Foot Typology, Dynamic and Static Weight Distribution, and Radiographic Changes After Subtalar Arthroereisis in Juvenile Symptomatic Flexible Flat Feet.

Flexible flatfoot is among the most common skeletal disorders in childhood. This study describes the dynamic and static correction effects of subtalar arthroereisis in adolescents with flexible symptomatic flatfeet in comparison to normal subjects as well as to results before and after removal of metal. Eighteen adolescents with 25 symptomatic flexible flatfeet were treated surgically with a subtalar arthroereisis at a mean of 12.5 (10-16) years. At follow-up (mean 3.9 years, range 0.4-8), patients filled out the American Orthopaedic Foot and Ankle Society questionnaire, received radiographs and were examined using dynamic and static pedobarography as well as static hindfoot axis examination. Results were compared to healthy controls (n = 13; 26 feet). Surgically treated feet (n = 25) had better questionnaire results after surgery than before, but lower scores than healthy feet. Radiological parameters improved significantly after surgery. Removal of metal did not influence post-surgical results (follow-up 2.8 years). Surgically treated feet had larger contact areas than normal feet with predominance to the midfoot region. The relative maximum force, relative peak pressure and contact time were higher in the midfoot of treated feet compared to controls. When comparing pedobarography data of treated versus untreated feet of the same patients (subgroup n = 11 feet), there were no differences. Subtalar arthroereisis was able to effectively treat symptomatic flexible flatfeet in this population. Results improved significantly evaluating a questionnaire, radiographs, dynamic and static weight distribution, but were still worse than results of healthy feet. There was no relapse after removal of metal.

[Injuries in German Paralympic alpine skiing over 25 years]. / Verletzungen im deutschen paralympischen Ski Alpin über einen 25-jährigen Zeitraum.

INTRODUCTION: Despite the size of the Paralympic Games and the large number of people with disabilities, there is a lack of studies on (high-performance) Paralympic sports. Major injuries in the German Paralympic Alpine Skiing Team have been recorded and presented in this retrospective cohort study. PATIENTS AND METHODS: All major injuries in competition and training of the German Paralympic Ski Team were recorded over 25 years. A descriptive statistic evaluation was performed. RESULTS: Major injuries were sustained by 22 of 94 athletes (23 %). These included 12 (55 %) "sitting" athletes, 9 (41 %) "standing" athletes and one "visually impaired" athlete (5 %). The most common injuries were upper extremity injuries (n = 9, 41 %), especially of the shoulder (n = 8, 36 %). Seated athletes were particularly prone to shoulder injuries. The most dangerous disciplines by far were the speed disciplines Downhill and Super-G (n = 17, 77 %). The average injury rate was 7 % of the athletes per year. In our cohort, the highest absolute number of athletes got injured during the 1998 Paralympic Games in Nagano (n = 4). The highest injury rate, however, was observed during the Sotchi 2014 Paralympic Games (33 %). DISCUSSION: The current literature indicates that, contrary to previous assumptions, the risk of sustaining an injury seems to be higher in Paralympic athletes compared with Olympic athletes. Sitting athletes, in particular, have an increased risk of injury. They should be given special consideration when implementing preventive measures. An intensified training of the core muscles seems to be essential. Technical equipment such as the mono-ski bob deserves special attention to ensure safe usage. Shoulder injuries are particularly frequent and, at the same time, particularly debilitating for seated athletes. Careful strength training of the shoulder seems to be indispensable. In order to reduce the frequency and severity of injuries, the further development of preventive measures is essential. We think that the Paralympic sport should be further professionalized. CONCLUSIONS: Sitting athletes show an increased injury rate and tend to have shoulder injuries, which often have a debilitating effect on an athlete's everyday life. We consider the further development of preventive measures to be essential for the future of Paralympic sport.

Non-operative treatment of unicompartmental osteoarthritis of the knee: a prospective randomized trial with two different braces-ankle-foot orthosis versus knee unloader brace.

BACKGROUND: The use of an unloader brace is a non-surgical treatment option for patients with medial osteoarthritis (OA). However, many patients do not adhere to brace treatment, because of skin irritation due to the pads at the level of the joint space and bad fit. A new concept to unload the medial compartment of the knee is a foot ankle brace with a lever arm pressing the thigh in valgus. The aim of this prospective randomized trial was to examine the outcomes of patients with medial OA after treatment with a conventional knee unloader brace (Unloader One®) and the new foot ankle orthosis (Agilium FreeStep®). METHODS: For this multicenter trial, 160 patients (> 35 years) with medial OA were randomly allocated to treatment with a conventional knee unloader brace (Unloader One®) or treatment with the new knee OA ankle brace (Agilium FreeStep®). The primary outcome measure was pain (numerical analog scale) at baseline (T0), 8 weeks (T1), and 6 months (T2). Secondary outcome measures were knee function (Knee Injury and Osteoarthritis Outcome Score, KOOS), side effects, additional interventions, and compliance. RESULTS: In both groups, walking pain improved between T0 and T1 and also between T0 and T2 without a significant group difference. For pain at sports, both groups showed a significant improvement between T0 and T2 without a significant group difference. The KOOS subscales symptoms, pain, activity, sport, and quality of life increased significantly in both treatment groups without any significant group differences at T 0, T1, and T2. There was also no significant group difference in additional interventions and weekly or daily brace use. In the Agilium FreeStep® group (23.5%), significantly less patients reported bruises in contrast to the Unloader One® group (66.7%). DISCUSSION: The results of this clinical trial show that the foot ankle brace is as effective as a conventional knee unloader brace for the treatment of medial knee OA with regard to clinical outcome. The rate of side effects such as bruises was significantly lower in the Agilium FreeStep® group. TRIAL REGISTRATION: DRKS00009215, 13.8.2015.

[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.

Effects of a novel foot-ankle orthosis in the non-operative treatment of unicompartmental knee osteoarthritis.

INTRODUCTION: Unloader braces are non-surgical treatment options for patients with unicompartmental knee osteoarthritis (OA). However, many patients do not adhere to brace treatment because of complications related to discomfort and poor fit. An alternative to knee bracing is an ankle-foot orthosis (AFO) with a lever arm that presses the lower leg into valgus or varus. The aim of this study is to evaluate the clinical benefits of this AFO for patients with unicompartmental knee OA. MATERIALS AND METHODS: Twenty-three patients with knee OA were enrolled in this observational study. The primary clinical outcome measure was the Western Ontario and McMasters Universities Arthritis Index (WOMAC) total score. Secondary outcome measures included WOMAC subscores, visual analogue pain scale, activity restriction and complication rate. Clinical scores were collected at start and 3, 6, 9, and 12 months after enrollment. Statistical evaluation was performed using the Student's t test. RESULTS: Of the patients enrolled, 83 % suffered from medial compartment OA. Most patients had Grade II OA according to the Kellgren and Lawrence classification. WOMAC total score, both subscores and visual analogue pain scale were significantly improved over time. Patients also noted a reduction in restrictions to activities of daily living and sport-related activities while using the AFO. No patients discontinued orthosis use because of adverse effects. Two types of complications were noted: discomfort or light pressure sores around the ankle (7 patients), and wear and tear of the shoe in which the AFO was worn (14 patients). CONCLUSIONS: This observational study suggests that this AFO is effective at significantly reducing pain and stiffness as well as improving the physical function of patients with mild to moderate unicompartmental osteoarthritis of the knee.