Does the long-term use of medial arch support insole induce the radiographic structural changes for pediatric flexible flat foot? - A prospective comparative study.

BACKGROUND: Several conservative treatment methods, from intrinsic muscle exercises to orthoses, including insoles or specially designed shoes, have been introduced for pediatric flexible flat foot (PFFF). However, the structural effects of a long-term use of medial arch support insole remain unclear because the normal physiological maturation of the medial longitudinal arch cannot be ruled out. METHODS: From January 2005 to June 2015, 18 patients (34 feet) in group 1 (continuously insole applied group) and 13 patients (26 feet) in group 2 (untreated group) were enrolled. Medial arch support insole was applied from the age 10-11years to radiographic physeal closure. RESULTS: In group 1, talonavicular coverage angle, lateral talo-1st metatarsal angle, calcaneal pitch angle and medial cuneiform height were significantly changed at final follow-up, although all values were still within the abnormal range. Further, no significant differences were found in any of the increments of the radiographic parameters between group 1 and 2. CONCLUSIONS: Radiographic improvements were found in both of medial arch support insole treated or untreated group despite all radiographic values were still within the abnormal range. It was meaningful that the PFFF could be improved somewhat until the physes were closed. And the hindfoot alignment remained unchanged regardless of medial arch support insole application.

Adult-acquired flatfoot deformity.

Adult-acquired flatfoot deformity (AAFD) is a known and recognized cause of pain and disability. Loss of PTT function is the most important contributor to AAFD, and its estimated prevalence is thought to be over 3%. This review aims to summarize the current literature and encompass recent advances regarding AAFD.

Nonoperative care for the treatment of adult-acquired flatfoot deformity.

Nonoperative therapy for adult-acquired flatfoot is a reasonable treatment option that is likely to be beneficial for most patients. In this article, we describe the results of a retrospective cohort study that focused on nonoperative measures, including bracing, physical therapy, and anti-inflammatory medications, used to treat adult-acquired flatfoot in 64 consecutive patients. The results revealed the incidence of successful nonsurgical treatment to be 87.5% (56 of 64 patients), over the 27-month observation period. Overall, 78.12% of the patients with adult-acquired flatfoot were obese (body mass index [BMI] ≥ 30), and 62.5% of the patients who failed nonsurgical therapy were obese; however, logistic regression failed to show that BMI was statistically significantly associated with the outcome of treatment. The use of any form of bracing was statistically significantly associated with successful nonsurgical treatment (fully adjusted OR = 19.8621, 95% CI 1.8774 to 210.134), whereas the presence of a split-tear of the tibialis posterior on magnetic resonance image scans was statistically significantly associated with failed nonsurgical treatment (fully adjusted OR = 0.016, 95% CI 0.0011 to 0.2347). The results of this investigation indicate that a systematic nonsurgical treatment approach to the treatment of the adult-acquired flatfoot deformity can be successful in most cases.

A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet.

The pediatric flat foot is a frequent presentation in clinical practice, a common concern to parents and continues to be debated within professional ranks. As an entity, it is confused by varied classifications, the notion of well-intended prevention and unsubstantiated, if common, treatment. The available prevalence estimates are all limited by variable sampling, assessment measures and age groups and hence result in disparate findings (0.6-77.9%). Consistently, flat foot has been found to normally reduce with age. The normal findings of flat foot versus children's age estimates that approximately 45% of preschool children, and 15% of older children (average age 10 years) have flat feet. Few flexible flat feet have been found to be symptomatic. Joint hypermobility and increased weight or obesity may increase flat foot prevalence, independently of age. Most attempts at classification of flat foot morphology include the arch, heel position and foot flexibility. Usual assessment methods are footprint measures, X-rays and visual (scaled) observations. There is no standardized framework from which to evaluate the pediatric flat foot. The pediatric flat foot is often unnecessarily treated, being ill-defined and of uncertain prognosis. Contemporary management of the pediatric flat foot is directed algorithmically within this review, according to pain, age, flexibility; considering gender, weight, and joint hypermobility. When foot orthoses are indicated, inexpensive generic appliances will usually suffice. Customised foot orthoses should be reserved for children with foot pain and arthritis, for unusual morphology, or unresponsive cases. Surgery is rarely indicated for pediatric flat foot (unless rigid) and only at the failure of thorough conservative management. The assessment of the pediatric flatfoot needs to be considered with reference to the epidemiological findings, where there is consensus that pediatric flexible flat foot reduces with age and that most children are asymptomatic. Globally, there is need for a standard by which the pediatric flat foot is assessed classified and managed. Until then, assessment should utilize the available evidence-based management model, the p-FFP Future research needs to evaluate the pediatric flat foot from representative samples, of healthy and known disease-group children prospectively, and using validated assessment instruments. The preliminary findings of the benefits of foot exercises, and discrete investigation into the effects of shoes and footwear use are also warranted.

The effect of 3 foot pads on plantar pressure of pes planus foot type.

CONTEXT: Many styles of foot pads are commonly applied to reduce immediate pain and pressure under the foot. OBJECTIVE: To examine the effect of 3 different foot pads on peak plantar pressure (PPP) and mean plantar pressure (MPP) under the first metatarsophalangeal joint (MTPJ) during slow running. DESIGN: A 4 (pad) x 4 (mask) repeated-measures design. SETTING: University athletic training clinic and fitness facility. PARTICIPANTS: 20 physically active participants, 12 men (19.7 +/- 1.3 y, 181.5 +/- 6.3 cm, 83.6 +/- 12.3 kg) and 8 women (20.8 +/- 1.5 y, 172.7 +/- 11.2 cm, 69.9 +/- 14.2 kg) with navicular drop greater than or equal to 10 mm, no history of surgery to the lower extremity, and no history of pain or injury to the first MTPJ in the past 6 months. INTERVENTIONS: PPP and MPP were evaluated under 4 areas of the foot: the rear foot, lateral forefoot, medial forefoot, and first MTPJ. Four pad conditions (no pad, metatarsal dome, U-shaped pad, and donut-shaped pad) were evaluated during slow running. All measurements were taken on a standardized treadmill using the Pedar in-shoe pressure-measurement system. MAIN OUTCOME MEASURES: PPP and MPP in 4 designated foot masks during slow running. RESULTS: The metatarsal dome produced significant decreases in MPP (163.07 +/- 49.46) and PPP (228.73 +/- 63.41) when compared with no pad (P < .001). The U-shaped pad significantly decreased MPP (168.68 +/- 50.26) when compared with no pad (P < .001). The donut-shaped pad increased PPP compared with no pad (P < .001). CONCLUSIONS: The metatarsal dome was most effective in reducing both peak and mean plantar pressure. Other factors such as pad comfort, type of activity, and material availability must also be considered. Further research should be conducted on the applicability to other foot types and symptomatic subjects.

Prevalencia de alteraciones posturales en niños de Arica -Chile: efectos de un programa de mejoramiento de la postura / Prevalence of postural alterations and effects of a program to improve the posture in children from Arica-Chile

Los objetivos de este trabajo fueron calcular el índice de prevalencia de alteraciones posturales en una muestra de 120 alumnos (10,4 por ciento del universo total), de 4 años de edad de la ciudad de Arica y determinar el efecto de un programa de mejoramiento postural. Las alteraciones posturales más frecuentes corresponden a: inclinación de hombros (86 por ciento), escápula alada y escápula descendida (82 por ciento), proyección anterior de hombros (79 por ciento), pie plano (58 por ciento), columna lumbar hiperlordótica (51 por ciento) e inclinación de cabeza (50 por ciento). Posteriormente, se aplicó al grupo experimental un programa de ejercicio muscular y de reeducación postural, por un período de 8 meses. Al final del tratamiento se realizó un análisis post test a todos los sujetos del estudio. Los resultados en el grupo experimental muestran una disminución significativa de los índices iniciales de prevalencia, en todas las alteraciones en estudio. Los diferenciales de recuperación muestran diferencias significativas entre los grupos de estudio, con un 31 por ciento para inclinación de hombros, seguida de hiperlordosis lumbar con un 29 por ciento e inclinación de cabeza con 20 por ciento. La recuperabilidad más baja se observó en pie plano con un 7 por ciento (p≤0,05). El alto porcentaje de alteraciones posturales presentes en niños de 4 años, de la ciudad de Arica, podría ser producto de actitudes viciosas que, a futuro producen una estructuración inadecuada del cuerpo, entonces la aplicación de un programa de ejercitación muscular y de reeducación postural, dirigido por un equipo de Salud multiprofesional disminuirían significativamente estas alteraciones.

At present the educational institutions do not have an adequate system of Health to detect early changes in postural alteration in children. The aim of this study was to determine the most common postural changes in a sample of 120 students (10,4 percent of total universe), of 4 years old from Arica-Chile and to determine the effect of a program to improve the posture. The prevalence of the most frequent postural alterations relate to: inclination of shoulders (86 percent), winged scapula and descend scapula (82 percent), projection front shoulders (79 percent), flat feet (58 percent), lumbar hyperlordosis (51 percent) and inclination of head (50 percent). Subsequently in the experimental group was applied a program of exercise muscle and postural reeducation for a period of 8 months. At the end of treatment was applied a post-test to all children. The results in the experimental group showed a significant decrease in initial prevalence rates in all alterations. The differential recovery shows significant differences among the study groups, with 31 percent for inclination of shoulders, followed by lumbar hyperlordosis (29 percent) and inclination of head (20 percent). The recoverability lowest level was observed in flat feet with 7 percent (p≤0,05).The high percentage of postural disturbances in children aged 4 years in the city of Arica, could be the result of vicious attitudes that in the future produce an improper structuring of the body. Then the implementation of a program of exercise muscles and postural reeducation, led by a multiprofesional health team, decline rates of postural abnormalities present in children.

Rehabilitation of orthopedic and rheumatologic disorders. 4. Musculoskeletal disorders.

This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with orthopedic and musculoskeletal disorders. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses new advances in such topics as idiopathic scoliosis, nontraumatic shoulder pain, rotator cuff tendinitis, and Dupuytren's disease.

[Flatfoot]. / Das abgeflachte Fusslängsgewölbe.

Many parents are anxious because of the insufficient arch of the feet of their children. A true congenital deformity (congenital vertical talus) is extremely rare. In children the arch is physiologically flattened with a hypervalgus of the hindfoot. Those feet do not need treatment. If there is no medial recess in the footprint in a child over 3 years of age, then we are talking about a flexible flatfoot. When the load of the foot is more pronounced at the medial rather than at the lateral side, operative treatment can be indicated, such as a lengthening osteotomy of the calcaneum. If the flatfoot is rigid, the reason for it is usually a tarsal coalition. Operative transection of the osseous bridge with fat interposition can solve the problem. Flatfeet may also occur in neuromuscular diseases. Depending on the severity of the deformity, splints can be effective, or--in the more severe cases--operative treatment such as a triple arthodesis can be indicated.

El pie plano perspectiva actual

El pie plano valgo flexible es una de las causas más comunes de pie plano y un importante motivo de consulta, que debe ser manejado temprana y adecuadamente para prevenir sus repercuciones biomecánicas y funcionales. Se discuten las bases anátomicas y biomcánicas del pie plano valgo flexible, los aspectos etiológicos, así como el estudio por medio de la clínica de acuerdo a la edad. Se revisan los métodos paraclínicos, incluyendo el examen en el podoscopio, el fotopodograma y la exploración radiológica. Finalmente, se presenta el estado actual del conocimiento acerca del tratamiento por grupos etáreos, haciendo énfasis en los aspectos relacionados con el manejo ortésico y de rehabilitación

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

The Dynamic Stabilizing Innersole System (DSIS): the management of hyperpronation in children.

In a study of 50 children, the Dynamic Stabilizing Innersole System (DSIS) was found to decrease the mean resting calcaneal stance position (RCSP) by an average of 6 degrees. A comparison between the neutral calcaneal stance position and the RCSP with the DSIS showed no statistically significant difference between the means for the right or left foot, indicating that the DSIS is capable of returning severe flat foot deformities to their neutral calcaneal stance position. The RCSP with and without the DSIS differed significantly, indicating that the DSIS provides a considerable and statistically significant amount of correction in the RCSP in our study population. Furthermore, the results of linear regression showed that the DSIS appears to be sensitive to the severity of the deformity, preventing overcorrection of less severe flatfoot deformities and providing a long awaited alternative to traditional pediatric corrective flatfoot devices.

Incidência e prevençao de pé plano valgo em crianças da primeira série do primeiro grau nas classes A e D / Incidence and prevention of plano-valgus foot in children of first serie in first grade in A and D classroom

A persistência do arco longitudinal plantar a um plano inferior ao normal, mesmo após as variaçoes fisiológicas, as quais ocorrem dos 02 aos 05 anos de idade, alterando a constituiçao anatômica podálica da criança, vem sendo causa de destacável preocupaçao. Neste contexto, procurou-se abordar as características fisiológicas normais e patológicas podálicas, referentes ao tema. Para tal, utilizou-se os recursos bibliográficos e a pesquisa de campo, realizada nas escolas da rede de ensino particular, caracterizada como classe A, e municipal, caracterizada como classe D. Avaliou-se um total de 1090 crianças, detectando-se 20 crianças com pé plano valgo

Corrective shoes and inserts as treatment for flexible flatfoot in infants and children.

We performed a prospective study to determine whether flexible flatfoot in children can be influenced by treatment. One hundred and twenty-nine children who had been referred by pediatricians, and for whom the radiographic findings met the criteria for flatfoot, were randomly assigned to one of four groups: Group I, controls; Group II, treatment with corrective orthopaedic shoes; Group III, treatment with a Helfet heel-cup; or Group IV, treatment with a custom-molded plastic insert. All of the patients in Groups II, III, and IV had a minimum of three years of treatment, and ninety-eight patients whose compliance with the protocol was documented completed the study. Analysis of radiographs before treatment and at the most recent follow-up demonstrated a significant improvement in all groups (p less than 0.01), including the controls, and no significant difference between the controls and the treated patients (p greater than 0.4). We concluded that wearing corrective shoes or inserts for three years does not influence the course of flexible flatfoot in children.