Preventive strategy of flatfoot deformity using fully automated procedure.

A non-invasive, no radiation, out-of-hospital automated system is proposed to identify low arch integrated in the design and manufacturing of personalized orthoses using parametric modelling. The aim of the design process is to integrate assistive technology with assessment and prevent low arch progressing to a more serious case - flatfoot. In the automated procedure, we developed an assessment method including reliable thresholds of foot type classification and test protocol to reduce interferences due to preceding activities, an automation to translate scanned data into parametric design for orthotic customization, finite element model evaluating effectiveness of the personalized design, and a personalized comparative test to evaluate the long-term improvement of foot arch shape. Our low arch threshold established by subject-specific 3D models reduced the misclassification rate from 55%, as previously reported to 6.9%. Individuals who engaged in sedentary activity (i.e. sitting) had the greater change in arch height compared to active activity (i.e. standing and walking), which is more likely to affect the obtained measure. Therefore, a test protocol now states that participants are not allowed to sit over 100 min prior the measurement to reduce such interference. We have proposed and tested an automated algorithm to translate scanned data including seven foot's parameters into customised parametric design of the insert. The method decreases the required time of orthotic computer-aided design from over 3 h to less than 2 min. A finite element analysis procedure was additionally developed to assess the performance of geometries and material of designed orthotic based on the distribution of plantar pressure and internal stress. The personalized comparative assessment based on midfoot contact area was carried out periodically for follow-up and the orthotic could be re-designed if necessary. The proposed automated procedure develops a pre-screening system to distinguish low arch and provide preventatives before it becomes symptomatic. Furthermore, non-symptom flatfoot can be detected at early stages and referred to medics for further diagnosis or treatment.

Can an insole for obese individuals maintain the arch of the foot against repeated hyper loading?

BACKGROUND: Insoles are often applied as preventive therapy of flatfoot deformity, but the therapeutic effects on obese individuals are still controversial. We aimed to investigate the effect of insole use on time-dependent changes in the foot arch during a repeated-loading simulation designed to represent 20,000 contiguous steps in individuals with a BMI value in the range of 30-40 kg/m2. METHODS: Eighteen cadaveric feet were randomly divided into the following three groups: normal, obese, and insole. Ten thousand cyclic loadings of 500 N (normal group) or 1000 N (obese and insole groups) were applied to the feet. We measured time-dependent change in arch height and calculated the bony arch index (BAI), arch flexibility, and energy absorption. RESULTS: The normal group maintained more than 0.21 BAI, which is the diagnostic criterion for a normal arch, throughout the 10,000 cycles; however, BAI was less than 0.21 at 1000 cycles in the obese group (mean, 0.203; 95% confidence interval [CI] 0.196-0.209) and at 6000 cycles in the insole group (mean, 0.200; 95% CI, 0.191-0.209). Although there was a significant time-dependent decrease in flexibility and energy absorption in both the obese and insole groups (P < 0.001), the difference between 1 and 10,000 cycles were significantly smaller in the insole group than in the obese group (P = 0.024). CONCLUSIONS: Use of insoles for obese individuals may help to slow time-dependent foot structural changes. However, the effect was not enough to maintain the foot structure against repeated hyper loadings.

Static and dynamic effects of customized insoles on attenuating arch collapse with pregnancy: A randomized controlled trial.

INTRODUCTION: Anthropometric changes to the feet with pregnancy may increase risk for musculoskeletal disease. Customized arch-supportive orthoses to prevent anthropometric changes could potentially provide an inexpensive means to prevent musculoskeletal impairments and improve quality of life for women during their post-reproductive years. The objective of this prospective, randomized controlled trial was to determine whether customized foot orthoses can prevent arch collapse during pregnancy. MATERIALS AND METHODS: Seventy-two first trimester women (age 18-40) were randomized to wear either their usual footwear (control) or their usual footwear with custom-molded arch-supportive orthoses. Each participant in the customized orthosis group had orthoses customized by a certified orthotist. Baseline assessments were completed during the first trimester and follow-up assessments were completed approximately 8 weeks postpartum. The primary outcome measurements were static arch height index (AHI), arch drop, arch rigidity index, and center of pressure excursion index (CPEI). RESULTS: There were no statistically significant differences in the change in static foot structure or dynamic arch function between baseline and follow-up within either group. Comparing the customized orthosis and control groups, no significant differences were detected in change in AHI sitting (p=.44), AHI standing (p=.48), arch drop (p=.67), arch rigidity (p=.68) or CPEI (p=.77). CONCLUSIONS: There was no difference in arch change when comparing women who were randomized to wear customized orthoses or self-selected footwear. The finding of no arch drop in either group may indicate that both groups supported their arches during the study period or that neither group was predisposed to lose arch height with pregnancy.

[S2-Guideline: Pediatric Flat Foot]. / S2-Leitlinie: der kindliche Knick-Senk-Fuß.

In pediatric flat foot a differentiation has to be made between the flexible and the rigid form. The diagnosis is based on the history, clinical examination as well as pedobarography, gait analysis and imaging techniques. It is important to rule out neuropediatric conditions such as muscular dystrophies, Ehlers-Danlos- or Marfan syndrome. In children six years of age and younger a flexible flat foot is nearly always physiological (97% of all 19 months old children). Up to the age of ten years the medial column of the foot is developing. Only a minority of children (4% in ten year olds) has a persistent or progressive deformity. Beyond to age of ten there is a danger of deformity decompensation as well as an increased rigidity. Only a minority of children develops some pain (< 2%). A clear risk factor for persistent pediatric flat foot is obesity (62% of six year old children with flat foot are obese). Pathogenetic factors include muscular, bony or soft tissue conditions. However, there specific rule is still unclear. Prevention consists in a thorough parent information about the normal development as well as encouragement of regular sportive activities. Soft and large enough shoes should be carried as a protection. Barfoot walking has to be encouraged on uneven grounds. If physiotherapy is needed different methods can be applied. Orthosis treatment should include a proprioceptive approach. Surgical interventions in children are rare. If surgical treatment is planned a detailed algorhythm should be used before utilizing one of the many different surgical methods.

Revisión del tratamiento del pie plano adquirido del adulto en el estadio II / Treatment of adult acquired flatfoot stage II: a literature review

El pie plano adquirido del adulto es una patología compleja resultado de la insuficiencia del tendón tibial posterior y del fallo de las estructuras capsulares y ligamentosas del pié. En el estadio II existe una gran controversia respecto al tratamiento a elegir. Se ha realizado una revisión bibliográfica narrativa mediante el motor de búsqueda de Pubmed. La búsqueda se ha acotado a las publicaciones realizadas durante los últimos cinco años. Se han seleccionado 30 artículos que incluyen el pie plano adquirido en su conjunto y el estadio II. Los autores coinciden que el tratamiento conservador debe ser siempre la primera opción. En caso de cirugía debemos de valorar de manera independiente la corrección del valgo del retropié, siendo la osteotomía de medialización de calcáneo el tratamiento más extendido; el alargamiento de la columna externa; la inestabilidad de la columna medial; la supinación del antepié; y la presencia de equinismo. Cada paciente presenta una deformidad característica por lo que el tratamiento debe ser individualizado

Adult acquired flatfoot deformity is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. In stage II there is much controversy when it comes to treatment. We performed a narrative literature review using the PubMed search engine. The search was limited to publications over the past five years. We have selected 30 articles including acquired flatfoot a whole and stage II. The authors agree that conservative treatment should always be the first choice. When we decide surgical treatment independently assess the correction of the hindfoot valgus, medializing calcaneal osteotomy is the most accepted treatment; lengthening the lateral column; the instability of the medial column; supination of the forefoot; and the presence of equinus. Each patient has a characteristic deformity so the treatment must be individualized

Posterior tibial tendon transfer in the spastic brain-damaged adult does not lead to valgus flatfoot.

BACKGROUND: We studied the possible development of valgus flat foot after transfer of the posterior tibial tendon to the lateral cuneiform, used for surgical restoration of dorsiflexion in brain-damaged adult patients with spastic equinovarus foot. METHODS: Twenty hemiplegic patients were reviewed with a mean postoperative follow-up of 57.9 months. Weightbearing radiographs, static baropodometry analysis and functional evaluation were used to assess postoperatively outcomes. RESULTS: On the operated side, weightbearing radiographs showed an absence of medial arch collapse and a symmetrical and physiological hindfoot valgus; static baropodometric analysis showed a reduced plantar contact surface with a pes cavus appearance. The surgical procedure yielded good functional results. Nineteen patients were satisfied with the outcome of their surgery. CONCLUSIONS: Our findings support that transfer of the posterior tibial tendon does not lead to valgus flat foot in the spastic brain-damaged adult, and is still a current surgical alternative for management of spastic equinovarus foot.

A cross-sectional study on the development of foot arch function of 2715 Chinese children.

A cross-sectional study was conducted to investigate the foot arch function of Chinese children. A total of 2715 children, 1246 girls, and 1369 boys, 4-18 years of age were recruited from kindergartens, primary, and secondary schools. The dynamic footprints of the children were collected using a portable pressure-sensing mat. The Contact Force Ratio (CFR, i.e. the ratio of the mid-foot loading to the total loading of the contacted foot, with the toes ignored) of each age group was calculated. In general, the CFR decreased from 4 to 10 years and plateaued at 10-12 years and then increased until 15-16 years. An abnormal low arch foot was defined as the foot that had a CFR value larger than the corresponding age mean plus one standard deviation. The cut-off CFR values of each age group were calculated. With the exception of the 17 years age group, which consisted of a relatively small number of subjects, the percentage of low arch subjects of all the other age groups ranged from 15 to 20%.

Corrección del pie plano valgo en niños con enfermedades neuromusculares con artrorisis externa con grapa / Correction the flatfoot in children with disseases neuromuscular with staple arthroriesis

Presentamos nuestra experiencia quirúrgica para el tratamiento de Pie Plano Neuromuscular, con la técnica descrita por Crawford, artrorisis Subtalar con Grapa. Un total de 7 pacientes, 13 pies, cuya edad promedio al momento de la intervención fue de 6 años. Tratados en el Hospital San Juan de Dios de Caracas, con seguimiento promedio de 2 años. En el total de los casos obtuvimos resultados satisfactorios, por lo que consideramos esta técnica como una buena alternativa para el tratamiento de Pie Plano Neuromuscular en niños

Colaboraciones internacionales pie plano en el niño y acortamiento de sóleo y gemelos / The flat foot in child and shorttening of soleo and geminus

El pie plano se menciona como una situación temporal que corrige espontáneamente. Se presentan 16 pacientes con pie plano y acortamiento sóleo y gemelos estudiándose clínico y radiológicamente. Se aplica tratamiento con ejercicio de estiramiento muscular y ortesis de polipropileno. Se obtuvieron excelentes y buenos resultados con el tratamiento conservador en 26 pies y malos resultados en 6 pies ameritaron tratamiento quirúrgico que consistió en alargamiento del tendón de aquiles y atrodesis sub-astragalina. Se obtuvo en 3 pies excelentes y buenos resultados y en 2 pies malos resultados

Pie plano laxo / Flexible flat foot

El pié plano laxo se caracteriza por un aumento de la laxitud ligamentaria del pie y una deformación del arco longitudinal interno. Este problema es común en niños y su prevalencia es de 14.90 por ciento, siendo mayor en los varones que en las mujeres. El diagnóstico se realiza mediante el análisis de la huella plantar y la posición en valgo del talón. El manejo del pie plano laxo es controversial y no está comprobada la utilidad de los zapatos ortopédicos en el tratamiento de esta patología. Diversos autores han notado una estrecha asociación entre el síndrome benigno de hipermovilidad articular y el pie plano laxo.

[Influence of considerable athletic training on the foot condition of young athletes at a boarding school with a cross-section of sports]. / Vliianie znachitel'nykh sportivnykh nagruzok na sostoianie stopy iunykh sportsmenov shkoly-internate sportivnogo profilia.

The present day sport inevitably causes enormous physical loading on the locomotor system of the sportsman, and in particular on his foot. To obtain best results in any sport is closely connected with participation of children in systematic purposive training, therefore a necessity arises to study the influence of different time-limited loadings on the locomotor system--foot of young sportsmen. The work represents the data on changes of different parameters of the foot under time-limited loading for 18-30 h per week of the children attending a boarding-school of sporting type, which is a new type of going in for sports for children and teen-agers. We have stated that at the age of 10-11 years some undesirable changes in the longitudinal foot vault (its flattening) are observed, especially in children going in for skiing or gymnastics. Inclusion in training lessons special exercises contributing to fixation of the foot muscular ligamentous system prevents it, to a great extent from overloading and undesirable anatomical disturbances.