Tendon Transfers and Their Role in Cavus Foot Deformity.

Management of the cavus foot is a difficult task for the foot and ankle surgeon. Tendon transfers have been a longstanding accepted treatment for the flexible cavus foot. Performing tendon transfers requires an in-depth understanding of the patient's medical history, factors leading to the development of deformity, as well as the deforming forces contributing to the deformity. Evaluation of the patient for rigid, progressive, and/or spastic deformities is critical to avoid postoperative complications. Educating the patient on postoperative rehabilitation, potential complications, and postoperative expectations is essential to ensure appropriate surgical outcomes.

Comparative Evaluation of Radiographic Parameters of Foot Pronation in Two Different Conditions versus Barefoot.

BACKGROUND: To date, there is conflicting evidence that high-end "motion control" running shoes can correct and control rearfoot pronation. Many methods have been used to evaluate the efficacy of motion control footwear in reducing hindfoot pronation during gait, including stop-motion photography, three-dimensional camera kinematic analysis, and three-dimensional bone modeling using computed tomography. Until now, there have been no radiographic studies that examined the effect of motion control running shoes on the static posture of the foot. Murley et al devised a reliable system that correlated noninvasive clinical examinations to radiographic values that correspond to foot pronation. The aim of this prospective investigation was to determine whether motion control running shoes are able to produce a significant difference in pronation through a radiographic study, using the angular relationships as described by Murley et al, in two different shoe conditions as compared to the barefoot condition in female subjects. METHODS: This prospective study screened 28 female subjects ranging in age from 22 to 27 years on the basis of arch height index. The 24 subjects with a standing arch height index less than 0.370 were invited to participate in the study. Unilateral weightbearing dorsoplantar and lateral foot radiographs were taken in barefoot, neutral shoe, and motion control shoe conditions. Calcaneal inclination angle, calcaneal-first metatarsal (CFMA) angle, talonavicular coverage angle (TNCA), and talus-second metatarsal angle were measured in each condition by two independent observers using the Opal-Ortho PACS software package and then averaged. Angles were compared to barefoot baseline values using paired t tests. RESULTS: The motion control running shoe produced average decreases of 2.64% in CFMA, 12.62% in TNCA, 5.3% in talus-second metatarsal angle and an average increase of 1.3% in calcaneal inclination angle. Statistically significant ( P > .05) improvements in CFMA were noted in both the motion control ( P < .000) and neutral shoe conditions ( P < .000) when compared to barefoot, whereas TNCA improved only in the motion control shoe condition as compared to barefoot ( P = .003). CONCLUSIONS: This investigation found evidence that the particular models of motion control running shoes studied could correct foot pronation in the transverse and sagittal planes in stance. Motion control running shoes improved CFMA and TNCA from the barefoot condition and were more effective in correcting pronation compared with neutral running shoes in this radiographic study simulating static foot posture in stance.