Influence of a Foot Insole for a Down Syndrome Patient with a Flat Foot: A Case Study.

Background and Objectives: Patients with Down syndrome have many orthopedic problems including flat foot. Insertion of an insole for a flat foot provides support to the medial longitudinal arch; thus, insole therapy is often used to treat a flat foot. However, the influence of an insole insertion on the knee joint kinematics for a patient with Down syndrome is unknown. This study aimed to elucidate the influence of an insole for a flat foot on the knee kinematics during gait for a patient with Down syndrome. Materials and Methods: The subject was a 22-year-old male with Down syndrome who had a flat foot. The knee joint angle during the gait was measured using a 3D motion capture system that consisted of eight infrared cameras. Results: The gait analysis demonstrated a reduction in the knee flexion angle during double knee action. The knee valgus and tibial internal rotation angles also decreased during the loading response phase while wearing shoes that contained the insole. Conclusions: As the angle of the knee joint decreased during the gait, it was considered that the stability of the knee joint improved by inserting the insole. In particular, there was a large difference in the tibial internal rotation angle when the insole was inserted. It is thus hypothesized that the insole contributes to the rotational stability of the knee joint. This study suggests that knee stability may improve and that gait becomes more stable when a Down syndrome patient with a flat foot wears an insole.

High Rates of Psychiatric Disorders and Below Normal Mental Capacity Associated With Spastic Peroneal Flatfoot: A New Relationship.

Spastic peroneal flatfoot (SPFF) is a rare hindfoot pathology usually seen in the adolescent age group that is characterized by painful spasms in the peroneal muscles. We have clinically observed that patients with SPFF also have some behavioral and emotional difficulties and problems in their academic achievements. Because of these observations, we investigated the prevalence and patterns of psychiatric disorders and intellectual disability among young subjects with SPFF. Our cohort consisted of 16 patients with SPFF. Their mean age at presentation was 21 (range 13 to 31) years. Only 6 patients had a tarsal coalition as an underlying condition. The psychometric evaluation was conducted using validated instruments (Wechsler Intelligence Scale for Children-revised form, Stanford Binet intelligence quotient [IQ] test, and Cattell IQ test). Psychiatric disorders were assessed using a semistructured diagnostic instrument (Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version). The testers and psychiatrists were unaware of the orthopedic condition and the preliminary psychiatric diagnoses. The ethical committee approved the study protocol. The mean follow-up period was 41 (range 12 to 97) months. The mean IQ score of the patients was 75.1 ± 17.9 (range 52 to 107). Compared with the general population, the rate of intellectual disability was significantly greater (p = .0001) and the rate of normal intelligence significantly lower (p = .0015) in our patient group. Furthermore, according to the community schooling ratio, our cohort also had lower junior high and secondary education rates compared with the general population. The rate of most psychiatric disorders diagnosed in the SPFF patients was greater than that in the normal population. The most commonly identified psychiatric disorders were social phobia and attention deficit and hyperactivity disorder (75%). Timely interventions of the psychosocial and academic problems of patients with SPFF might increase their compliance with orthopedic treatment and help with their psychological well-being and academic achievement. In addition, this relationship might be a clue for uncovering the etiology of this disease, which has not yet been clarified.

Utility outcome assessment of pes planus deformity.

BACKGROUND: Despite being a common condition, there are no objective measures in the literature to reflect the burden of pes planus on affected individuals. Our primary objective was to evaluate this burden by recruiting a sample from the general population using validated utility outcome measures. METHODS: Participants were recruited online and filled a questionnaire to help measure the health burden of pes planus. Three recognized utility outcome scores were used to compare the health burden of monocular blindness, binocular blindness, and pes planus. These included the standard gamble (SG), time trade-off (TTO), and visual analogue score (VAS). Paired t test, independent t test, and linear regression were used for statistical analysis. RESULTS: Ninety-two participants were included in the final analysis. The utility outcome scores (VAS, TTO, SG) for pes planus were 73±17, 0.90±0.08, and 0.88±0.12, respectively. The linear regression analysis showed that age was inversely proportional to the time trade-off. However, race, educational level, and income were not significant predictors of utility outcome score for pes planus. CONCLUSIONS: This study shows that the perceived burden of living with pes planus is comparable to living with some debilitating conditions. Our participants were willing to sacrifice 3.6 years of life, and have a procedure with a theoretical 12% mortality risk to attain perfect health.

Patient-perceived outcomes after subtalar arthroereisis with bioabsorbable implants for flexible flatfoot in growing age: a 4-year follow-up study.

PURPOSE: Results of subtalar arthroereisis in flexible flatfoot have been mainly reported in the literature using clinical or radiographical findings. However, the aim of this study is to evaluate the patient-perceived quality of life using self-reported questionnaires after subtalar arthroereisis using a bioabsorbable implant. METHODS: Italian modified FFI and the SEFAS scores were submitted to a consecutive series of 173 patients who underwent surgical treatment for flatfoot deformity using a bioabsorbable endo-orthotic implant. Postoperative complication rates were assessed. Time needed to resume normal sports activities was recorded. RESULTS: Mean population age was 11.2 years with slight variability between males and females. At a mean follow-up of 4 years, arthroereisis with bioabsorbable implants showed excellent results for the perception of the quality of life with an average result for FFI score of 4.5 and an average SEFAS score of 47.19. Time needed to resume sport activities was 4.7 months ± 0.2 with almost no difference between the groups. Four patients needed a second procedure for implant removal. CONCLUSION: Arthroereisis using a bioabsorbable implant offers good results in terms of satisfaction and quality of life with a negligible rate of failures and patient complaints based on self-reported questionnaires. The patient reported high degrees of satisfaction, and their quality of life was not compromised at all by the procedure.

Correlation of postoperative midfoot position with outcome following reconstruction of the stage II adult acquired flatfoot deformity.

BACKGROUND: No studies investigating the effect of the midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from anteroposterior (AP) radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). METHODS: Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors' institution who underwent flatfoot reconstruction for a stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo-first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with 2 or more measurements in the abduction category were classified as the abduction group (n = 30); those with 1 or fewer measurements in the abduction category were placed in the adduction group (n = 25). The preoperative and postoperative FAOS values with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests. RESULTS: Patients corrected to a position of adduction showed significantly lower improvement in the FAOS daily activities (P = .012) and quality of life subscales (P = .046). The mean improvement in subscale scores for the adducted group was lower for pain (P = .052) and sports activities (P = .085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (P = .372) between groups was found. CONCLUSION: Correction of the talonavicular joint to a position of adduction following a stage II AAFD was associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in reconstruction of a stage II AAFD.

Validation of the Foot and Ankle Outcome Score in adult acquired flatfoot deformity.

INTRODUCTION: The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score has been under recent scrutiny. The Foot and Ankle Outcome Score (FAOS) is an alternative subjective survey, assessing outcomes in 5 subscales. It is validated for lateral ankle instability and hallux valgus patients. The aim of our study was to validate the FAOS for assessing outcomes in flexible adult acquired flatfoot deformity (AAFD). METHODS: Patients from the authors' institution diagnosed with flexible AAFD from 2006 to 2011 were eligible for the study. In all, 126 patients who completed the FAOS and the Short-Form 12 (SF-12) on the same visit were included in the construct validity component. Correlation was deemed moderate if the Spearman's correlation coefficient was .4 to .7. Content validity was assessed in 63 patients by a questionnaire that asked patients to rate the relevance of each FAOS question, with a score of 2 or greater considered acceptable. Reliability was measured using intraclass correlation coefficients (ICCs) in 41 patients who completed a second FAOS survey. In 49 patients, preoperative and postoperative FAOS scores were compared to determine responsiveness. RESULTS: All of the FAOS subscales demonstrated moderate correlation with 2 physical health related SF-12 domains. Mental health related domains showed poor correlation. Content validity was high for the Quality of Life (QoL; mean 2.26) and Sports/Recreation subscales (mean 2.12). All subscales exhibited very good test-retest reliability, with ICCs of .7 and above. Symptoms, QoL, pain, and daily activities (ADLs) were responsive to change in postoperative patients (P < .05). CONCLUSION: This study has validated the FAOS for AAFD with acceptable construct and content validity, reliability, and responsiveness. Given its previous validation for patients with ankle instability and hallux valgus, the additional findings in this study support its use as an alternative to less reliable outcome surveys. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Foot-ground interaction during upright standing in children with Down syndrome.

This study aimed to quantitatively characterize the main foot-ground contact parameters during static upright standing and to assess foot evolution with increasing age in young individuals affected by Down syndrome (DS). To this end, 99 children with DS of mean age 9.7 (1.7) were tested using a pressure sensitive mat, and the raw data were processed to extract information about overall and rearfoot, midfoot and forefoot contact area, Arch Index (AI) and average contact pressure. The values obtained were then compared with those calculated from a sample of age- and gender-matched participants (control group, CG). Children with DS exhibited larger midfoot and reduced forefoot contact areas with respect to CG participants (+53% and -35% respectively, p<0.001), increased AI values (DS 0.31, CG 0.20, p<0.001) and increased average contact pressures in the midfoot and forefoot. The overall foot development for the two groups followed a similar trend, although in individuals with DS a curve that relates increases in midfoot contact area with age is characterized by a steeper gradient, and the forefoot contact area appeared systematically smaller regardless of age. The large prevalence of the flatfoot type in children with DS (which is known to be originated by hypotonia and ligamentous laxity) associated with the presence of higher average contact pressure in midfoot and forefoot justify the need for careful podiatric surveillance throughout childhood to reduce balance and gait impairment which are likely to affect untreated subjects when they reach adulthood.