Effects of short foot training on foot posture in patients with flatfeet: A systematic review and meta-analysis.

BACKGROUND: With lifestyle changes, the prevalence of flatfoot is increasing year by year, with a prevalence of 29%. Flatfoot will lead to an inevitable injury and reduce the quality of life. Short foot exercises can enhance the strength of the intrinsic muscles of the foot and improve the symptoms of flatfoot. However, there is controversy regarding its specific efficacy. OBJECTIVE: This meta-analysis quantitatively evaluates the effect of short foot training on patients with flatfeet and provides evidence to inform the clinical approach to short foot training in patients with flat feet. METHODS: A total of eight databases were searched, including CNKI, WANFANG, VIP, and CBM in Chinese and PubMed, Cochrane, Web of Science, and Embase in English. The timeframe for searching the literature was March 2023 for each database build. English database search terms and search formulas were: (flat foot OR talipes valgus OR talipes calcaneovalgus) AND (short foot exercises OR physical therapy OR neurophysiotherapy). RESULTS: The current pooled results show no significant difference in the improvement of the navicular drop test and foot posture index with short foot exercises compared to controls; only short foot exercises greater than 6 w showed a significant improvement in the navicular drop test, and sensitivity analysis showed a significant improvement in the foot posture index with short foot exercises. CONCLUSION: This systematic review and meta-analysis showed that short foot exercises need a larger sample size to find their effect on improving flat feet; the duration of the intervention is a factor. As most studies are currently unclear whether the participants were patients with flat feet or asymptomatic individuals with flat feet the disease syndrome in patients with flatfoot may also be a factor.

A modified lateral column lengthening for the treatment of flexible flatfoot: From clinical applications to finite element analysis.

BACKGROUND: Finite element (FE) analysis and clinical follow-up were used to evaluate the efficacy of a modified lateral column lengthening (H-LCL) for treating flexible flatfoot. METHODS: By applying inclusion and exclusion criteria, we selected patients who underwent H-LCL surgery at our institution from January 2019 to January 2023. We compared the Visual Analog Scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Pain Interference (PI), and Physical Function (PF) scores in Patient-Reported Outcomes Measurement Information System (PROMIS) between preoperative and final follow-up assessments of patients, as well as FE submodels. Furthermore, evaluate the H-LCL's biomechanical characteristics and clinical outcome before and after surgery. RESULTS: A total of 66 patients met the criteria. The average surgery time was 69.47 ± 13.22 min, and the follow-up duration was 15.18 ± 6.40 months. In the last follow-up, VAS and PI decreased compared to before surgery, while AOFAS and PF increased compared to before surgery. Meary's angle (dorsoplantar image and lateral image), calcaneal valgus angle, and talonavicular coverage angle decreased compared to before surgery, while the pitch angle increased compared to before surgery. In FE analysis, postoperative tension on the plantar fascia (PF), spring ligament (SL), and posterior tibial tendon (PTT) decreased compared to before surgery, pressure on the talonavicular joint and subtalar joints also decreased compared to before surgery, and there was no significant change in pressure on the calcaneocuboid joint. CONCLUSION: H-LCL in correcting flexible flatfoot resulted in a significant improvement of clinical outcome scores and led to good radiological correction of flatfoot deformities. It can reduce the soft tissue and interosseous pressure in maintaining the foot arch.

Peroneus Brevis to Longus Tendon Transfer in the Treatment of Flexible Progressive Collapsing Foot Deformity: A Cadaveric Study.

BACKGROUND: Although operative treatment of the flexible progressive collapsing foot deformity (PCFD) remains controversial, correction of residual forefoot varus and stabilization of the medial column are important components of reconstruction. A peroneus brevis (PB) to peroneus longus (PL) tendon transfer has been proposed to address these deformities. The aim of our study was to determine the effect of an isolated PB-to-PL transfer on medial column kinematics and plantar pressures in a simulated PCFD (sPCFD) cadaveric model. METHODS: The stance phase of level walking was simulated in 10 midtibia cadaveric specimens using a validated 6-degree of freedom robot. Bone motions and plantar pressure were collected in 3 conditions: intact, sPCFD, and after PB-to-PL transfer. The PB-to-PL transfer was performed by transecting the PB and advancing the proximal stump 1 cm into the PL. Outcome measures included the change in joint rotation of the talonavicular, first naviculocuneiform, and first tarsometatarsal joints between conditions. Plantar pressure outcome measures included the maximum force, peak pressure under the first metatarsal, and the lateral-to-medial forefoot average pressure ratio. RESULTS: Compared to the sPCFD condition, the PB-to-PL transfer resulted in significant increases in talonavicular plantarflexion and adduction of 68% and 72%, respectively, during simulated late stance phase. Talonavicular eversion also decreased in simulated late stance by 53%. Relative to the sPCFD condition, the PB-to-PL transfer also resulted in a 17% increase (P = .045) in maximum force and a 45-kPa increase (P = .038) in peak pressure under the first metatarsal, along with a medial shift in forefoot pressure. CONCLUSION: The results from this cadaver-based simulation suggest that the addition of a PB-to-PL transfer as part of the surgical management of the flexible PCFD may aid in correction of deformity and increase the plantarflexion force under the first metatarsal. CLINICAL RELEVANCE: This study provides biomechanical evidence to support the addition of a PB-to-PL tendon transfer in the surgical treatment of flexible PCFD.

Investigation of inter-rater and test-retest reliability of Y balance test in college students with flexible flatfoot.

BACKGROUND: The Lower Quarter Y Balance Test (YBT-LQ) has been widely used to assess dynamic balance in various populations. Dynamic balance in flexible flatfoot populations is one of the risk factors for lower extremity injuries, especially in college populations in which more exercise is advocated. However, no study has demonstrated the reliability of the YBT-LQ in a college student flexible flatfoot population. METHODS: A cross-sectional observational study. 30 college students with flexible flatfoot were recruited from Beijing Sports University. They have been thrice assessed for the maximal reach distance of YBT under the support of the lower limb on the flatfoot side. Test and retest were performed with an interval of 14 days. The outcome measures using the composite score and normalized maximal reach distances in three directions (anterior, posteromedial, and posterolateral). The relative reliability was reported as the Intraclass Correlation Coefficient (ICC). Minimal Detectable Change (MDC), Smallest worthwhile change (SWC), and Standard Error of Measurement (SEM) were used to report the absolute reliability. RESULTS: For inter-rater reliability, the ICC values for all directions ranged from 0.84 to 0.92, SEM values ranged from 2.01 to 3.10%, SWC values ranged from 3.67 to 5.12%, and MDC95% values ranged from 5.58 to 8.60%. For test-retest reliability, the ICC values for all directions ranged from 0.81 to 0.92, SEM values ranged from 1.80 to 2.97%, SWC values ranged from 3.75 to 5.61%, and MDC95% values ranged from 4.98 to 8.24%. CONCLUSIONS: The YBT-LQ has "good" to "excellent" inter-rater and test-retest reliability. It appears to be a reliable assessment to use with college students with flexible flatfoot. TRIAL REGISTRATION: This trial was prospectively registered at the Chinese Clinical Trial Registry with the ID number ChiCTR2300075906 on 19/09/2023.

Acute effects of athletic taping on arch deformity and plantar pressure in young female adults with flexible flatfoot.

OBJECTIVE: This work aimed to explore the acute effects of athletic taping techniques on foot arch deformity and plantar pressure in young female adults with flexible flatfoot (FFT). METHODS: Twenty young female adults with FFT were recruited in the current study. Each participant was randomly divided into two taping groups, namely, augmented low-dye (ALD) and modified low-dye (MLD). The foot arch deformity and plantar pressure were measured at baseline, after taping and after 20 min of walking. The foot arch deformity was determined based on navicular drop distance (NDD) and resting calcaneal stance position (RCSP). RESULTS: Compared with baseline, the NDD values were significantly lower after taping. After 20 min of walking, ALD taping resulted in a lower NDD value than MLD (p < 0.001). ALD maintained a higher RCSP than baseline after 20 min of walking (p = 0.004). Furthermore, compared with baseline, medial midfoot force-time integration (p = 0.013) and contact area (p = 0.022) increased after taping with MLD, and peak pressure in the medial midfoot increased after walking for 20 min with MLD (p = 0.026). Peak pressure in the second to fifth toes significantly decreased after 20 min of walking with ALD compared with that after taping immediately (p = 0.002). CONCLUSIONS: ALD and MLD taping could improve FFT arch deformity and plantar pressure distribution, prospectively changing peak pressure of the second to fifth toe area and medial midfoot after 20 min of walking, integrated contact area and force-time integration medial midfoot during walking in young female adults. Furthermore, ALD taping could improve FFT deformity more than using MLD after 20 min of walking. Thus, when treating FFT in young female adults, ALD taping should be considered adaptively to guide arch support production and correct midfoot pronation.

Accessory navicular in children.

Accessory navicular (AN) is a developmental variation of the secondary ossification center of the navicular tuberosity. Ten percent of patients with AN will have pain symptoms that affect walking and life. As the AN changes the position of the posterior tibial tendon insertion, children with AN often have posterior tibial tendon function insufficiency and flexible flat foot. Surgical treatment is often required after failure of conservative treatment. This article reviewed the etiology, clinical manifestations, complications, and treatment methods of AN.

Comparison of the Influence of Supportive and Sensorimotor Insoles on Flat Feet in Children - a Double-Blind, Prospective, Randomized, Controlled Trial.

BACKGROUND: Besides arch-supportive insoles, sensorimotor insoles are used for the treatment of flatfoot in children. The aim of this study was to compare the effect of both types of insoles on the arch-supporting muscles and clinical aspects in children with flexible flatfoot. MATERIAL AND METHODS: 52 children with flexible flatfoot (mean age of 8.22.7 years) were enrolled. Supportive, sensorimotor, and placebo insoles were compared. Muscle activity was detected by surface electromyography during the midstance phase. Valgus index, foot and ankle disability index (FADI) and pain were assessed at enrolment and after 6 and 12 months. Mixed-design ANOVA was used for statistical evaluation. RESULTS: Supportive and sensorimotor insoles caused significantly lower activity in the tibialis anterior in comparison to placebo insoles regarding the parameter Mean. No significant differences could be detected between both types of therapeutic insoles. Supportive insoles showed a significant decrease regarding the parameter Amplitude of the peroneus longus. Placebo insoles produced an increase in the valgus index, while both therapeutic insoles did not induce any changes. The sensorimotor insoles induced an increase in FADI, while the supportive and placebo insoles had no significant effect on this parameter. CONCLUSIONS: 1. Supportive and sensorimotor insoles potentially influence muscle activity in the lower leg. 2. Both could influence the longitudinal arch in flat feet. 3. While placebo insoles caused a deterioration of the valgus index, both kinds of therapeutic insoles could possibly prevent the progression of the flatfoot. 4. Clinical studies including more clinical aspects and long-term observations are necessary.

Mid-term assessment of subtalar arthroereisis with Talar-Fit implant in pediatric patients with flexible flatfoot and comparing the difference between different sizes and exploring the position of the inserted implant.

Background: Subtalar arthroereisis (STA) has gained growing acceptance as a viable approach solution for the management of pediatric flexible flatfoot. However, STA still remains controversial. The purpose of this study is to assess the effect of STA using the Talar-Fit implant for treating pediatric flexible flatfoot. Specifically, the aims of the study are as follows: first, to present the mid-term outcomes of STA using the Talar-Fit implant; second, to compare the radiographic and clinical outcomes associated with varying sizes of Talar-Fit implant; and third, to analyze the optimal position of the inserted implants. Methods: A retrospective analysis was conducted on a cohort of 57 pediatric patients diagnosed with flexible flatfoot (77 feet) who underwent STA utilizing Talar-Fit between January 2014 and December 2021. The participants were categorized into five groups according to the size of the implant: Group 8, Group 9, Group 10, Group 11, and Group 12. The evaluation included the assessment of clinical function using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, as well as the assessment of radiographic data such as the calcaneal pitch angle (CPA), lateral Meary angle (LMA), talar declination angle (TDA), and medial longitudinal arch angle (MLAA) were evaluated. Furthermore, the position of the inserted implants was also recorded, including angle, depth, and distance. The comparison of pre- and postoperation was conducted using the paired Student's t-test, whereas the analysis of differences among subgroups was performed using the Wilcoxon rank-sum test. A P-value < 0.05 is considered statistically significant. Results: In total, 57 pediatric patients (77 feet) were successfully followed-up for an average period of 26.8 months. The overall AOFAS score significantly improved from 58.6 ± 10.9 to 85.2 ± 8.6 (P < 0.001). Furthermore, the LMA decreased from 20.3° ± 3.6° to 4.5° ± 1.3°, the CPA increased from 14.8° ± 1.6° to 23.6° ± 2.7°(P < 0.05), the TDA decreased from 40.2° ± 2.3° to 25.5° ± 3.2°(P < 0.05), and the MLAA decreased from 140.1° ± 2.8° to 121.4° ± 3.9°(P < 0.05). No statistically significant differences were observed among subgroups regarding the final outcomes. The improvements of CPA, TDA, and MLAA among different groups were significantly different; however, the adjusted P-values were all greater than 0.05. The implant were inserted at a mean angle of 89.5° ± 2.4°, a mean depth of 0.9 mm ± 2.1 mm, and a mean distance of 9.9 mm ± 0.9 mm. Eight patients experienced complications, including six cases of pain occurrence and two cases of implant dislocation. Conclusion: STA with Talar-Fit has demonstrated satisfactory mid-term outcomes. A Talar-Fit with a larger size may demonstrate a superior effect when compared with that of a smaller size. The implants were inserted in a similar position, indicating that the medial edge of the implant may be possible to transcend the midline of the talus neck.

[Comparison of the effectiveness of two kinds of surgeries for treatment of flexible flatfoot combined with painful accessory navicular bone in children].

Objective: To compare the effectiveness of subtalar arthroereisis (STA) combined with modified Kidner procedure versus STA alone in the treatment of flexible flatfoot combined with painful accessory navicular bone in children. Methods: The clinical data of 33 children with flexible flatfoot combined with painful accessory navicular bone who were admitted between August 2018 and August 2021 and met the selection criteria were retrospectively analyzed. They were divided into a combination group (17 cases, treated by STA combined with modified Kidner procedure) and a control group (16 cases, treated by STA alone) according to the surgical methods. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, affected side of the foot, disease duration, and preoperative visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talonavicular coverage angle (TCA), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle), and heel valgus angle (HV). The operation time, incision length, intraoperative blood loss, number of intraoperative fluoroscopies, and perioperative complications were recorded in both groups. The anteroposterior, lateral, and calcaneal axial X-ray films for the affected feet were taken regularly, and T1MT, T2MT, TCA, Meary angle, Pitch angle, and HV were measured. The VAS score, AOFAS ankle-hindfoot score were used to evaluate pain and functional recovery before and after operation. Results: Surgeries in both groups were successfully performed without surgical complication such as vascular, nerve, or tendon injuries. Less operation time, shorter incision length, less intraoperative blood loss, and fewer intraoperative fluoroscopies were found in the control group than in the combination group ( P<0.05). One case in the combination group had partial necrosis of the skin at the edge of the incision, which healed after the dressing change and infrared light therapy, and the rest of the incisions healed by first intention. All children were followed up 12-36 months, with a mean of 19.6 months. At last follow-up, VAS score and AOFAS ankle-hindfoot score significantly improved in both groups when compared with preoperative ones ( P<0.05), and the differences of these scores between before and after operation improved more significantly in the combination group than in the control group ( P<0.05). Imaging results showed that the T1MT, T2MT, TCA, Meary angle, and HV significantly improved in both groups at last follow-up when compared with preoperative ones ( P<0.05), and the Pitch angle had no significant difference when compared with preoperative one ( P>0.05). But there was no significant difference in the difference of these indicators between before and after operation between the two groups ( P>0.05). Conclusion: Both procedures are effective in the treatment of flexible flatfoot children with painful accessory navicular bone. STA has the advantage of minimally invasive, while STA combined with modified Kidner procedure has better effectiveness.

Efficacy of modified kidner procedure combined with subtalar arthroereisis treating adolescent type 2 painful accessory navicular with flexible flatfoot.

Purpose: To investigate the clinical efficacy of modified kidner procedure combined with subtalar arthroereisis in the treatment of adolescent type II painful accessory navicular with flexible flatfoot. Methods: From January 2018 to January 2022, 25 adolescent patients (40 feet) with painful type II accessory navicular and flexible flatfoot admitted to our hospital were enrolled in the study, including 13 males (23 feet) and 12 females (17 feet). All patients underwent modified kidner procedure combined with subtalar joint arthrodesis. The Meary's Angle, the first metatarsal Angle of talus (APTMT), the second metatarsal Angle of talus, Pitch Angle, talus tilt Angle, talonavicular coverage Angle (TCA), talus calcaneal Angle (LTCA), and calcaneal Angle were measured on weight-bearing anteroposterior and lateral x-ray films before operation and at last follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) were used to evaluate the improvement of foot function and pain. Results: All patients were followed up for average 17.4 ± 2.6 months (12-24). The incisions of 25 patients healed by first intention. The weight-bearing anteroposterior and lateral x-ray films of the foot showed that the suture anchors did not pull out or break, and the foot arch did not collapse further. There was no screw withdrawal or secondary operation to remove the screw in all patients. At the last follow-up, the postoperative visual analogue scale (VAS) score of the affected foot was significantly lower than that before operation (P < 0.01), and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function score was significantly higher than that before operation (P < 0.01). At the last follow-up, the weight-bearing anteroposterior and lateral foot x-ray films showed that: The Meary's Angle, the first metatarsal Angle of the talus (APTMT), the second metatarsal Angle of the talus, Pitch Angle, talar tilt Angle, talonavicular overbite Angle (TCA), talocalcaneal Angle (LTCA), and calcaneal Angle significantly improved when compared with those before operation (P < 0.01). Conclusions: The modified kidner procedure combined with subtalar arthroereisis has a good clinical effect in the treatment of adolescent type II painful accessory navicular with flexible flatfoot, which can effectively improve the pain symptoms, improve the foot function and imaging manifestations, and correct the flatfoot deformity.

Efficacy of Personalized Foot Orthoses in Children with Flexible Flat Foot: Protocol for a Randomized Controlled Trial.

Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or clear treatment approach. There are multiple conservative and surgical treatments, the implantation of foot orthoses (FO) being the most used treatment. The evidence supporting FO is very thin. It is not clearly known what the effect of these is, nor when it is convenient to recommend them. The main objective of this protocol is to design a randomized controlled trial to determine if personalized FO, together with a specific exercise regimen, produce the same or better results regarding the signs and symptoms of PFF, compared to only specific exercises. In order to respond to the stated objectives, we have proposed a randomized controlled clinical trial, in which we intend to evaluate the efficacy of FO together with strengthening exercises, compared to a control group in which placebos will be implanted as FO treatment along with the same exercises as the experimental group. For this, four measurements will be taken throughout 18 months (pre-treatment, two during treatment and finally another post-treatment measurement). The combination of FO plus exercise is expected to improve the signs and symptoms (if present) of PFF compared to exercise alone and the placebo FO group. In addition, it is expected that in both conditions the biomechanics of the foot will improve compared to the initial measurements.

Union in Lateral Column Lengthening by Plate Fixation Without Bone Graft in Flexible Flatfoot: A Case Series.

Purpose: This study's goal was to evaluate the outcomes of lateral column lengthening by plate fixation without bone graft in the management of symptomatic flexible flatfoot. Methods: A prospective randomized trial study included 30 feet (27 patients) and was performed from March 2017 to December 2019. Functional and radiological evaluations were done pre-operative and at the final post-operative follow-up. The functional assessment was done using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: The mean follow-up was 16.5 ± 3.027 months. The mean age of patients was 22.6 ± 6.29 years. All cases showed union ranging from 8 to 12 weeks, with a mean of 10 ± 1.88 weeks. The mean AOFAS score improved from 51.6 ± 6.75 to 92.2 ± 6.21. The mean anteroposterior (AP) talo-first metatarsal angle improved from 25.3° ± 8.31° to 3.4° ± 5.10°. The mean anteroposterior (AP) talo-navicular coverage improved from 22.10° ± 4.28° to 2.3° ± 3.46°. The mean Lateral talo-first metatarsal angle improved from 18.6° ± 4.79° to 3.3° ± 3.16°. The calcaneal pitch angle improved from 9.6° ± 4.14° to 15.1° ± 4.43°. The mean lateral talo-calcaneal angle improved from 45.7° ± 3.77° to 37.5° ± 3.47°. Conclusion: Using an interposition wedge plate for LCL without bone graft leads to a high union rate, maintains the correction, and avoids possible complications of autografts and allografts.

Short-Term and Medium-Term Radiological and Clinical Assessment of Patients with Symptomatic Flexible Flatfoot Following Subtalar Arthroereisis with Spherus Screw.

BACKGROUND: There have been no reports on arthroereisis screw insertion into the talus in patients with flexible flatfoot. We aimed to conduct a clinical and radiological assessment in patients with symptomatic pes planovalgus deformity treated with a talar screw. METHODS: This study involved a prospective assessment of 27 patients treated surgically for symptomatic flexible flatfoot deformity in the period 2021-2022. The following parameters were assessed in this study: Meary's angle, the Costa-Bartani angle, the calcaneal pitch angle, surgery duration, the length of hospital stay, patient satisfaction, patients' retrospective willingness to consent to the treatment they received, postoperative complications, and the use of analgesics. RESULTS: The mean follow-up period was 14.76 months. Meary's angle decreased from 18.63° before surgery to 9.39° at follow-up (p = 0.004). The Costa-Bartani angle decreased significantly from 154.66° before surgery to 144.58° after surgery (p = 0.012). The calcaneal pitch angle changed from 16.21° before to 19.74°. Complications were reported in three patients (11.11%). The mean surgery duration was 32 min. The mean hospital stay was 2.2 days. Fourteen patients (51.85%) were highly satisfied with the treatment, and 12 patients (44.44%) were quite satisfied with treatment. Twenty-five (92.59%) of the evaluated patients would choose the same type of treatment again. Six patients (22.22%) needed to use analgesics prior to surgical treatment, whereas none of the patients needed to use them by the final follow-up. CONCLUSION: Spherus screw arthroereisis helps improve radiological parameters in patients with flexible flatfoot. We observed good clinical outcomes after treatment with a talar screw, with a majority of patients reporting moderate-to-high levels of satisfaction with treatment. Both short- and medium-term treatment outcomes of pes planovalgus treatment with the use of Spherus screw are good.

Tibialis anterior rerouting combined with calcaneal lengthening osteotomy as a single-stage reconstruction of symptomatic flexible flatfoot in children and adolescents.

BACKGROUND: Symptomatic flexible flatfoot in children and adolescents should be surgically managed only if conservative measures have failed. The aim of this study was to assess functional and radiological results of tibialis anterior rerouting combined with calcaneal lengthening osteotomy as s single-stage reconstruction of symptomatic flexible flatfoot. METHODS: The current study was a prospective study of patients with symptomatic flexible flatfoot treated by single-stage reconstruction in the form of tibialis anterior tendon rerouting combined with calcaneal lengthening osteotomy. The American Orthopaedic Foot and Ankle Society score (AOFAS) was utilized to evaluate the functional outcomes. The evaluated radiological parameters included the standing anteroposterior (AP) and lateral talo-first metatarsal angle, talar head coverage angle, and calcaneal pitch angle. RESULTS:  The current study included 16 patients (28 feet) with a mean age of 11.6 ± 2.1 years. There was a statistically significant improvement in the mean AOFAS score from 51.6 ± 5.5 preoperatively to 85.3 ± 10.2 at final follow-up. Postoperatively, there was a statistically significant reduction in the mean AP talar head coverage angle from 13.6 ± 4.4° to 3.9 ± 3°, the mean AP talo-first metatarsal angle from 16.9 ± 4.4° to 4.5 ± 3.6°, and the mean lateral talo-first metatarsal angle from 19.2 ± 4.9° to 4.6 ± 3.2°, P < 0.001. Additionally, the mean calcaneal pitch angle increased significantly from 9.6 ± 1.9° to 23.8 ± 4.8°, P < 0.001. Superficial wound infection occurred in three feet and was treated adequately by dressing and antibiotics. CONCLUSION:  Symptomatic flexible flatfoot in children and adolescents can be treated with combined lateral column lengthening and tibialis anterior rerouting with satisfactory radiological and clinical outcomes. Level of evidence Level IV.

Effects of short foot exercise combined with lower extremity training on dynamic foot function in individuals with flexible flatfoot: A randomized controlled trial.

BACKGROUND: Flexible flatfoot has demonstrated biomechanical linkages between distal and proximal lower extremities. However, supporting evidence is required to investigate the benefits of short foot exercise (SF) and short foot exercise in combination with lower extremity training (SFLE) on dynamic foot function. RESEARCH QUESTION: This study aimed to determine the effects of a 6-week SF, 6-week SFLE, or control condition (no intervention) on dynamic foot function during gait in individuals with flexible flatfoot. METHODS: Forty-five individuals with flexible flatfoot were randomly assigned into three conditions: (1) SF, (2) SFLE, and (3) control conditions. Participants in two intervention programs performed daily training via telerehabilitation and a home-based exercise program. Foot kinematics and center of pressure excursion index (CPEI) during the gait, intrinsic foot muscle test, and navicular drop test were assessed at baseline and after the 6-week intervention program. RESULTS: Post-intervention participants in the SF and SFLE conditions showed a shorter time to the lowest medial longitudinal arch (MLA) and improved MLA motion during the stance phase compared with the baseline. In addition, participants in the SFLE conditions showed greater changes in CPEI than in the SF and control conditions. Improvements in intrinsic foot muscle and navicular drop tests were also observed in participants in both intervention programs post-intervention. SIGNIFICANCE: A major finding of the study was the improvement in dynamic foot function during gait in individuals with flexible flatfoot after the six weeks of the SF and SFLE intervention programs. Both intervention programs appear to have the potential for inclusion in a corrective program for individuals with flexible flatfoot.

Really Asymptomatic? Health-Related Quality of Life and Objective Clinical Foot Characteristics among 5-10-Year-Old Children with a Flexible FlatFoot.

The potential effects of asymptomatic flexible flatfoot (FF) on children's health-related quality of life (QoL) and objective clinical foot characteristics have been poorly investigated in the literature. Therefore, this study aimed to analyse these indicators, comparing the children with asymptomatic FF and a control group. METHODS: In total, 351 children were enrolled in this cross-sectional study-160 children with asymptomatic FF and 191 controls (children with normal feet). The children and their parents completed the Paediatric Quality of Life Inventory (PedsQLTM 4.0). The objective foot characteristics included clinical foot posture measures, footprints, general hyperlaxity, and X-ray measurements. RESULTS: Children with asymptomatic FF had a significantly lower QoL (overall and all four dimensions). The parents' assessment of the QoL of their children with asymptomatic FF in most cases was lower compared to their children's self-reported QoL. Moreover, almost all clinical foot measures also had significantly worse profiles among asymptomatic FF cases compared to the controls. This was observed with the Foot Posture Index-6 (FPI-6), the navicular drop (ND) test, the Chippaux-Smirak Index (CSI), Staheli's Index (SI), the Beighton scale, and radiological angles (except the talo-first metatarsal angle). CONCLUSION: The findings suggest that asymptomatic FF not always reflects a normal foot development. This condition is related to decreased health-related quality of life, so the 5-10-year-old children's and their parents' complaints should be considered more closely in identification, treatment, and monitoring plans.

Is Kidner procedure necessary during subtalar arthroereisis for pediatric flexible flatfoot that combined with symptomatic type 2 accessory navicular? A retrospective comparative study.

BACKGROUND: Kidner procedure is thought to be able to eliminate the medial foot pain and contribute to restoring the medial longitudinal foot arch, making it particularly suitable for surgical treatment of pes planus that combined with symptomatic type 2 accessory navicular (AN). However, controversy remains, and the clinical evidence is still lacking. The aim of the current study is to verify the necessity of Kidner procedure during subtalar arthroereisis (STA) for pediatric flexible flatfoot (PFF) that combined with symptomatic type 2 AN. METHODS: Forty pediatric patients (72 feet) who had undergone STA for flexible flatfoot and were also diagnosed with symptomatic type 2 AN concomitantly were reviewed retrospectively and divided into two groups (STA + Kidner vs STA alone). The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Oxford ankle foot questionnaire for children (OAFQC), and the radiographic parameters that quantifying pes planus were evaluated as primary outcomes. Secondary outcomes included the incidence of complications. RESULTS: There were 35 feet in the STA + Kidner group and 37 feet in the STA alone group, with mean follow-up periods of 2.7 years and 2.1 years, respectively. The VAS, AOFAS, OAFQC scores and radiographic parameters presented no significant difference between the two groups both preoperatively and at final follow-up (P > 0.05 for each). The complications of STA surgery occurred equally in both groups, and Kidner procedure could lead to more incision problems (22.9% vs. 2.7%) and a longer time to return to activity. CONCLUSION: Kidner procedure may be unnecessary during surgical treatment of PFF that combined with painful type 2 AN. Correcting the PFF while leaving the AN alone has a high possibility of relieving the pain in the AN region, and tibialis posterior tendon (TPT) rerouting hardly aids in reconstruction of the medial foot arch. LEVEL OF EVIDENCE: III.

Flexible flatfoot in the childhood: negative influence of inappropriate footwear

An analysis was carried out in relation to the adverse effects produced by the use of inadequately made footwear in patients with flexible flat feet in pediatric ages; we carried out an anatomical-functional reminder of the foot as a basic structure for standing and walking. The functional adaptability of the feet was valued in those populations with the habit of walking barefoot, also making a description of the basic characteristics that a properly made footwear must have. We address the different therapeutic approaches and their behavior over time. We highlight the widespread use in our society of inappropriate footwear, mainly of the flip-flop type, and its negative influence on the feet of those children with flexible flat feet and valgus of the ankle.

Se llevó a cabo un análisis en relación a los efectos adversos producidos por el uso de calzados de confección inadecuada en los pacientes portadores de pies planos flexibles en edades pediátricas. Se realizó un recordatorio anatomo-funcional del pie como estructura básica para la bipedestación y la marcha. Se valoró la adaptabilidad funcional de los pies en aquellas poblaciones con hábito de andar descalzos, haciéndose, además, una descripción de las características básica que debe reunir un calzado adecuadamente confeccionado. Se abordó los diferentes enfoques terapéuticos y su comportamiento en el tiempo, destacando el uso generalizado en la sociedad cubana de calzados inapropiados, principalmente del tipo chancletas, y su influencia negativa sobre los pies de aquellos niños con pies planos flexibles y tobillo valgo.

[Controversy of subtalar arthroereisis in symptomatic flatfoot].

Flatfoot could be divided into flexible flatfoot and rigid flatfoot. Flatfoot with symptoms is called symptomatic flatfoot, surgical treatment is required if conservative treatment is not effective. Subtalar arthroereisis is a minimally invasive procedure which has been used for many years with good results in flexible flatfoot, however, still has many controversial points. Controversial points focus on indications and contraindications, optimal age, subtalar arthroereisis alone or not, efficacy and safety of absorbable material implants, and implant removal. The paper reviewed and summarized the use and controversies of subtalar arthroereisis in symptomatic flatfoot as follows:the best indication for subtalar arthroereisis was pediatric flexible flatfoot syndrome and aged from 10 to 12 years old was optimal age for treatment;tarsal coalitions with flatfoot and adult flatfoot were relative indications. Stiff flatfoot, joint laxity, and subtalar arthritis were contraindications;obesity and neurogenic flexible flatfoot were relative contraindications. The correction ability of subtalar arthroereisis alone was limited, and it's combined with other procedures depending on patient's situation. The safety and efficacy of absorbable material implants had been reported. Routine removal of the implant was not necessary, the main reason of which was tarsal sinus pain.

Effect of Insoles Treatment on School-Age Children with Symptomatic Flexible Flatfoot: A 2-Year Follow-Up Study.

Background: Flatfoot is common among children. Symptomatic flexible flatfoot is one of the various types which needs treatment. Wearing insoles is considered one of the conservative therapies, but its effects are still uncertain. This study aims to provide evidence for the efficacy of insoles treatment among school-aged children with symptomatic flexible flatfoot. Methods: Patient who were Children who were diagnosed with symptomatic flexible flatfoot and received insoles treatment in authors' institute were retrospectively included. Their ages, body mass index, pain positions, pain frequency, valgus angle, arch index and visual analogue scale (VAS) score were collected before and after insole treatment. Results: A total of 32 children were included in this study. The results showed that wearing insoles for 2 years caused a significant improvement in pain frequency, valgus angle, arch index and VAS score. Conclusions: This study indicated that pediatric symptomatic flexible flatfoot could be relieved by wearing insoles for 2 years. Insole treatment might be a workable option for pediatric symptomatic flexible flatfoot in children older than 6 years old.