Prospective randomized comparative study on V-Y and pants-over-vest capsulorraphy in chevron and scarf osteotomy.

The contribution of capsulorraphy techniques at hallux valgus surgery to sustain the longevity of the achieved correction is not well documented. This study aims to evaluate the outcome of two different capsulorraphies (V-Y and pants-over-vest). 88 feet were prospectively included and followed for 2 years. Capsulorraphy type was determined by randomisation. Primary outcome was the correction of the intermetatarsal angle (IMA) and the metatarso-phalangeal angle (MPA). Secondary endpoints were the Kitaoka-MTP1-score and the SF-36. A linear model for repeated measures was used for statistical analysis. VY and PV showed a comparable evolution for IMA (p = 0.42) and MPA (p = 0.36). However, a tendency to loss of MPA correction was noted in the scarf group for PV as compared to VY (p = 0.037). Secondary outcomes showed no significant differences between PV and VY in evolution over time for SF-36 total (p = 0.45) nor for the Kitaoka score (p = 0.15). We observed a complication rate comparable with those previously reported. The 2 year follow up did not reveal significant loss of correction of the IMA, regardless of the capsulorraphy used. The SF-36 and Kitaoka score results were stable over the study period.

Repeatability in the assessment of multi-segment foot kinematics.

A recently published systematic review on 3D multi-segment foot models has illustrated the lack of repeatability studies providing evidence for appropriate clinical decision making. The aim of the current study was to assess the repeatability of the recently published model developed by Leardini et al. [10]. Foot kinematics of six healthy adults were analyzed through a repeated-measures design including two therapists with different levels of experience and four test sessions. For the majority of the parameters moderate or good repeatability was observed for the within-day and between-day sessions. A trend towards consistently higher within- and between-day variability was observed for the junior compared to the senior clinician. The mean inter-session variability of the relative 3D rotations ranged between 0.9-4.2° and 1.6-5.0° for respectively the senior and junior clinician whereas for the absolute angles this variability increased to respectively 2.0-6.2° and 2.6-7.8°. Mean inter-therapist standard deviations ranged between 2.2° and 6.5° for the relative 3D rotations and between 2.8° and 7.6° for the absolute 3D rotations. The ratio of inter-therapist to inter-trial errors ranged between 1.8 and 5.5 for the relative 3D rotations and between 2.4 and 9.7 for the absolute 3D rotations. Absolute angle representation of the planar angles was found to be more difficult. Observations from the current study indicate that an adequate normative database can be installed in gait laboratories, however, it should be stressed that experience of therapists is important and gait laboratories should therefore be encouraged to put effort in training their clinicians.

Repeatability of a 3D multi-segment foot model protocol in presence of foot deformities.

Repeatability studies on 3D multi-segment foot models (3DMFMs) have mainly considered healthy participants which contrasts with the widespread application of these models to evaluate foot pathologies. The current study aimed at establishing the repeatability of the 3DMFM described by Leardini et al. in presence of foot deformities. Foot kinematics of eight adult participants were analyzed using a repeated-measures design including two therapists with different levels of experience. The inter-trial variability was higher compared to the kinematics of healthy subjects. Consideration of relative angles resulted in the lowest inter-session variability. The absolute 3D rotations between the Sha-Cal and Cal-Met seem to have the lowest variability in both therapists. A general trend towards higher σ(sess)/σ(trial) ratios was observed when the midfoot was involved. The current study indicates that not only relative 3D rotations and planar angles can be measured consistently in patients, also a number of absolute parameters can be consistently measured serving as basis for the decision making process.