y Google académico, usando los términos therapy, flatfoot, flatfeet, pie plano y pes planus; población hasta los 18 años, publicaciones hasta abril 2017 y restringiendo por idiomas español e inglés. Para el aná- lisis de los artículos se utilizaron la guía de lectura crítica del Hospital Garrahan y la escala de calidad metodológica JADAD. Resultados: de 778 artículos encontrados, 421 correspondían a pacientes con enfermedad de base, 194 evaluaban corrección quirúrgica, 144 eran descriptivos, 7 comparaban diferentes ortesis entre sí y 7 eran revisiones de trabajos. Finalmente fueron analizados 5 trabajos (cuatro ECCAs y un estudio de cohorte). De los 5 artículos, 2 poseían aceptable y muy buena calidad metodológica según la escala JADAD, ninguno demostrando diferencias significativas con el tratamiento ortésico. De los 3 restantes, sólo uno halló mejores resultados en cuanto al alivio del dolor y de la marcha combinando ortesis con ejercicios (RR 0.33 y 0.29 respectivamente). Conclusión: en base a esta revisión no hay evidencia científica que demuestre la eficacia del uso de ortesis para la corrección del pie plano flexible en la población pediátrica sana.(AU)

Introduction: Flexible flatfoot is one of the most common orthopedic findings in children. Some authors consider the entity to be a normal anatomical variant. Uncertainty regarding outcome and prognosis added to the worries and demands of the parents often results in the indication of orthotic treatment. Methods: A systematic search was conducted in Medline, Lilacs, Cochrane, and Google academics using the terms therapy, flatfoot, flatfeet, and pes planus; population up to 18 years of age, publications until April 2017, in Spanish and English. For the analysis of the articles the critical reading guidelines of Hospital Garrahan and the JADAD scale for methodological quality were used. Results: Of 778 articles found, 421 were related to patients with an underlying disease, 194 evaluated surgical correction, 144 were descriptive studies, 7 compared different orthosis, and 7 were review studies. Finally, 5 studies were analyzed (four randomized controlled trials (RCT) and one cohort study). Of the five studies, two were considered acceptable and of good quality on the JADAD scale. None of the studies showed significant differences with orthotic treatment. Of the three remaining studies, only one found better results regarding pain relief and gait improvement with orthosis combined with exercise (RR 0.33 and 0.29, respectively). Conclusion: Based on this review, there is no scientific evidence that shows efficacy of the use of orthosis for the correction of flatfoot in healthy children. (AU)

Correcting of pronated feet reduce skeletal muscle injury in young women with biomechanical abnormalities / 대한해부학회지

Biomechanical abnormalities of pronated feet accompanied by functional leg length disparity may increase the risk of skeletal muscle injury. Objective of the study is to prove that correction of pronated feet by the foot orthoses will reduce the creatine kinase-MM (CK-MM) concentrations as the muscle injury indicator. The design study was double blind randomized clinical trials with control. Research subjects were divided into two groups, group 1 used the foot orthoses while group 2 did not used the foot orthoses. The whole subject examined the concentrations of the CK-MM enzyme before, and 24–72 hours after the walking test. The walking test was conducted 15 minutes with maximum speed. The concentration of the CK-MM enzyme before walking test on treatment group was 70.07±15.33 International Unit (IU), similar with the control group was 69.85±17.03 IU (P=0.971). The increased in CK-MM enzyme concentrations 45 hours after the walking test was lower in the treatment group (7.8±9 IU) than the control group (22.0±11.5 IU) (P=0.001). The CK-MM enzyme concentrations continued to decline in the treatment group after the second walking test (77.21±17.47 IU), and after the third walking test (69.86±11.88 IU) (P=0.018). The foot orthoses for correcting the pronated feet on the young women with biomechanical abnormalities is able to reduce the degree of the skeletal muscle injury after walking activity.

Effects of a Resting Foot Splint in Early Brain Injury Patients

OBJECTIVE: To assess the effectiveness of the resting foot splint to prevent ankle contracture. METHODS: We performed a randomized controlled trial in 33 patients with brain injury with ankle dorsiflexor weakness (muscle power ≤grade 2). Both groups continued conventional customized physical therapy, but the patients in the foot splint group were advised to wear a resting foot splint for more than 12 hours per day for 3 weeks. The data were assessed before and 3 weeks after the study. The primary outcome was the change in ankle dorsiflexion angle after 3 weeks. RESULTS: Before the study, there were no differences between groups in gender, age, time post-injury, brain injury type, initial edema, spasticity, passive range of ankle dorsiflexion, Fugl-Meyer score (FMS), or Functional Ambulation Classification. A significant improvement in ankle dorsiflexion angle, and FMS was found after 3 weeks in both groups. The splint group showed more spasticity than the control group after 3 weeks (p=0.04). The change of ankle dorsiflexion angle, foot circumference, spasticity, and FMS after adjusting initial value and spasticity were not significantly different between the 2 groups. CONCLUSION: Wearing a resting foot splint for 3 weeks did not affect joint mobility in patients with subacute brain injury regularly attending personalized rehabilitation programs. Further studies of larger sample sizes with well controlled in spasticity are required to evaluate the effects of the resting foot splint.

Lateral wedge insole for knee osteoarthritis: randomized clinical trial / Palmilha valgizante para osteoartrite de joelhos: ensaio clínico randomizado

CONTEXT AND OBJECTIVE: Optimal management of knee osteoarthritis requires a combination of pharmacological and non-pharmacological methods. The use of lateral wedge insoles to treat medial knee osteoarthritis is recommended, but there is still controversy about its efficacy. The purpose of this study was to ascertain whether the use of lateral wedge insoles can diminish pain and improve function in patients with medial knee osteoarthritis. DESIGN AND SETTING: Prospective randomized trial conducted in a tertiary-level hospital. METHODS: We prospectively enrolled 58 patients with medial knee osteoarthritis and randomized them to use either a lateral wedge insole with subtalar strapping (Group W), or a neutral insole with subtalar strapping (Group N - control). All the patients were instructed to use the insole for five to ten hours per day. A visual analogue pain scale, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Lequesne questionnaire were applied at baseline and at weeks 2, 8 and 24. RESULTS: At weeks 8 and 24, both groups showed lower scores for WOMAC (P = 0,023 and P = 0,012 respectively). There were no statistically significant differences between the groups regarding the visual analogue pain scale, WOMAC or Lequesne results at any time evaluated. CONCLUSION: The use of a lateral wedge insole with subtalar strapping improved the patients' symptoms and function but was not superior ...

CONTEXTO E OBJETIVO: O manejo ideal da osteoartrite de joelhos requer combinação entre modalidades farmacológicas e não farmacológicas. O uso de palmilhas valgizantes no tratamento da osteoartrite medial do joelho é recomendado, mas sua eficácia ainda é controversa. Este estudo objetiva verificar se o uso da palmilha valgizante pode diminuir a dor e melhorar a função dos pacientes com osteoartrite medial dos joelhos. DESENHO E LOCAL: Ensaio clínico prospectivo e randomizado conduzido em hospital de atenção terciária. MÉTODOS: Alocamos prospectivamente 58 pacientes com osteoartrite medial dos joelhos que foram randomizados para fazer uso de palmilha valgizante com amarrilho subtalar (Grupo W) ou palmilha neutra com amarrilho subtalar (Grupo N - controle). Todos os pacientes foram orientados a utilizar a palmilha entre cinco e dez horas por dia. Foram aplicados os questionários Western Ontario and McMaster Universities Arthritis Index (WOMAC) e Lequesne, além da escala visual analógica da dor, nos momentos pré e após 2, 8 e 24 semanas. RESULTADOS: Após 8 e 24 semanas, ambos os grupos apresentaram redução dos valores de WOMAC (P = 0,023 e P = 0,012 respectivamente). Não houve diferença estatisticamente significativa entre os grupos nos resultados de WOMAC, Lequesne e escala visual analógica de dor, em nenhum dos momentos avaliados. ...

Effect of postural insoles on static and functional balance in children with cerebral palsy: A randomized controlled study

BACKGROUND: Improved gait efficiency is one of the goals of therapy for children with cerebral palsy (CP). Postural insoles can allow more efficient gait by improving biomechanical alignment. OBJECTIVE: The aim of the present study was to determine the effect of the combination of postural insoles and ankle-foot orthoses on static and functional balance in children with CP. METHOD: A randomized, controlled, double-blind, clinical trial. After meeting legal requirements and the eligibility criteria, 20 children between four and 12 years of age were randomly allocated either to the control group (CG) (n=10) or the experimental group (EG) (n=10). The CG used placebo insoles and the EG used postural insoles. The Berg Balance Scale, Timed Up-and-Go Test, Six-Minute Walk Test, and Gross Motor Function Measure-88 were used to assess balance as well as the determination of oscillations from the center of pressure in the anteroposterior and mediolateral directions with eyes open and closed. Three evaluations were carried out: 1) immediately following placement of the insoles; 2) after three months of insole use; and 3) one month after suspending insole use. RESULTS: The EG achieved significantly better results in comparison to the CG on the Timed Up-and-Go Test as well as body sway in the anteroposterior and mediolateral directions. CONCLUSION: Postural insoles led to an improvement in static balance among children with cerebral palsy, as demonstrated by the reduction in body sway in the anteroposterior and mediolateral directions. Postural insole use also led to a better performance on the Timed Up-and-Go Test. .

Tenodesis vs. tunelización del tendón flexor largo de los dedos en el tratamiento de la disfunción del tendón tibial posterior en estadio II / Tenodesis Vs. Tunneling of Flexor tendon length of the fingers in the treatment of Posterior Tibial Tendon Dysfunction Stage II

El tratamiento , en el estadio II de disfunción del tendón tibial posterior (DTTP) consiste en la transferencia del tendón Flexor Largo de los dedos (FLD) para suplir al tendón tibial posterior insuficiente y un procedimiento óseo para corregir la deformidad adquirida del retropié. En este estudio, evaluamos la función y eficacia de la transferencia del FLD tunelizado en el escafoide tarsiano vs la tenodesis del mismo al muñón distal del tendón tibial posterior. Material y método: Se realizó un estudio retrospectivo y comparativo de los pacientes intervenidos por esta patología en la Unidad de Pie y Tobillo del HCC, entre los años 2005 y 2012. En 27 pacientes se realizó tunelización del FLD en el escafoides tarsiano y en 49 pacientes se realizó tenodesis del FLD al muñón distal del tendón tibial posterior; en todos los pacientes se realizó un procedimiento óseo para corregir la deformidad adquirida del retropié. Se midió goniometricamente, inversión y flexión plantar del pie al año de postoperatorio en todos los pacientes y se comparó con el pie sano. Se evaluó pérdida de función ó dolor en zona de la transferencia. El análisis estadístico se realizó con t-student. Resultados: 6 pacientes presentaron DTTP bilateral y fueron descartados de este estudio. Los pacientes con tunelización del FLD en el escafoides tarsiano, presentaron una media de 62% de inversión y 86% de flexión plantar, los pacientes con tenodesis de FLD, presentaron una media de 86% de inversión y 89% de flexión plantar. Perdieron función del tendón, 1 paciente con tendón tunelizado, y 2 con tenodesis; presentaron dolor en la zona de la transferencia 2 pacientes con tenodesis del FLD. Conclusión: De nuestro estudio podemos concluir, que la tenodesis del FLD al muñón distal del tendón Tibial posterior, produce una mejor inversión del pie que la tunelización del FLD en el escafoides tarsiano(AU)

The surgical treatment of stage II posterior tibial tendon dysfunction (PTTD) is the transfer of the flexor digitorum longus tendon (FDL) to supply the posterior tibial tendon and a bone procedure to correct the acquired deformity of the hindfoot. In this study we evaluated the role and effectiveness of the FDL transfer to a tarsal scaphoid tunnel vs tenodesis of the distal stump of the posterior tibial tendon. Materials and methods: We performed a retrospective comparative study of patients with this disease in the Foot and Ankle Unit of HCC between 2005 and 2012, in 27 patients FDL tunnel was performed in the tarsal navicular and in 49 patients FDL tenodesis was performed to the distal posterior tibial tendon stump; in all patients a bone procedure was performed to correct acquired deformity of the hindfoot. Goniometrical measure was performed for forefoot inversion and plantar flexion at 12 months postop and compared with the healthy foot. Pain or loss of function in the transfer zone was evaluated. Statistical analysis was performed using T-student. Results: 6 patients had bilateral and PTTD and were excluded from this study. Patients with tarsal scaphoid FDL tunnel showed a mean of 62% forefoot inversion and 86% of plantar flexion, patients with FDL tenodesis, showed an average of 86% forefoot inversion and 89% of plantar flexion. One tendon tunnel patient lost tendon function and 2 tenodesis patient lost tendon function. 2 patients with FDL tenodesis had pain in the transfer area. Conclusion: From our study we can conclude that FDL tenodesis to the distal posterior tibial tendon stump produces a better forefoot inversion than the FDL tarsal navicular tunnel(AU)

Effect of Foot Orthoses on Children With Lower Extremity Growing Pains

OBJECTIVE: To evaluate the effect of custom molded foot orthoses on children with growing pains of the lower extremities. METHODS: Children with growing pains were recruited during a clinic visit. None had any bony deformities, inflammatory joint disease or depression. Resting calcaneal stance position (RCSP) and calcaneal pitch angle were measured, and individual custom molded rigid foot orthoses were prescribed using the inverted orthotic technique to control for foot overpronation using the RCSP angle. Pain sites, degree and frequency of pain, and balance ability were evaluated using Balance Master computerized posturography prior to foot orthosis fitting, and 1 and 3 months later. RESULTS: Twenty children completed the study. Seventeen (75%) had overpronated feet. Significant improvements were noted after 1 and 3 months in pain degree and frequency, and after 3 months in balancing ability. CONCLUSION: The use of custom molded foot orthoses is a good method for treating children with multiple musculoskeletal pains in the leg.

Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children With Symptomatic Flexible Flat Feet

OBJECTIVE: To evaluate the effect of custom-molded foot orthoses on foot pain and balance in children with symptomatic flexible flat foot 1 month and 3 months after fitting foot orthosis. METHOD: A total of 24 children over 6 years old with flexible flat feet and foot pain for at least 6 months were recruited for this study. Their resting calcaneal stance position and calcaneal pitch angle were measured. Individual custom-molded rigid foot orthoses were prescribed using inverted orthotic technique to control foot overpronation. Pain questionnaire was used to obtain pain sites, degree, and frequency. Balancing ability was determined using computerized posturography. These evaluations were performed prior to custom-molded foot orthoses, 1 month, and 3 months after fitting foot orthoses. RESULT: Of 24 children with symptomatic flexible flat feet recruited for this study, 20 completed the study. Significant (p<0.001) improvements in pain degree and frequency were noted after 1 and 3 months of custom-molded foot orthoses. In addition, significant (p<0.05) improvement in balancing ability was found after 3 months of custom-molded foot orthoses. CONCLUSION: Short-term use of custom-molded foot orthoses significantly improved foot pain and balancing ability in children with symptomatic flexible flat foot.