Four-Year Treatment Effect of Custom-Made Foot Orthosis on Pediatric Symptomatic Accessory Navicular Bone Combined with Flexible Flatfoot.

Purpose: Congenital accessory navicular bone (ANB) is a common variant in the foot and is prone to cause several clinical symptoms. Wearing custom-made foot orthosis is considered a desirable option; however, there is limited evidence of its effectiveness. This study aims to report the mid-term effect of foot orthosis for symptomatic pediatric ANBs. Methods: School-age children with symptomatic ANBs combined with flexible flatfoot in the authors' institute were recruited and got custom-made foot orthosis treatment. They were followed up over 4 years. The general characteristics of these children were collected before treatment, including age, gender, and body mass index (BMI). The indicators of foot symptoms, including frequency and location of pain, visual analogue scale (VAS), arch index (AI), and hind foot valgus angle (HVA), were measured during pretreatment and at the last follow-up. Results: Twenty-seven children were recruited for this study. After 4 years of custom-made foot orthosis treatment, significant improvements showed in pain frequency, VAS, AI, and HVA (P < 0.001). Type II ANBs showed a higher pain index pretreatment (P < 0.001) and reduced after treatment (P < 0.001). Conclusion: Mid-term effect of custom-made foot orthosis is inspiring in clinical symptoms of pediatric congenital ANBs combined with flexible flatfoot and may be an optional nonoperative treatment. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-024-01210-7.

Correlation of Posterior Tibial Tendon Ultrasound with Calcaneal Inclination Angle in Indonesian Professional Athletes with Medial Ankle Pain.

Background: Adult-acquired flatfoot deformity (AAFD) is characterized by partial or complete flattening of the longitudinal medial arch, which develops after maturity. AAFD secondary to posterior tibialis tendon dysfunction (PTTD) is one of professional athletes' most common foot and ankle pathologies. Different modalities and procedures can be used to establish the diagnosis of AAFD and PTTD. However, imaging measurements such as the calcaneal inclination index and ultrasonography (US) of the posterior tibialis tendon (PTT) in professional athletes with medial ankle and focal pain along the PTT have yet to be widely studied. This study investigates the correlation of PTT ultrasound for evaluating PTTD with calcaneal inclination angle (CIA) for evaluating AAFD in professional athletes with medial ankle and focal pain along the PTT. Through this study, clinicians and radiologists may benefit from considering AAFD in athletes with PTTD. Methods: 112 Indonesian professional athletes with medial ankle or foot pain and focal pain along the direction of the PTT underwent foot radiography using the CIA and ankle ultrasound to observe PTT abnormalities. Results: A negative correlation between fluid thickness surrounding the PTT and the CIA (p<0.001; 95% CI - 0.945, - 0.885), as well as a negative correlation between PTT thickness and CIA (p<0.001, 95% CI - 0.926, - 0.845), with a correlation coefficient (r) of - 0.921 and - 0.892, respectively. No significant correlation was found between PTT tear and CIA (p = 0.728; 95% CI -0.223, - 0.159; r - 0.033). Conclusion: This study showed a negative correlation between PTTD and AAFD via ultrasound and CIA in professional athletes with medial ankle and focal pain along the PTT. A better understanding of PTTD and AAFD imaging will lead to more effective management and prompt treatment.

Deep learning-based automated angle measurement for flatfoot diagnosis in weight-bearing lateral radiographs.

This study aimed to develop and evaluate a deep learning-based system for the automatic measurement of angles (specifically, Meary's angle and calcaneal pitch) in weight-bearing lateral radiographs of the foot for flatfoot diagnosis. We utilized 3960 lateral radiographs, either from the left or right foot, sourced from a pool of 4000 patients to construct and evaluate a deep learning-based model. These radiographs were captured between June and November 2021, and patients who had undergone total ankle replacement surgery or ankle arthrodesis surgery were excluded. Various methods, including correlation analysis, Bland-Altman plots, and paired T-tests, were employed to assess the concordance between the angles automatically measured using the system and those assessed by clinical experts. The evaluation dataset comprised 150 weight-bearing radiographs from 150 patients. In all test cases, the angles automatically computed using the deep learning-based system were in good agreement with the reference standards (Meary's angle: Pearson correlation coefficient (PCC) = 0.964, intraclass correlation coefficient (ICC) = 0.963, concordance correlation coefficient (CCC) = 0.963, p-value = 0.632, mean absolute error (MAE) = 1.59°; calcaneal pitch: PCC = 0.988, ICC = 0.987, CCC = 0.987, p-value = 0.055, MAE = 0.63°). The average time required for angle measurement using only the CPU to execute the deep learning-based system was 11 ± 1 s. The deep learning-based automatic angle measurement system, a tool for diagnosing flatfoot, demonstrated comparable accuracy and reliability with the results obtained by medical professionals for patients without internal fixation devices.

The effects of foot orthoses on radiological parameters and pain in children with flexible flat feet: a systematic review and meta-analysis.

Objective: This study aimed to investigate the impact of foot orthoses on foot radiological parameters and pain in children diagnosed with flexible flatfoot. Methods: A comprehensive search was conducted across several databases, including PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO, covering publications from the inception of each database up to 8 June 2024. The study focused on randomized controlled trials investigating the use of foot orthoses for treating flexible flat feet in children. Four researchers independently reviewed the identified literature, extracted relevant data, assessed the quality of the studies, and performed statistical analyses using RevMan 5.4 software. Results: Six studies involving 297 participants were included. The methodological quality of the included literature ranged from moderate to high. Radiological parameters of the foot improved significantly in older children with flexible flat feet following foot orthotic intervention compared to controls, particularly in the lateral talar-first metatarsal angle [mean difference (MD) = -2.76, 95% confidence interval (95% CI) -4.30 to -1.21, p = 0.0005], lateral talo-heel angle (MD = -5.14, 95% CI -7.76 to -2.52, p = 0.0001) and calcaneal pitch angle (MD = 1.79, 95% CI 0.88-2.69, p = 0.0001). These differences were statistically significant. Additionally, foot orthoses significantly improved the ankle internal rotation angle and reduced foot pain in children with symptomatic flexible flatfoot (MD = -2.51, 95% CI -4.94 to -0.07, p = 0.04). Conclusion: The use of foot orthoses positively impacts the improvement of radiological parameters of the foot and reduces pain in older children with flexible flat feet. However, in younger children with flexible flat feet, the improvement from foot orthoses was not significant, likely due to challenges in radiological measurements caused by the underdevelopment of the ossification centers in the foot. Further studies are needed. Consequently, the results of this meta-analysis support the implementation of an early intervention strategy using foot orthoses for the management of symptomatic flat feet in older children. Systematic Review Registration: https://www.crd.york.ac.uk/, PROSPERO [CRD42023441229].

Morphological changes in flatfoot: a 3D analysis using weight-bearing CT scans.

BACKGROUND: Flatfoot is a condition resulting from complex three-dimensional (3D) morphological changes. Most Previous studies have been constrained by using two-dimensional radiographs and non-weight-bearing conditions. The deformity in flatfoot is associated with the 3D morphology of the bone. These morphological changes affect the force line conduction of the hindfoot/midfoot/forefoot, leading to further morphological alterations. Given that a two-dimensional plane axis overlooks the 3D structural information, it is essential to measure the 3D model of the entire foot in conjunction with the definition under the standing position. This study aims to analyze the morphological changes in flatfoot using 3D measurements from weight-bearing CT (WBCT). METHOD: In this retrospective comparative our CT database was searched between 4-2021 and 3-2022. Following inclusion criteria were used: Patients were required to exhibit clinical symptoms suggestive of flatfoot, including painful swelling of the medial plantar area or abnormal gait, corroborated by clinical examination and confirmatory radiological findings on CT or MRI. Healthy participants were required to be free of any foot diseases or conditions affecting lower limb movement. After applying the exclusion criteria (Flatfoot with other foot diseases), CT scans (mean age = 20.9375, SD = 16.1) confirmed eligible for further analysis. The distance, angle in sagittal/transverse/coronal planes, and volume of the two groups were compared on reconstructed 3D models using the t-test. Logistic regression was used to identify flatfoot risk factors, which were then analyzed using receiver operating characteristic curves and nomogram. RESULT: The flatfoot group exhibited significantly lower values for calcaneofibular distance (p = 0.001), sagittal and transverse calcaneal inclination angle (p < 0.001), medial column height (p < 0.001), sagittal talonavicular coverage angle (p < 0.001), and sagittal (p < 0.001) and transverse (p = 0.015) Hibb angle. In contrast, the sagittal lateral talocalcaneal angle (p = 0.013), sagittal (p < 0.001) and transverse (p = 0.004) talocalcaneal angle, transverse talonavicular coverage angle (p < 0.001), coronal Hibb angle (p < 0.001), and sagittal (p < 0.001) and transverse (p = 0.001) Meary's angle were significantly higher in the flatfoot group. The sagittal Hibb angle (B = - 0.379, OR = 0.684) and medial column height (B = - 0.990, OR = 0.372) were identified as significant risk factors for acquiring a flatfoot. CONCLUSION: The findings validate the 3D spatial position alterations in flatfoot. These include the abduction of the forefoot and prolapse of the first metatarsal proximal, the arch collapsed, subluxation of the talonavicular joint in the midfoot, adduction and valgus of the calcaneus, adduction and plantar ward movement of the talus in the hindfoot, along with the first metatarsal's abduction and dorsiflexion in the forefoot.

Individuals with asymptomatic hallux valgus exhibit altered foot kinematics during gait regardless of their foot posture.

BACKGROUND: A flatfoot has been believed to be closely associated with the development of hallux valgus; however, the association is still controversial. Abnormal foot kinematics has been identified as a possible risk factor for the development of hallux valgus, but it remains unclear whether foot posture contributes to abnormal foot kinematics. This is the first study to investigate the differences in foot kinematics during gait between individuals with and without hallux valgus, while controlling for foot posture. METHODS: Twenty-five females with hallux valgus and 25 healthy females aged 18 to 22 were recruited. Foot posture was measured using normalized navicular height truncated and the leg-heel angle. Foot kinematic and kinetic data during gait were recorded by a three-dimensional motion capture system. To investigate the characteristics of foot kinematics in individuals with hallux valgus while controlling for foot posture, we used a propensity score matching method. The matching was obtained by using the 1:1 nearest-neighbor procedure and a caliper width of 0.2. FINDINGS: Twelve pairs were matched. Individuals with hallux valgus had significantly increased midfoot dorsiflexion from 56% to 80% during stance phase, rearfoot eversion from 53% to 71%, and forefoot abduction from 5% to 29% compared with control. INTERPRETATION: Individuals with hallux valgus have a flexible foot that cannot suppress the dynamic deformation of the rearfoot and midfoot during gait. To suppress the development of hallux valgus, interventions that aim to prevent dynamic deformations of the rearfoot and midfoot during gait may be necessary, regardless of their static foot posture.

Abductor hallucis muscle activity during short foot exercise in combination with static and dynamic functional tasks.

BACKGROUND: Short foot exercise (SFE) can be combined with dynamic functional tasks such as squats; however, it is unclear whether this combination increases intrinsic foot muscle activity. RESEARCH QUESTION: This study aimed to investigate and compare the abductor hallucis muscle (AbdH) activity during SFE in static and dynamic functional tasks. METHODS: The AbdH electromyography data of 17 healthy participants with and without SFE were analyzed during static tasks (sitting, double-leg standing, and single-leg standing) and dynamic tasks (double-leg squat, single-leg squat, split squat, and heel-raise). The static tasks were performed with SFE for 5 seconds, and the dynamic tasks were performed while performing SFE. AbdH activity with or without SFE during the task was compared using the Friedman and Wilcoxon signed-rank tests. RESULTS: AbdH activity was significantly greater in conditions with SFE than in those without SFE for all tasks (P < 0.01) except for heel-raise (P = 0.163). AbdH activity during SFE in single-leg standing was significantly higher than that in sitting, double-leg standing, and double-leg squats (P < 0.05). AbdH activity during SFE in the single-leg squat was also significantly greater than that in the sitting position (P = 0.024). No significant differences were found in any other between-task comparisons of AbdH activity during SFE. AbdH activity during tasks without SFE revealed significantly lower levels for sitting and double-leg standing compared to single-leg squat, split squat, and heel-raise (P < 0.001). Additionally, the activity in double-leg squat was significantly lower than in both single-leg squat and heel-raise (P < 0.05). SIGNIFICANCE: Combining dynamic tasks, except for the heel-raise task, with SFE can increase AbdH activity more than dynamic tasks without SFE. However, clinicians should note that combining dynamic tasks with the SFE may not increase AbdH activity compared to combining static tasks with the SFE.

Effect of orthopedic insoles on lower limb motion kinematics and kinetics in adults with flat foot: a systematic review.

Flatfoot is characterized by the collapse of the medial longitudinal arch, eversion of the rearfoot and abduction of the loaded forefoot. Orthopedic insoles are the frequently recommended treatment to support the arch of the foot, adjust the structure of the foot, reduce pain, improve stability and new techniques have been applied to the design of orthopedic insoles in recent years. However, the effectiveness of orthopedic insoles in different motions is still debated from the perspective of biomechanics. Therefore, this study aimed to explore the impact of orthopedic insoles on the kinematics and kinetics of lower limb motion, and to verify effectiveness and propose possible future research directions. We conducted a literature search across three databases employing Boolean operations and filtered results based on eligibility criteria. A total of 671 relevant literature were searched in this review, and 19 literature meeting the requirements were finally included. The results showed that: 1) orthopedic insoles were effective when patients walk, run and jump from the perspective of biomechanics; 2) orthopedic insoles had different result on the change of ankle sagittal angle, moment and peak pressure in the metatarsal region; 3) Whether the effect of insoles, which uses new techniques such as different 3D printed technologies and adds various accessories, can be further improved remains to be further studied; 4) Follow-up studies can pay more attention to the differences between diverse populations, increase the breadth of running and jumping and other movements research and long-term intervention.

Biomechanical variations in patients with flatfoot deformity: Impact of gender, age, and BMI on foot kinetics and kinematics.

Background: Flatfoot is considered by the collapse of the foot arch, altered biomechanics and impacting functional abilities. The biomechanical gait alteration of foot kinematics and kinetics in individuals with flatfoot, based on gender, age and Body mass index (BMI) in each cohort is unclear. This study explores how gender, age, and body mass index (BMI) impact distinct foot biomechanical characteristics, including ankle joint angle (Jc°), Ground force reaction angle (GFR°), Achilles tendon force (T), Ankle joint force (Jc) and vertical ground reaction force (VGRF) during the gait stance phase, in flatfoot versus normal-foot individuals on Indian Population. Method: A foot pressure test and sagittal plane motion analysis were performed on 142 individuals with normal-foot arches and 102 with flatfoot, stratified by gender, age, and BMI. Calculations of the magnitude and direction of forces in ankle joint equilibrants relied on inverse dynamic analysis, vertical ground force reaction and mapping motion data of the gait stance phases. Result: In the midstance phase, females with high BMI (HBMI) in the middle and older age group (p = 0.029 and p = 0.014), and males with HBMI in the older age group (p = 0.039) demonstrate significantly higher V G R F . Females and males with HBMI in middle and older age groups, along with males with normal BMI in the older age cohort, show positive and negative ranges of GFR°, indicating gait instability. In the push-off phase, females with HBMI in a middle-aged group exhibit significantly lower T a n d J c (p = 0.023 and p = 0.026) respectively. Conclusion: The biomechanical issues in individuals with flatfoot, while accounting for the influence of gender, age and BMI, are crucial for tailored interventions and precise solutions to biomechanical issues, thereby enhancing foot function and reducing discomfort.

Chronic Deltoid Insufficiency in Stage IV Adult Acquired Flatfoot Deformity: Do We Have a Good Answer?

Stage IV adult acquired flatfoot deformity (AAFD) with secondary chronic deltoid ligament insufficiency is a challenging deformity to treat, with minimal consensus in the literature concerning its surgical management. Many surgical treatment options have been described, including joint-sparing techniques, fusions, osteotomies, and even arthroplasties. However, questions remain as to what, if any, treatment is optimal. This contribution reviews studies on surgical treatments for stage IV AAFD with deltoid ligament failure and provides a critical analysis regarding the quality of outcomes reported for those different treatment options. PubMed and Google Scholar databases were searched between June 1, 2022, and August 15, 2022, for studies published between 1990 and 2022 that describe the treatment of stage IV AAFD with deltoid ligament insufficiency. Articles included in the study focused on subjects with stage IV AAFD and associated deltoid ligament insufficiency undergoing surgical correction. Exclusion criteria included stage I, II, and III AAFD, as well as deltoid ligament repair following acute injury/rupture. Nine studies covering five different treatment options for patients with stage IV AAFD and chronic deltoid insufficiency were included, with minimal overlap in outcome measures used to assess the efficacy of the procedure. Triple arthrodesis with deltoid ligament reconstruction resulted in a 62.5% (5/8) success rate with a residual tibiotalar (TT) angulation of 2° (success defined as <3°). Tibiotalar arthrodesis of four patients resulted in an average post-operative tibiotalar angulation of 4.8° with all patients showing progressive destabilization of the hindfoot complex at 12-18 year follow-ups. Deltoid arthroscopic laminoplasty (Brostrom) resulted in an increased American Orthopaedic Foot and Ankle Society (AOFAS) score from 49.7 pre-op to 91.9 post-op. There was no long-term follow-up of these patients. Deltoid ligament reconstruction using autografts of the peroneus longus resulted in a post-operative valgus of 2.1° in one study and <5° in another. Deltoid ligament reconstruction using an anterior tibial tendon autograft resulted in a gain of 126.4 + 40.2% in stiffness compared to an intact ligament. Twinfix suture anchors resulted in a post-operative hindfoot angle averaging 5.3°. Combined deltoid and spring ligament reconstruction resulted in a 5.1° valgus angulation. There is currently no standard of care or clinical consensus regarding surgical treatment for stage IV AAFD with deltoid insufficiency. Several studies imply that mild valgus malalignment around the tibiotalar joint can result in satisfactory outcomes. A few studies even deemed <5° of valgus tilt post-operatively successful. However, it has been described that any imbalance in tibiotalar tilt is a significant risk factor for progressive arthritis and future ligamentous failure. No treatment option was able to correct valgus tilt to an anatomical standard (i.e., to normal anatomy). These varied findings, along with the lack of consensus on post-surgical measures to assess efficacy, are worrisome and emphasize the need for better surgical options. Moreover, there is a critical need for additional research on the long-term outcomes following stage IV AAFD and deltoid insufficiency repair, particularly, as over five million people in the United States and 10% of the geriatric population are affected by AAFD with a risk of progressing to stage IV.

Influence of the transverse tarsal arch on radiological components of progressive collapsing foot deformity.

The importance of the transverse tarsal arch (TTA) has recently been extensively reevaluated and has even been considered to play a greater role in foot stability than the medial longitudinal arch (MLA). However, the relevance of this observation in the context of common clinical foot disorders, such as progressive collapsing foot deformity (PCFD), has not yet been fully clarified. In this biomechanical study, we examined ten pairs of human cadaveric feet by serial weight-bearing cone-beam computed tomography under controlled loading using a custom-designed testing machine. The MLA and TTA were transected separately, alternating the order in two study groups. A semiautomated three-dimensional evaluation of their influence on three components of PCFD, namely collapse of the longitudinal arch (sagittal Meary's angle), hindfoot alignment (sagittal talocalcaneal angle), and forefoot abduction (axial Meary's angle), was performed. Both arches had a relevant effect on collapse of the longitudinal arch, however the effect of transecting the MLA was stronger compared to the TTA (sagittal Meary's angle, 7.4° (95%CI 3.8° to 11.0°) vs. 3.2° (95%CI 0.5° to 5.9°); p = 0.021). Both arches had an equally pronounced effect on forefoot abduction (axial Meary's angle, 4.6° (95%CI 2.0° to 7.1°) vs. 3.0° (95%CI 0.6° to 5.3°); p = 0.239). Neither arch showed a consistent effect on hindfoot alignment. In conclusion, weakness of the TTA has a decisive influence on radiological components of PCFD, but not greater than that of the MLA. Our findings contribute to a deeper understanding and further development of treatment concepts for flatfoot disorders.

Comparative study of the effects of custom-made insole and ordinary insole in adults with flexible flatfoot on different slopes.

BACKGROUND: Flatfoot (pes planus) is a common foot deformity, and its causes are mainly related to age, gender, weight, and genetics. Previous studies have shown that custom-made insoles could have a positive effect in improving plantar pressure and symptoms in individuals with flexible flatfeet, but it remains to be explored whether they can still show benefits in daily walking on different slopes. OBJECTIVE: This study aims to investigate a custom-made insole based on plantar pressure redistribution and to verify its effectiveness by gait analysis on different slopes. METHODS: We recruited 10 subjects and compared the peak pressure and impulse in each area between custom-made insole (CI) and ordinary insole (OI) groups. RESULTS: The results illustrate that CI raises the pressure in T area, improves the ability of the subjects to move forward in the slope walking, which was beneficial to gait stability. CONCLUSION: The redistribution of pressure in MF and MH area is promoted to provide active protection for subjects. Meanwhile, CI could decrease the impulse in MF area during uphill and level walking, which effectively reduces the accumulation of fatigue during gait. Moreover, avoiding downhill walking could be able to protect foot from injury in daily life.

Knowledge and Attitudes Regarding Flatfoot in the Al-Jouf Region, Saudi Arabia.

Background Flatfoot is a syndrome that includes multiple static and dynamic deformities, characterized by the flattening of the medial arch. It is a common disorder that may affect any age group, causing foot malalignment, pain, and loss of function. Community awareness about flatfoot is essential for the prevention and control of flatfoot complications, ultimately improving the quality of life. The current study aimed to assess community knowledge and attitudes about flatfoot in the Al-Jouf region, Saudi Arabia. Methods The study enrolled 315 participants from different sectors of the Saudi population in the Al-Jouf region. An online questionnaire was distributed to them. Answers were scored on a scale of five (never "1", rarely "2", sometimes "3", often "4", always "5"). The level of their knowledge was determined by calculating the scores. Results There were significant disparities in the answers, with the majority of participants denying the effect of flatfoot on walking (135, 42.9%), running (123, 39%), standing for long periods (186, 59%), or causing tripping. More than half of the participants agreed that flatfoot never affects school activities or participation in clubs or activities after school. However, most participants showed a good attitude toward individuals with flatfoot, as they were not bothered by their way of walking (199, 63.2%) or how their foot or ankle looks (255, 80.9%), and never embarrassed them because of their foot or ankle (266, 84.5%). Most participants agreed that no one has the right to be unkind to them because of their foot or ankle (276, 87.5%). These positive attitudes are likely due to the cultural norms of the community. Conclusion There is a decreased level of awareness about the effects of flatfoot on daily physical activities among the Saudi population in the Al-Jouf region. However, their attitude toward people suffering from flatfoot is highly appreciated. Health education programs are recommended.

Effects of Preoperative Abnormality of Posterior Tibial Tendon on the Surgical Outcomes of Medial Osteochondral Lesion of the Talus.

BACKGROUND: Although surgical treatment for osteochondral lesion of the talus (OLT) can obtain good clinical outcomes, the rate of return to sports is variable. It is reported that medial OLT unrelated to trauma has abnormal structures in the medial aspect, which may induce the medial OLT due to the medial instability. The posterior tibial tendon (PTT) plays an important role in the stabilization of the foot, and high mechanical stress may be added to the PTT to compensate for medial instability in medial OLT. We investigated whether abnormal PTT findings on preoperative magnetic resonance imaging (MRI) in patients with OLT affect clinical outcomes after surgery.  Methods: Eighty-one ankles in 74 patients who were treated surgically for OLT were included in this study (41 men and 33 women; mean age, 26.0 years). Abnormalities of the PTT were evaluated using preoperative MRI. The Japanese Society for Surgery of the Foot (JSSF) scale, arch height, and ankle activity score (AAS) on standing plain radiogram were compared between patients with and those without preoperative PTT abnormalities. RESULTS: Twenty-five ankles (30.9%) had PTT abnormalities on preoperative MRI. All patients with preoperative PTT abnormalities were medial OLT. There were no significant differences in the preoperative JSSF scale in the procedures for OLT. The postoperative JSSF scale and arch height were significantly lower in patients with preoperative PTT abnormalities than those without them. AAS in patients with preoperative abnormalities significantly decreased at the final follow-up.  Conclusion: PTT abnormalities on preoperative MRI may affect clinical outcomes even in preoperative asymptomatic patients in the medial OLT unrelated to trauma.

Association between Elastic Modulus of Foot Soft Tissues and Gait Characteristics in Young Individuals with Flatfoot.

Flatfoot is a common foot deformity, causing foot pain, osteoarthritis of the midfoot, and even knee and hip dysfunction. The elastic modulus of foot soft tissues and its association with gait biomechanics still remain unclear. For this study, we recruited 20 young individuals with flatfoot and 22 age-matched individuals with normal foot arches. The elastic modulus of foot soft tissues (posterior tibial tendon, flexor digitorum brevis, plantar fascia, heel fat pad) was obtained via ultrasound elastography. Gait data were acquired using an optical motion capture system. The association between elastic modulus and gait data was analyzed via correlation analysis. The elastic modulus of the plantar fascia (PF) in individuals with flatfoot was higher than that in individuals with normal foot arches. There was no significant difference in the elastic modulus of the posterior tibial tendon (PTT), the flexor digitorum brevis (FDB), or the heel fat pad (HFD), or the thickness of the PF, PTT, FDB, and HFD. Individuals with flatfoot showed greater motion of the hip and pelvis in the coronal plane, longer double-support phase time, and greater maximum hip adduction moment during walking. The elastic modulus of the PF in individuals with flatfoot was positively correlated with the maximum hip extension angle (r = 0.352, p = 0.033) and the maximum hip adduction moment (r = 0.429, p = 0.039). The plantar fascia is an important plantar structure in flatfoot. The alteration of the plantar fascia's elastic modulus is likely a significant contributing factor to gait abnormalities in people with flatfoot. More attention should be given to the plantar fascia in the young population with flatfoot.

Do First Ray-Related Angles Change following Subtalar Arthroereisis in Pediatric Patients? A Radiographic Study.

INTRODUCTION: Subtalar Arthroereisis (STA) is a surgical intervention for pediatric flexible flatfoot (PFF), primarily targeting hindfoot alignment by limiting excessive subtalar eversion. However, its effects on forefoot parameters remain underexplored. This study aims to investigate radiological changes following STA in pediatric patients. MATERIALS AND METHODS: A retrospective analysis was conducted on consecutive patients treated with STA for PFF. First ray-related angles, including the Hallux Valgus Angle (HVA) and the Intermetatarsal Angle (IMA), alongside hindfoot radiological parameters such as the Meary, Calcaneal Pitch, and Costa Bartani angles, were assessed. Subgroup analysis by gender was performed, and correlations between demographic and preoperative radiological parameters were examined. RESULTS: Forty-one patients (81 feet) with an average age of 11.6 years were included, with a mean follow-up duration of 6.4 months. No significant differences were observed in first ray-related angles pre-and postoperatively, with the mean IMA changing from 7.97° to 7.18° and the mean HV angles changing from 9.51° to 8.66°. Noteworthy improvements were seen in flat foot angles, including the Meary, Calcaneal Pitch, and Costa Bartani angles, postoperatively. The age subgroup analysis revealed similar trends in IMA and HVA changes between Group A (who underwent surgery before peak growth) and Group B (who underwent surgery after peak growth). Higher preoperative angles tended to improve, while lower preoperative IMAs and HVAs tended to worsen postoperatively, all remaining within normal ranges. CONCLUSION: STA showed positive radiological outcomes for PFF treatment, while negligible changes in first ray-related angles were observed. The age subgroup analysis indicated similar trends regardless of operation timing. Higher preoperative angles tended to improve, while lower preoperative angles tended to worsen postoperatively, despite all falling within non-pathological ranges. Further research is warranted to confirm this correlation.

Non-surgical management of posterior tibial tendon dysfunction- a UK survey.

BACKGROUND: Posterior Tibial Tendon Dysfunction (PTTD) is commonly seen within musculoskeletal care. The condition's prevalence and management is poorly understood. This study aims to demonstrate current practice by multi-professional clinicians across the United Kingdom within the National Health Service. METHODS: A national (UK) cross-sectional online survey was conducted among multi-professionals who treat PTTD within their NHS practice. The survey covered assessment, management and evaluation. This was shared via social media and professional groups. RESULTS: Two hundred thirteen surveys were completed, with 153 matching the eligibility criteria. The main respondents were Physiotherapists (48%) and Podiatrists (38%). Ultrasound scanning was used most frequently when considering initial imaging (67%). Many different treatment modalities were used, but a core set of education/advice, foot orthoses, and foot specific as well as general exercise were most commonly chosen. Outcome measures routinely used were pain scale (96/269) and single leg heel raise (84/269), but patient reported outcome measures were not routinely used. The most frequent reason to escalate care was failure to manage symptoms with conservative management (106/123; 86.2%), followed by fixed deformity (10/123; 8.2%). CONCLUSIONS: This survey provides evidence on current non-surgical management for PTTD from UK NHS practice. It provides a valuable marker for clinicians to use to compare their own practice and can be used in further research as a comparator.

Flatfoot Deformity; Exercise to Therapeutic Interventions: A Systematic Review.

Background: Deviation of the foot from the normal posture affects the function of the foot and lower limb and causes lower limb injuries in normal people and athletes. Flat feet or flatfoot deformity are usually associated with pain in the foot area and a decrease in the normal function of the foot, which can negatively affect the sports ability of athletes. Therefore, we aimed to investigate the abnormality of flat feet from training, exercise to therapeutic interventions. Methods: Articles were identified by searching five databases: PubMed, Scopus, Google Scholar, Science Direct, and Gate & Pasteur from 2000 to 2022. The keywords were selected specifically and correctly and all the researches and articles related to the title of the article were searched and found. This research was also searched in Persian databases that this database, included: Irandoc, Mag Iran and Noormagz. Results: Finally, 30 studies met the criteria for entering this study, selected and used to conduct this study. Conclusion: By using the results obtained in the research, which include corrective exercises and therapeutic interventions, especially the use of orthoses and various medical insoles, it is possible to help in the treatment and improvement of this anomaly.

[Relación entre el estado ponderal y la postura del pie en escolares españoles: estudio transversal]. / Relationship between weight status and foot posture in spanish schools: cross-sectional study.

OBJECTIVE: Childhood flatfoot and overweight can affect children's quality of life and influence their development, increasing the risk of musculoskeletal problems in adulthood. There is evidence linking overweight to the development of childhood flatfoot. The aim of the study was to assess the relationship between the weight status of school children and their foot posture and to determine whether there are differences between both sexes. METHODS: A cross-sectional study (2021) in a sample of schoolchildren (n=296, 153 boys and 143 girls, mean age 8.5±2.7) from Colegio San Agustín in Zaragoza was carried out. Foot posture was assessed according to the foot postural index, and weight status was obtained using the body mass index according to the criteria of the International Obesity Task Force. The correlation between weight status and foot posture was analyzed using Spearman's coefficient. The Chi-square test was used to determine the differences between the variables according to sex. RESULTS: Weight status showed no correlation with foot posture in boys (right foot p=0.095; left foot p=0.067) and girls (right foot p=-0.04; left foot p=0.008). Boys had a higher prevalence of flat feet than girls (boys foot posture index=8; girls foot posture index=7; right foot p<0.036; left foot p<0.009). Boys had higher prevalence of overweight than girls (28.75; 18.18, p<0.027). CONCLUSIONS: Weight status has no effect on foot posture. The male gender could predispose to the development of flat feet and overweight in childhood.

OBJECTIVE: El pie plano infantil y el sobrepeso pueden afectar a la calidad de vida durante la infancia e influir en su desarrollo, aumentando el riesgo de problemas musculoesqueléticos en la edad adulta. Existe evidencia que relaciona el sobrepeso con el desarrollo de pie plano infantil. El objetivo del estudio fue evaluar la relación entre el estado ponderal de los escolares y su postura del pie y determinar si existían diferencias entre ambos sexos. METHODS: Se realizó un estudio descriptivo de corte transversal en el mes de febrero de 2021, en una población de escolares españoles (n=296, 153 niños y 143 niñas, edad media de 8,5±2,7 años). La postura del pie se evaluó según el índice postural del pie, y el estado ponderal se obtuvo mediante el índice de masa corporal según criterios de la International Obesity Task Force. Se analizó la correlación entre el estado ponderal y la postura del pie con el coeficiente de Spearman. Mediante la prueba Chi-cuadrado se determinaron las diferencias entre las variables según sexo. RESULTS: El estado ponderal no mostró correlación respecto a la postura del pie en niños (pie derecho p=0,095; pie izquierdo p=0,067) y en niñas (pie derecho p=-0,04; pie izquierdo p=0,008). Los niños presentaron una prevalencia mayor de pies planos que las niñas (índice postural del pie en niños=8; índice postural del pie en niñas=7; pie derecho p<0,036; pie izquierdo p<0,009). Los niños tuvieron mayor prevalencia de sobrepeso respecto a las niñas (28,75; 18,18, p<0,027). CONCLUSIONS: El estado ponderal no influye sobre la postura del pie. El sexo masculino podría predisponer al desarrollo de pie plano y sobrepeso en la infancia.

Effect of short foot exercise on lower-limb motor control function during single-leg standing in university students with flatfoot: A randomized controlled trial.

INTRODUCTION: Intrinsic foot muscles (IFMs) play an important role in lower-limb motor control, including biomechanics and neuromuscular control function. Short foot exercise (SFE) and toe curl exercise (TC) are methods used to train the IFMs, but their effect on lower-limb motor control has not been reported in previous studies. This study evaluated the effects of SFE and TC on lower-limb motor control function during single-leg standing (SLS). TRIAL DESIGN: Randomized control trial. METHOD: Thirty-six participants with flatfoot were randomly assigned to the SFE or TC group and performed exercise for 8 weeks. The assessment items were navicular drop test, toe grip strength (TGS), plantar sensation, and SLS. In the SLS assessment, we measured the mean center of pressure (COP) amplitude in the anteroposterior (AP) and mediolateral (ML) directions, onset time of gluteus maximus (G. max) and gluteus medius (G. med), angle of forefoot/hindfoot protonation and hip adduction, and lateral pelvic shift. Mixed-model repeated-measures analysis of variance and Bonferroni corrections were performed in statistical analysis. RESULTS: The SFE group showed significant differences between pre- and post-intervention for TGS (p < 0.001), COP ML (p = 0.039), and onset times of G. max (p = 0.015), and G. med (p < 0.001). The TC group showed no significant differences in all assessment items. CONCLUSION: Our finding suggests that SFE contributes to lower neuromuscular control function in people with flatfoot. TRIAL REGISTRATION: UMIN000049963.