A Foot to Last a Lifetime-Is Hindfoot Fusion Ever Appropriate for Pediatric Orthopaedic Conditions?

INTRODUCTION: Hindfoot deformities in the pediatric population can be painful and result in severe limitations. Although arthrodesis is known to relieve pain, there are concerns over its use because of the risk that adjacent joint degenerative disease could result, leading to a new source of pain, dysfunction, and additional surgical procedures later in life. METHODS: A literature review of hindfoot fusions in children focused on articles with the highest levels of evidence and those of particular historical significance. Case examples were obtained by querying the billing records of the local clinic system for Current Procedural Terminology (CPT) codes of hindfoot arthrodeses. Surgery procedures were performed by both fellowship-trained pediatric orthopaedists and fellowship-trained foot and ankle orthopaedic surgeons. RESULTS: The medical literature for this topic generally is divided into 2 main types of articles: those that describe hindfoot fusion procedures for a specific type of deformity or disease process and those that provide the indications and results of a single type of arthrodesis. Long-term follow-up studies are limited. DISCUSSION: The long-term risk of degeneration to adjacent joints has been studied, with mixed results. Other problems, such as recurrent deformity, overcorrection, pseudarthrosis, osteonecrosis, and foot shortening also may be encountered over intermediate-term follow-up. Nevertheless, in properly chosen patients, hindfoot fusion can offer a great improvement over the damaging and destructive deformities of the feet caused by a variety of diseases and traumatic injuries. Hindfoot fusions have been used for the treatment of foot deformities secondary to severe trauma, hemophilia, tarsal coalition, clubfoot, and neurological disease such as polio, static encephalopathy, hereditary motor and sensory neuropathies, and myelodysplasia. CONCLUSIONS: Hindfoot fusion in a child or adolescent should be considered only for the most extreme cases when all other options, short of amputation, have been considered or exhausted. While these procedures can offer improvement in the challenging cases, the surgeon should be aware of their long-term implications, including adjacent joint degeneration.

Deformidades de los pies en niños / Foot deformities in children

Las alteraciones en los pies son una consulta frecuente en ortopedia pediátrica. La gran mayoría corresponde a condiciones que no constituyen patología y habitualmente no necesitan tratamiento, como el pie plano flexible. Por otro lado, existen deformidades patológicas que necesitarán un adecuado estudio y tratamiento. Según su morfología podemos clasificarlas en cavo-varo, plano-valgo y misceláneas. Su origen puede ser congénito o adquirido y de diversas etiologías, destacando el pie bot, metatarso varo, hallux valgus juvenil y aquellas secundarias a enfermedades neuromusculares, entre otras. Conocer la historia natural de cada deformidad nos permite decidir el momento más adecuado para cada tratamiento. Los antecedentes mórbidos y perinatales del paciente son muy importantes, así como el nivel de actividad física y/o deportiva. El examen físico debe incluir observar la marcha, extremidades inferiores, tobillo y pie. En el pie se debe analizar cada segmento por separado (antepié, mediopié y retropié) y las articulaciones respectivas. Es muy importante distinguir entre deformidades rígidas y flexibles. El tratamiento incluye la observación (condiciones benignas y autolimitadas), calzado adecuado, insertos plantares, órtesis, yesos correctores, cirugía de partes blandas y cirugía ósea; todo complementado por un adecuado programa de rehabilitación funcional y deportivo.

Foot disorders are a frequent cause of consultation in pediatric orthopaedics. The vast majority correspond to conditions that don't constitute pathology and usually don ́t need treatment, such as flexible flat foot. On the other hand, there are pathological deformities that will require a proper study and treatment. According to their morphology we can classify them in cavo-varus, plano-valgus and miscellaneous. Its origin can be congenital or acquired and due to various etiologies, highlighting clubfoot, metatarsus adductus, juvenile hallux valgus and those secondary to neuromuscular diseases, among others. Knowing the natural history of each deformity allows us to decide the most appropriate time for each treatment. Patient's morbility and perinatal history is very important, as well as their level of physical and/or sports activity. Physical exam should include gait obsevation, lower limbs, ankles and feet. In the foot, each segment should be analyzed separately (forefoot, midfoot and hindfoot) and their joints. It ́s very important to distinguish between rigid and flexible deformities. Treatments include observation (benign and self-limited conditions), adequate footwear, insoles, orthosis, corrective casting, soft tissue surgery and bone surgery; all complemented by an adequate functional and sports rehabilitation programs

Foot deformities in patients with diabetic mellitus (with and without peripheral neuropathy).

BACKGROUND: Diabetic peripheral neuropathy (DPN) is one of the most common complications in diabetes mellitus. It is the disorder that most commonly affects the feet of people with diabetes. The aim of the present study is to determine the relationship between DPN and the presence of deformities in the foot. MATERIAL AND METHODS: A descriptive observational study was conducted of 111 patients diagnosed with Diabetes Mellitus (DM) type 1 or 2. All participants were aged at least 18 years and were previously informed in detail about the aims and procedures of the study. RESULTS: Regarding the presence of DPN, the only significant relationships were found for the right foot with the deformity of the second toe (claw, hammer or mallet) (p = 0.017, OR 0.29 [0.10-0.83]) and for the left foot with the deformity of the second toe (p = 0.048; OR: 0.37 [0.14-1.01]), third toe (p = 0.012; OR: 0.29 [0.11-0.79]) and the presence of hallux extensus (p = 0.05; OR: 8.27 [1.05-64.98]). CONCLUSIONS: A significant number of foot deformities were observed among these patients with DM, regardless of the presence of DPN. These deformities should be carefully evaluated in order to determine the most appropriate treatment at an early stage, which will reduce the risk of ulceration. Although it should be use with caution to be transferrable to the general population with peripheral neuropathy.

Intra- and inter-observer reliability of the AFCP classification for sagittal plane deformities of the second toe.

BACKGROUND: The French Association of Foot Surgery (AFCP) recently proposed a morphological classification of lesser toe deformities, describing the position of each joint (metatarsophalangeal or MTP, proximal interphalangeal or PIP and distal interphalangeal or DIP) in relation to their anatomic position in the sagittal plane. A study was designed to test its reliability for assessment of sagittal plane deformities of the second toe. METHODS: In this retrospective study 55 toes (55 feet, 50 patients) were evaluated. Eleven foot and ankle surgeons assessed independently standardized photographs of each case acquired in a blinded fashion. Assessment was repeated three times, each 15 days apart. Intra- (Intraclass Correlation Coefficient or ICC) and inter-observer reliability (Fleiss' Kappa coefficient) were calculated for each joint. RESULTS: Intra- and inter-observer reliability were moderate for the MTP joint (ICC range, 0.54-0.61) (Kappa range, 0.53-0.61) and substantial for the PIP (ICC range, 0.60-0.71) (Kappa range, 0.68-0.75) and DIP joints (ICC range, 0.69-0.78) (Kappa range, 0.74-0.78). Mean assessment time±standard deviation was 35±10s per case. CONCLUSIONS: The AFCP classification proved itself reliable in the assessment of sagittal plane defomities of the second toe among eleven foot and ankle surgeons. It is based only on a visual description of the deformity, and does not provide informations on either the clinical reducibility of the deformity and the radiographic joint status. LEVEL OF EVIDENCE: Level IV, retrospective cohort study.

Influencia de la práctica deportiva sobre la huella plantar en atletas españoles / Influence of sport practice on the footprint in Spanish athletes

El objetivo de este estudio fue conocer la asociación entre el entrenamiento de atletas con las características de cada pie. Se midieron y compararon las huellas plantares de tres grupos de deportistas (28 velocistas, 29 fondistas, 47 nadadores) y de 67 sujetos no entrenados (GC). Para la captura de parámetros plantares se empleó una plataforma de escaneado podálico Podoscanalycer®. El índice podálico, metatarsal, medio podálico, y calcáneo fue inferior en GC respecto a corredores de velocidad, fondo, y nadadores (p<0.001). El riesgo relativo de tener un pie cavo o un tipo de pié específico por pertenecer a una determinada modalidad atlética no resulto significativo (todos p>0.05). Se concluye que los años de entrenamiento y la edad en atletas españoles no se asocian significativamente con la curvatura y tipología del pie ni sobre ningún índice plantar específico. Sin embargo, sexo e IMC se asocia significativamente con los índices plantares según la modalidad atlética (AU)

The aim of the present study was to determine the association between athletic training and characteristics of each foot. Plantar foot print of three groups of athletes (28 sprinters, 29 distance runners, 47 swimmers) and 67 sedentary subjects (CG) were measured and compared. A scanning platform breech Podoscanalyzer was employed to obtain plantar pressure measurements. The breech, metatarsal, middle breech, and calcaneus index, were lower in CG compared to sprinters, long-distance runners, and swimmers (p<0.001). The relative risk of having a cavus foot or any specific type of foot as a result of practicing a particular athletic discipline was not significant (all p>0.05). We conclude that the years of training and the age are not significantly associated neither with the curvature and the type of the foot nor with any specific plantar arch index in Spanish athletes. Nevertheless, sex and BMI are significantly associated with the plantar arch indexes according to the athletic discipline (AU)

Metatarsalgia, lesser toe deformities, and associated disorders of the forefoot.

Forefoot pain in the adult often alters mobility and has a negative impact on quality of life. Metatarsalgia describes pain localized to the forefoot. Forefoot pain may be caused by conditions of the lesser toes themselves (eg, hammertoes, mallet toes, claw toes). The pathophysiology of lesser toe deformities is complex and is affected by the function of intrinsic and extrinsic muscle units. In addition to lesser toe and metatarsal abnormality, forefoot pain can be attributed to interdigital neuritis, disorders of the plantar skin, and gastrocsoleus contracture. Treatment of these conditions may include shoe modifications, appliances, therapeutic exercises, and surgical repair.

Classification of midfoot break using multi-segment foot kinematics and pedobarography.

Midfoot break (MFB) is a foot deformity that can occur when ankle dorsiflexion is restricted due to muscle spasticity or contractures, causing abnormal increased motion through the midfoot. MFB has been previously described in terms of forefoot (FF) and hindfoot (HF) motion in the sagittal plane. The purpose of this study was to further classify MFB by describing FF and HF motion in the coronal and transverse planes along with plantar pressures, with the goal of optimizing treatment of this deformity. Three-dimensional foot kinematics were assessed using a multi-segment foot model in children with MFB (n=30) and children with no foot or gait abnormalities (n=30). The MFB group was subdivided into three categories: (1) Pronated MFB, (2) Supinated MFB and (3) Flat Foot MFB. Unique patterns of plantar pressures and foot kinematics were identified for each MFB group. The Pronated MFB group had increased medial midfoot pressures, increased forefoot pronation, and increased external forefoot rotation (forefoot abductus). The Supinated MFB group had increased lateral midfoot pressures, increased forefoot supination, and increased internal forefoot rotation (forefoot adductus). In the Flat Foot MFB group, midfoot pressures were increased and distributed uniformly between the medial and lateral sides, forefoot pronation was increased, and internal forefoot rotation was present. By combining this new information with previously reported methods of measuring sagittal plane kinematics of MFB, it is now possible to characterize midfoot break in terms of severity and foot-floor contact pattern.

Metatarso aducto congénito: clasificación clínica y actitud terapéutica / Congenital metatarsus adductus: a clinical classification and therapeutic attitude

Objetivo. En este estudio se propone una clasificación clínico-terapéutica para el metatarso aducto congénito, con el objetivo de aunar criterios de diagnóstico y tratamiento, así como anticipar un pronóstico. Material y métodos. Seleccionamos 87 pacientes (144 pies) que se clasifican según su gravedad: •- Grado 1: antepié en aducción. Corrección total de la deformidad. •- Grado 2: antepié en aducción e inversión. Borde externo convexo (base del quinto metatarsiano palpable). Borde interno cóncavo. Arco longitudinal normal. Corrección parcial. •- Grado 3: grado 2 asociado a surcos transversales. No corregible. Tratamos el grado 1 con estimulación y manipulación. Para el grado 2 y 3 se realiza estimulación, manipulación y vendaje corrector, añadiendo férulas y botas de horma recta (opcional en el grado 2). Se ha realizado un estudio estadístico para determinar los casos que necesitan tratamiento, su duración y su eficacia. Resultados. Los 73 pies grado 1, 55 grado 2 y 16 grado 3 de nuestra serie se trataron de la forma indicada. Se consiguió la corrección total de 137 pies. La duración global del tratamiento fue de 4,65 meses, el período de corrección de 2,98 y el de seguimiento fue de 8,57 meses. Estos parámetros se asocian de manera significativa (p<0,05) con el grado de afectación. Conclusiones. Ninguno de nuestros pacientes precisó el uso de yesos ni intervención quirúrgica, lo que unido al porcentaje de correcciones totales nos hace pensar que nuestro protocolo es aceptable (AU)

Objective. This study proposes to make a clinical and therapeutic classification for congenital metatarsus adductus in order to unify criteria for diagnosis and treatment as well as to anticipate a prognosis. Material and methods. We selected 87 patients (144 feet) that were classified according to their severity: Grade 1: forefoot adduction. Total correction of the deformity. Grade 2: forefoot adduction and inversion. Convex outer edge (palpable first metatarsal base). Concave inner edge. Normal longitudinal arch. Partial correction. Grade 3: Grade 2 associated with transverse grooves. Uncorrectable. We treated level 1 with stimulation and manipulation. For grade 2 and 3 we applied stimulation, manipulation and corrective dressing, adding braces and straight-last boots (optional in grade 2). We performed a statistical study to identify cases that needed treatment, its duration and efficacy. Results. The 73 feet of grade 1, 55 grade 2 and 16 grade 3 of our series were treated as indicated. Total correction was achieved in 137 feet. Overall duration of treatment was 4.65 months, correction period 2.98 and monitoring was 8.57 months. These parameters were significantly associated (P<.05) with the degree of impairment. Conclusions. The percentage of total corrections and the fact that none of our patients required the use of casts or surgery makes us consider that our protocol is acceptable (AU)

Congenital fibular deficiency: a review of thirty years' experience at one institution and a proposed classification system based on clinical deformity.

BACKGROUND: Congenital longitudinal deficiency of the fibula is the most common lower extremity congenital deficiency, with a broad spectrum of severity and subsequent reconstructive treatment. Published classification schemes do not accurately predict reconstructive treatment currently in practice. METHODS: We reviewed all medical records of patients with a dominant deformity of congenital fibular deficiency who were managed at our institution between 1971 and 2005. We assessed the impact of limb-length inequality, foot deformity, bilateral extremity involvement, and extent of fibular preservation on the treatment of the limb deficiency. RESULTS: One hundred and four patients (including twenty-two with bilateral congenital fibular deficiency) with 126 affected extremities had adequate radiographs to be included in the study. Femoral shortening was noted in seventy (85.4%) of eighty-two patients with unilateral limb involvement. Limb-length discrepancy prior to any treatment remained proportional in forty-seven (82.5%) of fifty-seven patients during an average duration of follow-up of ten years and ten months (range, two years to fifteen years and six months). Limb salvage with foot preservation was deemed feasible in thirty-eight (97.4%) of thirty-nine five-rayed feet, thirty (81.1%) of thirty-seven four-rayed feet, twenty (48.8%) of forty-one three-rayed feet, and one of nine feet having fewer than three rays. Twenty-two (41.5%) of fifty-three limbs with an absent or vestigial fibula were not treated with amputation. Of the twenty-two patients with bilateral fibular deficiency, twelve (54.5%) had preservation of both feet, three (13.6%) had unilateral amputation, and seven (31.8%) had bilateral amputation. CONCLUSIONS: We propose a simplified classification for congenital fibular deficiency based on the clinical status of the foot and the magnitude of limb shortening as a percentage of the contralateral limb on radiographs. This classification may be effectively applied in infancy to allow the physician and family to anticipate the extent of deformity at maturity and to estimate the amount of treatment required to reconstruct this limb deformity. This system more accurately predicted the management of patients with fibular deficiency who were managed at our institution over the past three decades .

Skewfoot.

Skewfoot is a rare deformity characterized by forefoot adduction and hindfoot valgus. Its etiology and natural history are unknown, although congenital and syndromic forms are observed. Currently, there is no consent about the treatment of skewfoot. Due to its potential resistance to the effects of therapy, it must be differentiated from other, more common deformities. Treatment involves conservative and, most often, operative measures.

Correlation between static foot type measurements and clinical assessments.

BACKGROUND: An accurate and consistent differentiation of foot type is needed to assess appropriate treatments and to examine potential risk factors for acute and overuse injuries. MATERIALS AND METHODS: One hundred forty-seven members of the American Orthopaedic Foot and Ankle Society were asked to complete a questionnaire related to clinical assessments of foot type and to examine 30 photographs of healthy feet taken on the mirrored foot photo box (MFPB). Responders were asked to categorize each image into one of five categories (pes planus, low arch, normal, high arch, and pes cavus). Different static measurements were obtained from each image. Pearson correlations were calculated between the static foot measures and the clinical grade. Significantly correlated parameters were analyzed via regression analysis. RESULTS: Clinical assessment was reported to be the most important tool in defining foot type (69.9%) followed by standing radiographs and foot print measurements. Clinicians stated that arch height (56.2%) was the most used physical characteristic, while the lateral talo-first metatarsal angle (64.4%) was the most used radiographic assessment. Foot measurements were correlated with the clinical grade (r = 0.511 to 0.780). Regression analysis revealed that rearfoot angle, foot print index and truncated arch index were significant predictors of clinically defined foot type. Rearfoot angle accounted for 78% of the variance in clinically assessed foot type. CONCLUSION: The results of this study indicate the need to measure multiple parameters to assess foot type. However, if only one parameter can be collected, it appears that rearfoot angle explains the majority of variance in the clinically assessed foot type.

Opinions on lesser toe deformities among Dutch orthopaedic departments.

BACKGROUND: Wide variations in definitions of lesser toe deformities exist. In addition, a general consensus regarding treatment of lesser toe deformities is lacking. The objective of this study was to evaluate of the definitions, current concepts, and treatment protocols for lesser toe deformities among orthopaedic departments in The Netherlands. METHODS: A questionnaire with statements regarding lesser toe deformities was sent to all 101 Dutch departments of orthopaedic surgery. RESULTS: In total 76 (75%) completed forms were analyzed. A wide variation regarding definitions, concepts, and treatment strategies of lesser toe deformities was reported among the Dutch orthopaedic departments. Only half of all responding departments had a protocol or consensus in the treatment. CONCLUSIONS: The definitions of lesser toe deformities used in Dutch orthopaedic departments do not coincide. This might explain the variations in indications and the various performed interventions for different deformities. The differences of opinion among the Dutch orthopaedic departments may have important clinical consequences because an indication for surgery depends on the correct diagnosis. To correctly interpret and improve treatment results, a consensus on this topic should be introduced.

Effect of foot shape on the three-dimensional position of foot bones.

To eliminate some of the ambiguity in describing foot shape, we developed three-dimensional (3D), objective measures of foot type based on computerized tomography (CT) scans. Feet were classified via clinical examination as pes cavus (high arch), neutrally aligned (normal arch), asymptomatic pes planus (flat arch with no pain), or symptomatic pes planus (flat arch with pain). We enrolled 10 subjects of each foot type; if both feet were of the same foot type, then each foot was scanned (n=65 total). Partial weightbearing (20% body weight) CT scans were performed. We generated embedded coordinate systems for each foot bone by assuming uniform density and calculating the inertial matrix. Cardan angles were used to describe five bone-to-bone relationships, resulting in 15 angular measurements. Significant differences were found among foot types for 12 of the angles. The angles were also used to develop a classification tree analysis, which determined the correct foot type for 64 of the 65 feet. Our measure provides insight into how foot bone architecture differs between foot types. The classification tree analysis demonstrated that objective measures can be used to discriminate between feet with high, normal, and low arches.

Metatarsus adductus and skewfoot deformity.

Metatarsus adductus deformity should be recognized and addressed appropriately and in a timely fashion so as to achieve an effective correction with low rates of recurrence. Early diagnosis and treatment are of paramount importance, because spontaneous resolution is rare. Although nonoperative treatment is desirable via manipulation and soft tissue stretching and serial cast immobilization, appropriate surgical intervention needs to be used on occasion to achieve correction of resistant cases. Depending on the severity and flexibility of the deformity and the age of the patient, various methods of surgical reconstruction are available. A long-standing untreated or undertreated adductus deformity can lead to the formation of a skewfoot deformity with more significant symptoms and deformity. Treatment of this deformity is rarely successful by nonoperative means, and appropriate surgical procedures addressing the metatarsal adductus component and the flatfoot component can be used for correction of the dysfunctional or symptomatic skewfoot.

The peroneal tubercle: description, classification, and relevance to peroneus longus tendon pathology.

BACKGROUND: The size and configuration of the peroneal tubercle has been implicated in the pathogenesis of peroneal tendon tears and tenosynovitis. The purpose of this study was to determine the size and prevalence of the peroneal tubercle and devise a classification scheme according to the structure of the tubercle. METHODS: One hundred and seventeen calcanei were selected from 59 human skeletons in an osteological collection (one calcaneus was missing). Three were excluded because of the poor condition, leaving 114 calcanei. The peroneal tubercle was measured in length, height, and depth and its structure subjectively described as flat, prominent, concave, or tunnel for each specimen when present. RESULTS: This study revealed a peroneal tubercle prevalence of 90.4% (103) in 114 calcanei. The average length, height, and depth of the tubercle were 13.04 mm (range 3.61 mm to 26.66 mm), 9.44 mm (range 3.67 mm to 23.40 mm), and 3.13 mm (range 1 to 10), respectively. The peroneal tubercle was classified structurally as flat in 44 (42.7%), prominent in 30 (29.1%), concave in 28 (27.2%), and tunnel in one (1.0%). CONCLUSION: This data may further help to understand the size and assorted configurations of the peroneal tubercle and how they relate to peroneus longus tendon pathology.

Fuerzas de reacción del suelo en pies cavos y planos / Ground reaction forces in high-arch and flat feet

El objetivo de este estudio se ha centrado en medir las fuerzas de reacción en diferentes movimientos (marcha, carrera, cambio de dirección y amortiguación de caída) en una muestra de sujetos sedentarios sanos con pies planos y cavos. Participaron en el estudio 15 mujeres jóvenes (edad: 19,4 +/- 1.3 afios; peso: 57,17 +/- 8,98 Kg); 8 con pies planos (P) y 7 con pies cavo s (C). Fueron sometidas a una batería de pruebas: marcha (velocidad = 1,6 mis), carrera (velocidad = 3 mis), amortiguación de caída (desde una altura de 0,75 m) y cambio de dirección. Se estudiaron las fuerzas verticales, anteroposteriores y mediolaterales, utilizando una plataforma de fuerzas piezoeléctrica. Aparecieron diferencias significativas (p<0,01) entre pies planos y cavos en la duración del apoyo en el cambio de dirección, siendo mayores en los planos (C = 0,30 +/- 0,04 s Y P = 0,37 +/- 0,04 s) y en el primer pico de fuerza de la amortiguación de la caída (p<0,05), con valores superiores en los cavos (C = 5,78 +/- 1,29 BWy P = 4,29 +/- 0,84 BW). El resto de variables estudiadas no mostraron diferencias significativas, aunque todos los picos de fuerza en los movimientos máximos fueron mayores en el grupo con pies cavos y los picos de impacto en marcha y carrera fueron ligeramente superiores en los pies planos. El grado de significación estadística no tiene por qué ser el límite que marque el mayor o menor riesgo de futura lesión asociada a las fuerzas de reacción. Pequefias y no significativas diferencias podrían marcar un incremento sustancial del riesgo. Cabe destacar los mayores valores registrados en los pies cavos, en los movimientos máximos, en los que existiría un mayor riesgo para ellos. Por otro lado las mínimas o nulas diferencias observadas en los patrones de movimiento podrían explicarse por adaptaciones que realiza el sujeto en el movimiento

The aim of this study was to measure the ground reaction force s in different movements (walking, running, changes of direction and landing), in a sample of sedentary subjects with high-arch feet or flat feet. Fifteen young women volunteered for the study (age: 19,40 +/- 1,29 years; weight: 57,17 +/- 8,98 Kg); 8 with flat feet (P) and 7 with high -arch feet (C). AlI of them carried out the following tests on a force platform: walking (speed = 1,6 mis), running (speed = 3 mis), drop landing (height = 0,75 m), and changes of direction. Vertical, horizontal and mediolateral ground reaction forces were collected using a piezoelectric force platform. There were significant differences (p < 0,01) between flat and high-arch feet in the contact time during the change of direction test, with greater contact times in subjects with flat feet (C = 0,30 +/- 0,04 s Y P = 0,37 +/- 0,04 s), and in the first peak vertical force during landing (p<0,05), with greater values in subjects with high-arch feet (C = 5,78 +/- 1,29 BW Y P = 4,29 +/- 0,84 BW). The other variables studied did not show significant differences between groups, although peak vertical force s for the maximum tests were greater in the high-arch feet group, and peak forces during walking and running were slightly greater for the flat feet group. The lack of significant differences does not have to be the limit to predict the risk of injury provoked by greater peak forces. Small and not significant differences might be enough to increase this risk. The higher force values found in the high-arch feet group during maximal tests show a higher risk of injury during these kinds of movements. The minimal differences found in the movement pattems between groups could be explained by individual adaptations during the tests

Midfoot osteotomies for the cavus foot.

Midfoot osteotomies have long been used for a wide variety of congenital and acquired deformities. Severe pes cavus often necessitates some form of surgical correction, and no single procedure can be used exclusively. Midfoot osteotomies may be combined with adjunctive procedures to form an appropriate strategy for the treatment of these deformities. The authors present an overview of pes cavus, including evaluation and classification of the deformity, as well as associated conditions. Several soft tissue and osseous procedures for correction of the cavus foot are discussed. Special attention is directed at the use of various midfoot osteotomies and their ability to enhance such correction.

Los pies del niño, motivo de consulta en rehabilitación / Foot problems in a children's rehabilitation service

Uno de los motivos más frecuentes de consulta en Rehabilitación infantil es la enfermedad podológica. Las consultas sobre posibles alteraciones de los pies tienen su importancia por el alto número de éstas, por tratarse de niños con padres preocupados, y porque, en ocasiones, son alteraciones secundarias a afecciones neurológicas, infecciosas y traumáticas, entre otras. En la mayoría de los casos, sólo es necesario recomendar un calzado adecuado, sencillas normas posturales y realizar un seguimiento del paciente, por lo que consideramos fundamental el conocimiento del desarrollo evolutivo normal del pie infantil. En menos casos, será precisa la indicación de ejercicios, estiramientos, estimulación, calzados correctores y adaptaciones ortopédicas. Las indicaciones quirúrgicas quedan reducidas a un porcentaje mínimo de los pacientes. En esta revisión intentaremos familiarizarnos con el crecimiento y el desarrollo del pie normal y distinguir las alteraciones más frecuentes observadas en Rehabilitación; por último, se tratarán algunos aspectos del tratamiento de estas alteraciones (AU)

Alteraciones de la bóveda plantar / Alterations of the plantar vault

No disponible

Foot type classification: a critical review of current methods.

Investigation into the effects of foot structure on foot function, and the risks of injury, has been at the core of many studies, sometimes with conflicting results. Often different methods of foot type classification have been used, making comparison of the results and drawing sound conclusions impossible. This article aims to critically review current methods of foot type classification. It is concluded that if a classification method combines data on structure with information on foot function in dynamic loading situations, it should relate more closely to the functional behaviour of the foot during locomotion.