The Effect of Foot Rehabilitation Protocol in Adults With Congenital Deformity of Foot: An Analytical Case Series.

Congenital deformities of the foot significantly challenge the mobility and quality of life of affected individuals. While surgical interventions are common, rehabilitation protocols tailored to address the specific needs of adults with congenital foot deformities are less explored. This case series aims to evaluate the effectiveness of a specialized foot rehabilitation protocol in improving functional outcomes and quality of life in adults with congenital foot deformities. A series of cases involving adults diagnosed with congenital foot deformities were enrolled in a structured rehabilitation program. The protocol incorporated a combination of therapeutic exercises, manual therapy, gait training, and orthotic management tailored to individual needs. Outcome measures included functional assessments, gait analysis, pain levels, and patient-reported outcomes at baseline, midpoint, and endpoint of the rehabilitation program. Preliminary findings from the case series indicate significant improvements in various outcome measures following the foot rehabilitation protocol. Participants demonstrated enhanced gait parameters, reduced pain levels, increased range of motion, and improved functional capacity. Moreover, subjective assessments revealed enhanced satisfaction and perceived improvements in quality of life among participants. The findings suggest that a tailored foot rehabilitation protocol can be beneficial in improving functional outcomes and quality of life in adults with congenital foot deformities. This underscores the importance of integrating comprehensive rehabilitation strategies alongside surgical interventions to optimize long-term outcomes and enhance the overall well-being of individuals with congenital foot deformities. Further research with larger sample sizes and controlled study designs is warranted to validate these findings and establish evidence-based rehabilitation guidelines for this population.

Classifications in adult pes cavus - A scoping review.

AIMS: The adult cavus foot represents a challenging clinical problem, with varied aetiology and complex, 3-dimensional deformities. Thus far, the cavus foot has eluded a unified classification. The aim of this paper was to appraise the literature to identify classification systems which guide the operative management of neurological cavus feet in adults. METHODS: As the aim of this paper was broad, a scoping review was conducted. The review was conducted in line with published frameworks. Our principal research question was 'what classification systems that guide surgical management currently exist for neurological cavus feet in adults'. We searched CINAHL, Embase, OVID, Proquest, Pubmed, Scopus and Web of Science databases using MESH and non-MESH terms. Two authors independently reviewed abstracts / papers and a data extraction sheet was used to collect the relevant data. RESULTS: A total of 1140 articles were initially screened, identifying 125 articles for which a full text review was performed. Only three articles met all our inclusion criteria. All these articles reported an anatomical classification with suggestions for treatment based on the classification. All were considered to comprise Level V evidence, and none reported outcomes of treatment based on the classification. CONCLUSIONS: There is currently a paucity of robust classifications to guide treatment in neurological cavus feet in adults. The few classifications systems that exist are varied and do not as yet have sufficient evidence to support their widespread use. Further work is required, aimed at identifying specific features of cavus feet that would guide operative treatment.

Forefoot Morphotypes in Cavovarus Feet: A Novel Assessment of Deformity.

BACKGROUND: The cavovarus foot is a complex 3-dimensional deformity. Although a multitude of techniques are described for its surgical management, few of these are evidence based or guided by classification systems. Surgical management involves realignment of the hindfoot and soft tissue balancing, followed by forefoot balancing. Our aim was to analyze the pattern of residual forefoot deformities once the hindfoot is corrected, to guide forefoot correction. METHODS: We included 20 cavovarus feet from 16 adult patients with Charcot-Marie-Tooth who underwent weightbearing CT (mean age 43.4 years, range: 22-78 years, 14 males). Patients included had flexible deformities, with no previous surgery. Using specialized software (Bonelogic 2.1, Disior) a 3-dimensional, virtual model was created. Using morphologic data captured from normal feet in patients without pathology as a guide, the talonavicular joint of the cavovarus foot was digitally reduced to a "normal" position to simulate the correction that would be achieved during surgical correction. Models of the corrected position were exported and geometrically analyzed using Blender 3.64 to identify anatomical trends. RESULTS: We identified 4 types of cavovarus forefoot morphotypes. Type 0 was defined as a balanced forefoot (2 cases, 10%). Type 1 was defined as a forefoot where the first metatarsal was relatively plantarflexed to the rest of the foot, with no significant residual adduction after talonavicular joint correction (12 cases, 60%). Type 2 was defined as a forefoot where the second and first metatarsals were progressively plantarflexed, with no significant adduction (4 cases, 20%). Type 3 was defined as a forefoot where the metatarsals were adducted after talonavicular derotation (2 cases, 10%). CONCLUSION: In this relatively small cohort, we identified 4 forefoot morphotypes in cavovarus feet that might help surgeons to recognize and anticipate the residual forefoot deformities after hindfoot correction. Different treatment strategies may be required for different morphotypes to achieve balanced correction. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Does the Sagittal Radiographic Morphology of Subtalar Joint Affect the Alignment of Foot?

OBJECTIVES: The etiology of flatfoot and cavus foot is multicausal and controversial. So far, no literature reports the relationship between the sagittal morphology of subtalar joint and the alignment of foot. The purpose of this study was to explore whether the subtalar alignment would influence the configuration of foot. METHODS: From January 2017 to January 2020, we included 109 feet in the flatfoot group, 95 feet in the cavus group, and 104 feet in the control group in this retrospective comparative study. The Gissane angle and calcaneal posterior articular surface inclination angle represented the sagittal morphology of the subtalar joint. Meary's angle, calcaneal pitch angle, and talar pitch angle reflected the alignment of foot. They were measured in the weightbearing foot X-rays. The angles in different groups were compared via Mann-Whitney U test. We calculated the correlation between the sagittal alignment of subtalar joint and the alignment of foot using Spearman's correlation analysis. Interobserver and intraobserver reliability were calculated. RESULTS: The Gissane angle, calcaneal posterior articular surface inclination angle, Meary's angle, talar pitch angle, and calcaneal pitch angle were significantly different in the three groups. The Gissane angle had an excellent correlation with the Meary's angle (r = 0.850, p < 0.0001), and the talar pitch angle (r = -0.825, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = 0.638, p < 0.0001). The calcaneal posterior articular surface inclination angle had an excellent correlation with the Meary's angle (r = -0.902, p < 0.001), and the talar pitch angle (r = 0.887, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = -0.702, p < 0.0001). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent. CONCLUSION: A subtalar joint with a larger Gissane angle and a more horizontal calcaneal posterior articular surface angle tended to have a higher foot arch and vice versa. The inspiration from this study was that the deformities of flatfoot and cavus foot may relate to the subtalar deformity.

Novel Insights from Clinical Practice: Xia-Gibbs Syndrome with Pes Cavus, Conjunctival Melanosis, and Eye Asymmetry due to a de novo AHDC1 Gene Variant - A Case Report and a Brief Review of the Literature.

Introduction: Xia-Gibbs syndrome (OMIM 615829) is a rare developmental disorder, caused by heterozygous de novo variants in the AHDC1 gene. Hallmark features include global developmental delay, facial dysmorphisms, and behavioral problems. To date, more than 250 individuals have been diagnosed worldwide. Case Report: We report a 13-year-old female who, in association with typical features of Xia-Gibbs syndrome, presented with macrocrania, pes cavus, and conjunctival melanosis. Whole-exome sequencing identified a de novo frameshift variant, which had not been reported in the literature before. Conclusion: We summarized the main clinical and phenotypic features of patients described in the literature, and in addition, we discuss another feature found in our patient and observed in other cases described, eye asymmetry, which has never been highlighted, and suggest that it could be part of the typical clinical presentation of this condition.

Impact of static foot disorders on the conservative treatment success in chronic venous disease patients without wounds.

OBJECTIVE: Chronic venous disease (CVD) and static foot disorders (SFDs) are prevalent conditions that commonly cause lower extremity pain. These conditions share common factors such as age and weight in their etiology. This study aimed to investigate the impact of SFDs on the treatment response of patients undergoing conservative treatment for CVD without wounds. MATERIALS AND METHODS: A retrospective evaluation was conducted on 328 patients (60 males, 268 females) with CVD. Parameters including age, gender, affected side, body mass index, Visual Analog Scale (VAS), Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, and revised Venous Clinical Severity Score (rVCSS) were considered for evaluation. Radiological measurements of calcaneal pitch angle (CPA) were analyzed as a determinant of SFDs. RESULTS: VAS and rVCSS of the patients were evaluated before and after conservative treatment of CVD without concomitant treatment of SFDs. The presence of SFDs was associated with decreased treatment success (P < .001). Among different types of SFDs, the pes cavus group exhibited the lowest change in VAS and rVCSS scores before and after conservative CVD treatment. In contrast, the normal group demonstrated the highest improvement. Patients with a normal foot medial arch consistently achieved the best treatment outcomes compared with patients with other SFDs. CONCLUSIONS: In conclusion, SFDs affect outcomes of conservative treatment of CVD in CEAP 0 to 3 patients, with the efficacy of treatment dependent upon the severity of SFDs.

Effect of sequential burr passes on minimally invasive akin and first metatarsal dorsiflexion osteotomies.

BACKGROUND: Minimally invasive surgical (MIS) osteotomies are increasing as a surgical option for treating midfoot and forefoot conditions. This study aimed to evaluate the impact of each burr pass on the degree of correction, gap size, and alignment in MIS Akin and first metatarsal dorsiflexion osteotomies (DFO). METHODS: MIS Akin and first metatarsal DFO were performed on ten cadaveric specimens. Fluoroscopic measurements included the metatarsal dorsiflexion angle (MDA), dorsal cortical length (MDCL), first phalangeal medial cortical length (PCML) and proximal to distal phalangeal articular angle (PDPAA). RESULTS: The average decrease in PCML with each burr pass was as follows: 1.53, 1.33, 1.27, 1.23 and 1.13 mm at the 1st to 5th pass, respectively. The MDCL sequentially decreased by 1.80, 1.59, 1.35, 0.75, and 0.60 mm. The MDA consistently decreased, and the PDPAA incrementally became more valgus oriented. CONCLUSION: On average, a first metatarsal dorsal wedge resection of 4.7 mm and first phalangeal medial wedge resection of 2.9 mm was achieved after 3 and 2 burr passes, respectively. This data may aid surgeons determine the optimal number of burr passes required to achieve the desired patient-specific surgical correction.

Feasibility and safety of minimally invasive calcaneal osteotomy (MICO) through a medial approach: a case-control study.

INTRODUCTION: Minimally invasive calcaneal osteotomy (MICO) is already an established surgical procedure for correcting hindfoot deformities using a lateral approach. So far, no description of a medial approach for MICO has been published. MATERIAL AND METHODS: Between August 2022 and March 2023, 32 consecutive patients (MICO with medial approach, MMICO: n = 15; MICO with lateral approach, LMICO: n = 17) underwent MICO as part of complex reconstructive surgery of the foot and ankle with concomitant procedures. The amount of correction in the axial view of the calcaneus and consolidation rates were evaluated radiographically. Subjective satisfaction, stiffness of the subtalar joint, and pain level (numeric rating scale, NRS) at the level of the heel were assessed clinically. The last follow-up was at 6 months. RESULTS: All osteotomies consolidated within 6 months after surgery. Displacement of the tuber was 9 mm on average in either group. Relevant subtalar joint stiffness was detected in 5 MMICO and 6 LMICO patients. No relevant differences between the groups were detected for wound healing problems, nerve damage, heel pain or patient satisfaction. CONCLUSION: In this study lateral and medial approaches for MICO were performed. Similar degrees of correction and low complication rates were found in both groups. The medial approach for MICO is safe and can be beneficial regarding patient positioning and arrangement of the C­arm.

The Association of Cavovarus Foot Deformity With an Os Peroneum.

OBJECTIVE: We sought to assess whether the presence of an os peroneum is correlated with cavovarus foot alignment in patients without a neurologic explanation for their foot shape. We hypothesized that a large os peroneum would increase the power of the peroneus longus and lead to a forefoot-driven, hindfoot varus deformity. MATERIALS AND METHODS: This was a retrospective cohort study conducted at a single institution and reviewed patients with 3 weightbearing views of the foot on plain radiography. Patients were characterized into having either no os peroneum (235), a small os peroneum (18), or a large os peroneum (23). The control group included the first 101 of the 235 patients without an os peroneum based on a power analysis of the primary outcome, which was the difference in the mean Meary's angle (lateral talo-first metatarsal angle) between groups. The kite angle (anterior-posterior [AP] talocalcaneal angle), as well as 4 other angles were measured as secondary outcomes. RESULTS: Those with a large os peroneum had on a mean 7.7° (P < .01) more apex dorsal angulation of Meary's angle than controls, and a kite angle 4.2° varus to that of the control group. There were no differences between the small os peroneum and control groups. CONCLUSION: These findings add to the existing literature surrounding the etiology of cavovarus foot shape and link the presence of an ossified os peroneum, an oftentimes incidental radiographic finding, to cavovarus foot deformity in those without an underlying neurologic diagnosis. LEVELS OF EVIDENCE: Therapeutic, Level III: Retrospective Case-Control.

Cavus Foot Deformity with Calcaneonavicular and Medial Cuneiform-Navicular Coalition: A Case Series.

Tarsal coalitions have only very infrequently been observed in the context of cavus foot abnormalities. Recognizing this diagnosis could be crucial to effective cavus repair. We report tarsal coalitions observed in cavus deformity here. Between 2022 and 2023, the records of every patient treated by one of the authors for a varus deformity who was later determined to have either a unilateral or bilateral tarsal coalition were examined. Two patients with cavus deformities who were treated by one of the authors have either a unilateral or bilateral tarsal coalition. Three foot (medial cuneiform-navicular n = 1 and calcaneonavicular n = 2) with tarsal coalition were examined. All of these cases occurred in patients with idiopathic cavus deformity. Computed tomography scans were used to make a firm diagnosis for each patient. We advise surgeons to keep an awareness for this potential comorbid issue in all cavus foot abnormalities and to take advanced imaging into consideration. In these uncommon cases, the medial cuneiform-navicular and calcaneonavicular joints formed an osseous coalition with pes cavus deformity, which successfully resolved with conservative and surgical treatment, respectively. Level of Clinical Evidence: IV.

Toes Deformities in Cavovarus: How to Approach Them.

Sagittal lesser toe deformities (LTD) are the most common in cavus foot. They are mainly the result of muscular imbalance between intrinsic and extrinsic muscles. Surgery is the second-line treatment if medical treatment fails. The aim of the present study was to provide an update on classification and surgical management of LTD in cavus foot including percutaneous procedures with a special focus on sagittal deformities. Joint sparing procedures are preferred for reducible LTD, whereas lesser toe fusions are used for rigid one in association with tendon transfer or percutaneous procedures depending of surgeon's experience and patient's clinical examination.

Midfoot Tarsectomy in Cavovarus: Why PSI Makes a Difference?

The cavovarus foot is a complex deformity that can be treated using multiple surgical procedures, ranging from soft tissue surgery to triple arthrodesis. Among these options, anterior midfoot tarsectomy is a three-dimensional closed-wedge osteotomy, traditionally performed slowly and progressively in a blind fashion, and remaining a challenge for unexperimented surgeons with variable outcomes. As such, we investigated and discussed the use of patient-specific cutting guides (PSCGs) in computer-assisted anterior midfoot tarsectomy in terms of accuracy, reproducibility, and safety.

Hindfoot Fusions in the Cavovarus Foot: What Is the Key for a Successful Outcome?

The aim of hindfoot fusions in the cavovarus foot is to establish a painless, plantigrade, balanced and stable foot. A comprehensive clinical and radiographic assessment enables the surgeon to fully understand the patient's deformity and plan a reliable surgical strategy for deformity correction. Pre-operative planning and intraoperative techniques are discussed.

Effects of plantar fascia stiffness on the internal mechanics of idiopathic pes cavus by finite element analysis: implications for metatarsalgia.

Metatarsalgia occurring in individuals with pes cavus is typically associated with abnormal loading patterns in the forefoot resulting from structural alterations. Simultaneously, the frequent overstress of the plantar fascia (PF) caused by the persistence of this foot deformity may further exacerbate the chronic pain induced by metatarsal overload. We aimed to investigate and quantify the effects of PF stiffness on the internal biomechanics of pes cavus using a computational modelling approach. A patient-specific finite element model of the foot-ankle complex using the actual three-dimensional geometry of idiopathic pes cavus bones and soft tissues was reconstructed. A sensitivity study was conducted to evaluate the effects of varying elastic modulus (0-700 MPa) of the PF on the metatarsal stress distribution, and force transmission through the metatarsophalangeal (MTP) and tarsometatarsal (TMT) joints in the pes cavus. The results indicated that variations in PF stiffness led to stress redistribution in the metatarsal region. Peak stress gradually reduced with decreasing stiffness until the PF was released, eventually resulting in a reduction of 22.39% compared to the reference value of 350 MPa. Furthermore, adjusting the PF stiffness to twice the reference value (700 MPa) increased the contact forces through the TMT and MTP joints by up to 23% and 116%, respectively. The reduction of PF stiffness alleviated focal metatarsal loading, and therefore, surgical fascia release can be considered to alleviate metatarsalgia in patients with pes cavus.

Understanding foot conditions, morphologies and functions in children: a current review.

This study provided a comprehensive updated review of the biological aspects of children foot morphology across different ages, sex, and weight, aiming to reveal the patterns of normal and pathological changes in children feet during growth and development. This review article comprised 25 papers in total that satisfied the screening standards. The aim was to investigate how weight changes, age and sex affect foot type, and gain a deeper understanding of the prevalent foot deformities that occur during children growth. Three different foot morphological conditions were discussed, specifically including the effect of sex and age differences, the effect of weight changes, and abnormal foot morphologies commonly documented during growth. This review found that sex, age, and weight changes would affect foot size, bony structure, foot posture, and plantar pressures during child growth. As a result of this biological nature, the children's feet generally exhibit neutral and internally rotated foot postures, which frequently lead to abnormal foot morphologies (e.g., flat foot, pronated foot, etc.). In the future, attention shall be paid to the causal factors leading to specific foot morphologies during the growth and development of children. However, sufficient evidence could not be provided due to a relatively short period of investigation and non-uniformed research methodology in the current literature. A more comprehensive and in-depth exploration is recommended to provide scientific evidence for the discovery of children foot development and personalized growth pattern.

Republication of "Minimally Invasive Surgery Using the Circular External Fixator to Correct Neglected Severe Stiff Equinocavus Foot Deformities".

Background: Stiff equinocavus deformities of the foot are challenging to treat, often requiring extensive soft tissue dissection and bone removal. These procedures frequently yield suboptimal results and not infrequently amputation. Minimally invasive surgery using a circular external fixator potentially avoids the trauma to the soft tissue and may lead to improvement in outcomes and a lower amputation rate. The objective of this study was to evaluate the efficacy of minimally invasive surgery using a circular external fixator and limited soft tissue release to correct stiff equinocavus deformities. Methods: The treatment outcome of 29 patients (31 feet) with stiff equinocavus deformities of the foot and ankle treated with minimally invasive surgery and circular external fixation were reviewed after a mean follow-up period of 63 months. Patients' demographics and cause of the deformities were recorded. Weight bearing radiographs of the foot were compared pre and postoperatively. Results: Outcome was satisfactory (plantigrade foot with improvement/resolution of pain) in 21 of 31 extremities, fair in 6 of 31 extremities, and poor in 4 of 31 extremities. In the majority of patients, a significant improvement in the equinocavus deformities was achieved with a statistically significant improvement in calcaneus and navicular height. Two patients with Charcot-Marie-Tooth and severely insensate feet had a poor outcome, resulting in transtibial amputation. Conclusion: Minimally invasive surgery with gradual correction of neglected stiff equinocavus deformities using a modular circular external fixator is a reliable initial limb salvage strategy. Minimally invasive surgery and gradual correction of neglected severe stiff equinocavus deformities using the modular circular external fixator to gradually correct neglected severe stiff equinocavus deformities, is a safe initial limb salvage strategy which may simplify secondary procedures such as arthrodesis. Level of evidence: IV.

Type of Feet in a Mexican Population: Analysis of the Footprint Morphology and Literature Review / Tipos de pies en una Población Mexicana: Análisis de la Morfología de la Huella Plantar y Revisión de la Literatura

ABSTRACT There is no specific age when the vault of the feet is completely formed. The objective of this study was to analyze the footprint morphology and obtain the Chippaux-Smirak Index in a Mexican population to identify the type of feet and its prevalence. A database of images of the soles of both feet was analyzed. The database contained images of 1,014 persons between 2 and 73 years old from Guanajuato state, Mexico. Moreover, a literature review was performed to identify the type of feet in the Mexican population. It was observed that less than 17 % of the population have cavus foot (p= 0.018). Furthermore, less than 25 % of the population between 17 and 73 years have flatfoot 3 (p= 0.0079) in the left foot. Also, only nine articles related to the type of foot in the Mexican population were found, but most of them were performed on young population. The formation of the medial arc could be beyond the first decade of life and the relatively high prevalence of flatfoot in adult life should be studied. Finally, the results found can be useful for orthopedists, physiotherapists, clinicians, and parents who are concerned about the foot health of their children.

RESUMEN No hay una edad específica en la que la bóveda de los pies esté completamente formada. El objetivo de este estudio fue analizar la morfología de la huella de los pies y obtener el Índice de Chippaux-Smirak en una población mexicana para identificar el tipo de pie y su prevalencia. Se analizó una base de datos de imágenes de las plantas de ambos pies. La base de datos contenía imágenes de 1,014 personas de entre 2 y 73 años del estado de Guanajuato, México. Además, se realizó una revisión bibliográfica para identificar el tipo de pie en la población mexicana. Se observó que menos del 17 % de la población tiene pie cavo (p= 0,018). Además, menos del 25 % de la población entre 17 y 73 años tiene pie plano 3 (p= 0,0079) en el pie izquierdo. Además, se encontraron 9 artículos relacionados con el tipo de pie en población mexicana, pero la mayoría de ellos fueron desarrollados en población joven. La formación del arco medial podría estar más allá de la primera década de vida. Se encontró una prevalencia relativamente alta de pie plano en la vida adulta que debe ser estudiada. Finalmente, los resultados encontrados pueden ser útiles para ortopedistas, fisioterapeutas, médicos y padres preocupados por la salud de los pies de sus hijos.

EXERCISES AND NEUROMUSCULAR ELECTRIC STIMULATION FOR MEDIAL LONGITUDINAL ARCH: CLINICAL TRIAL.

Objective: The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch. Methods: This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period. Results: No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle. Conclusion: NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic. Level of Evidence I; Randomized clinical trial.

Objetivo: Os músculos extrínsecos, como o tibial posterior e flexor longo do hálux e os intrínsecos do pé fazem parte do subsistema ativo do foot core system e exercem papel essencial no controle do arco longitudinal medial. Devido à dificuldade na contração desses músculos, a eletroestimulação neuromuscular (EENM) torna-se um recurso aliado ao fortalecimento e é recomendada para reabilitação. O objetivo desse trabalho é avaliar a eficácia da EENM associada ao exercício na deformação do arco longitudinal medial. Métodos: Este é um ensaio clínico randomizado cego. 60 participantes assintomáticos foram divididos em três grupos: EENM, exercício e controle. O grupo EENM e exercício realizaram sete exercícios para os músculos intrínsecos e extrínsecos duas vezes por semana por seis semanas, sendo o grupo EENM utilizou a EENM associada a cinco exercícios. A altura do navicular e o ângulo do arco longitudinal medial foram medidos antes e após o período de intervenção. Resultados: Não houve diferenças estatisticamente significativas entre os grupos para a altura do navicular e ângulo do arco longitudinal medial. Conclusão: A EENM associada ao exercício não altera as características do arco longitudinal medial em indivíduos assintomáticos. Nível de Evidência I; Estudo Clínico Randomizado.

Diagnostic Accuracy of Harris Imprint Index, Chippaux-Smirak Index, Staheli Index Compared With Talar-First Metatarsal Angle for Screening Arch of Foot.

OBJECTIVE: To determine the diagnostic accuracy and reliability of the Harris imprint index (HII), Chippaux-Smirak index (CSI), and Staheli index (SI) compared with the talar-first metatarsal angle. METHODS: Data was collected at the orthotic and prosthetic clinic, Thammasat University Hospital from January 1, 2016 to August 31, 2020. The three footprints were measured by the rehabilitation physician and the orthotist. The talar-first metatarsal angle was measured by the foot and ankle orthopaedist. RESULTS: The data from 198 patients with 274 feet was analyzed. The diagnostic accuracy of the footprint triad showed that CSI was the most accurate in pes planus prediction, followed by HII and SI (area under the receiver operating characteristic curve [AUROC]=0.73, 0.68, 0.68, respectively). In pes cavus, HII was the most accurate, followed by SI and CSI (AUROC=0.71, 0.61, 0.60, respectively). For pes planus, the intra-observer reliability by Cohen's Kappa was 0.92 for HII, 0.97 for CSI, and 0.93 for SI, the inter-observer reliability 0.82, 0.85, and 0.70, respectively. For pes cavus, the intra-observer reliability was 0.89 for HII, 0.95 for CSI, and 0.79 for SI, inter-observer reliability of 0.76, 0.77, and 0.66, respectively. CONCLUSION: The accuracy of HII, CSI, and SI was fair in screening of pes planus and pes cavus. The intra- and inter-observer reliability were in the moderate to almost perfect range by Cohen's Kappa.

NGS-Panel Diagnosis Developed for the Differential Diagnosis of Idiopathic Toe Walking and Its Application for the Investigation of Possible Genetic Causes for the Gait Anomaly.

Idiopathic toe walking (ITW) describes a condition affecting approximately 4.5% of children. Toe walking is an accompanying symptom for many hereditary disorders. This retrospective study uses next-generation sequencing-panel-diagnosis to investigate the feasibility of genetic testing to research the possible genetic causes of ITW and for differential diagnosis. Data were taken from our inhouse database, the minimum age for participants was 3 years. Underlying neurological or orthopaedic conditions were tested for and ruled out prior to diagnosing ITW. Patients, who experienced complications before, during or immediately after birth, children with autism, and patients toe walking less than 50% of the time were excluded. Eighty-nine patients were included in the study, in which 66 (74.2%) patients were boys and 23 (25.8%) girls. Mean age at testing was 7.7 years (range: 3-17 years). Fifteen of the 89 patients included in the study (16.9%) had a genetic variant identified as likely pathogenic or pathogenic by the genetics laboratory. Additionally, we found 129 variants of uncertain significance. About 65.2% of patients showed a pes cavus foot deformity, 27% of patients reportedly had at least one relative who also displayed the gait anomaly, and 37.1% had problems with their speech development. Despite the limitations of the sample size and the scope of our genetic testing targets, our results indicate that research into the genetic causes of ITW could better our understanding of the causes of ITW in otherwise healthy children, to help develop novel methods to detect serious conditions early. ITW could be an early onset symptom for further hereditary conditions.