Pediatric flexible flatfoot: Does obesity influence the outcomes of arthroereisis?

BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide.Although relationships between obesity and flatfoot have been shown,no studies have investigated the influence of obesity on arthroereisis outcomes.AIM To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants.METHODS This retrospective study included one hundred and sixty-nine pediatric patients(10-14 years old)who underwent subtalar arthroereisis(PEEK PitStop®device)for severe flexible flatfoot.Exclusion criteria were additional procedures,revision of previous corrective surgeries,rigid flatfoot with severe deformity,and neurologi-cal or post-traumatic flatfoot.Preoperative/postoperative European Foot and Ankle Society(EFAS)and visual analogue scale(VAS)scores were determined;radiographic assessment was conducted on weight-bearing foot X-rays:Kite angle,first metatarsal-talus angle,Meary angle,calcaneal pitch angle and lateral talo-calcaneal angle were analyzed.RESULTS EFAS and VAS scores improved post-operatively in the whole population.Only seven cases with complications were reported.Radiographic assessment revealed an improvement in all angles.Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes:Relationships were reported between BMI and postoperative EFAS/VAS scores,postoperative calcaneal pitch angle,Kite angle,Meary angle and talo-first meta-tarsal angle.CONCLUSION Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children,obesity significantly influences clinical and radiographic outcomes of arthroereisis,and obese children tend to perceive more pain and discomfort.

How to approach the pediatric flatfoot

The most difficult aspect regarding treatment of the pediatric flatfoot is understanding who needs surgery,when it is necessary, and what procedure to be done.A thorough history, clinical examination, and imaging should be performed to guide the surgeon through an often complex treatment path. Surgical technique can be divided in three categories: Soft tissue, bony,and arthroereisis. This paper will describe the jointpreserving techniques and their application to treat the pediatric flatfoot deformity.

Prevalence of Flatfoot and Its Correlation with Age,Gender and BMI among Undergraduates at the Faculty of Allied Health Sciences,General Sir John Kotelawela Defence University

Pes planus or flatfeet is a postural deformity which leads the entire sole of the foot to completely or near-completely touch the ground.Pes planus deformity occurs due to collapse of foot arches which can be congenital or pathological.The objective of this study was to determine the prevalence of flatfoot condition among undergraduates at the Faculty of Allied Health Sciences(FAHS),General Sir John Kotelawala Defence University(KDU)and its correlation with age,gender and BMI.A cross sectional study was conducted among 533 participants(Male=131,Female=402).Interviewer-administered questionnaire was used to collect the demographic data.BMI was calculated by obtaining height and weight measurements.Arch index method was used to determine the foot type taken using the Modified Harris Mat.The data analysis was done using SPSS software version 23.P value of less than 0.05 was considered as statistically significant.The study was done among people aged 19 to 26.The prevalence of flatfoot among this age group was 34.7%(n=185).Most of them are bilateral flat feet(73.5%),only 26.5%are unilateral flat feet.The proportion of patients with flat footedness was significantly higher in women(75%)than in men(25%).BMI in the overweight and obese categories(BMI>23)was statistically significant(p<0.05),which is 164(52.4%).Study shows a statistically significant association between flatfoot and increasing BMI beyond normal(p<0.05).There is no significant association between flatfoot with age and gender.Prevalence of flatfoot among allied health undergraduates was seemingly high requiring screening for early detection and appropriate referral for corrective measures.

乐山市中小学生平足症的现状调查与防治对策研究

目前国内关于平足症的预防筛查以及远期预后相关研究尚不全面,仍缺少标准化防治体系、专家共识及指南等相关指导,该研究以乐山市8所中小学10038名学龄儿童为研究对象,通过足骨形态测量、提踵实验、足印分析以及疼痛评分等方法筛查阳性平足症学龄儿童,进一步统计分析其年龄、体重指数(BMI)与平足分级相关性。结果表明:乐山市6~14岁学龄儿童平足症患病率为10.31%,轻度平足症850名(82.13%)、中度平足症144名(13.91%)、重度平足症41名(3.96%),乐山市学龄儿童平足症患病率与国际持平,患病率随着年龄的增长呈下降趋势。年龄较小、肥胖是平足症的危险因素(P<0.05)。基于该研究结果提出了相应防治措施,促进大众对平足症认知与重视,科学防治平足发生。

Relationship between symptoms and weight-bearing radiographic parameters of idiopathic flexible flatfoot in children

Background Idiopathic flexible flatfoot in children most frequently improves with age and remains asymptomatic. It is a physiological variation of the normality that does not require treatment unless it becomes symptomatic. The aim of this research was to investigate the reason why some individuals with flexible flatfoot become symptomatic by analysis of the differences in the relative alignment of each segment of the foot between symptomatic and asymptomatic patients with idiopathic flexible flatfoot using radiographic measurements. Methods One hundred patients with idiopathic flexible flatfoot were retrospectively identified and divided into two groups： asymptomatic （n=50） and symptomatic （n=50）. Standing anteroposterior and lateral radiographs of the foot were analyzed. Five measurements were calculated to describe the alignment of the foot. An independent-samples t-test and Logistic regression test were used for statistical analysis. Results Age and sex were similar in the two groups. The independent-samples test revealed significant differences in two parameters： the anteroposterior talonavicular coverage angle and the lateral talo-first metatarsal angle. When the Logistic regression test was performed, only the talonavicular coverage angle showed statistical significance. Conclusions The lateral displacement of the navicular bone, measured by the anteroposterior talonavicular coverage angle, seems to be related to the onset of symptoms. In individuals with otherwise normal flexible flatfoot, an increase in this angle might be an important risk factor for developing symptoms.

成都市某小学儿童扁平足抽样筛查分析

儿童的足部健康一直是备受关注的话题。为筛查成都市儿童扁平足发病率,并探究和验证相关的影响因素。利用问卷对成都市某小学进行调查,并使用Podo Med M6压力平板对参与问卷调查的儿童进行扁平足筛查,利用SPSS25.0和EXCEL进行分析。结果表明:性别、年龄、MBI、家族史、下肢受伤史、鞋子类型和鞋子软硬程度均是影响扁平足发生的潜在因素。本研究为探索扁平足影响因素和足弓停止发育时间的研究提供了参考,也为干预儿童扁平足的发育提供了指导。

胫骨后肌腱解剖学研究进展

胫骨后肌腱(posterior tibial tendon,PTT)是下肢的稳定装置,对维持足弓和踝关节内后方的动态稳定起重要作用,其收缩可完成足内翻和跖屈^([1])。PTT收缩时,控制中足的跗骨,使前、中、后足相协调,前足内收,抬高内侧纵弓,保护弹簧韧带,并支持后足内翻,协助维持内侧纵弓^([2,3])。当PTT功能出现障碍(posterior tibial tendon dysfunction,PTTD),使足内侧纵弓进行性塌陷,前足外展,距下关节、中跗关节活动受限。

矫形鞋垫干预柔韧性扁平足儿童青少年下肢功能的Scoping综述

目的对穿戴矫形鞋垫干预柔韧性扁平足儿童青少年足弓形态、疼痛和下肢运动功能进行Scoping综述。方法检索自建库至2024年10月PubMed、Web of Science、Embase、中国知网、万方数据库、中国生物医学文献数据库、维普数据库中相关文献,提取相关数据进行Scoping综述。结果最终纳入10篇文献,包括7篇队列研究,3篇随机对照试验,来自中国、韩国、伊朗、罗马尼亚,涉及520例柔韧性扁平足儿童和青少年。矫形鞋垫能增加跟骨倾斜角,降低距骨第一跖骨角和足弓指数;改善足部和下肢运动功能,提高前后、内侧和整体稳定性,调整步行运动学和地面反作用力;缓解疼痛并降低疼痛发生率。结论穿戴矫形鞋垫能改善柔韧性扁平足儿童青少年的足弓形态,提高动态平衡,改善步行,并缓解疼痛。

矫形鞋垫对扁平足患者下肢影响的生物力学分析

【目的】矫形鞋垫是非手术矫正扁平足的有效手段,但对于其康复治疗机制目前还未有统一的观点,以往的研究大多集中在对足底压力的改善。【方法】首先利用三维运动捕捉系统、测力台和足部测试系统分别对受试者进行测试,获取扁平足患者自然行走时下肢的运动学和动力学数据,然后使用Anybody软件建立受试者的肌骨模型并进行逆向动力学分析,对比分析扁平足患者使用矫形鞋垫前、后自然行走时下肢关节角度、地面反作用力、关节力矩和肌肉激活度等参数的变化。【结果】结果显示:扁平足患者穿戴矫形鞋垫后,足底压力分布有明显改善,步行周期内踝关节运动角度变化明显,支撑期内垂直地面和侧向地面反作用力峰值均变小,关节力矩和下肢主要肌肉的激活度均有不同程度的改变。【结论】可为临床扁平足患者的康复治疗提供一定参考。

扁平足治疗相关热点问题的探讨

扁平足是由先天或后天因素引起足部骨形态、排列异常以及肌腱韧带炎症或损伤,导致足弓塌陷的一种足部畸形疾病;无症状的扁平足患者可以不干预;对于有症状的患者,建议先采取保守治疗,保守治疗3个月以上仍没有效果的患者,可以采取手术治疗;成人和儿童扁平足采取不同的治疗策略。

Computational models of flatfoot with three-dimensional fascia and bulk soft tissue interaction for orthosis design

The finite element(FE)method has been widely used to investigate the internal force of plantar fascia,which could reveal the relationship between plantar fascia dysfunction and flatfoot deformity during weight-bearing conditions.However,for most foot FE models,plantar fascia utilized truss elements or three-dimensional geometry that did not consider the interaction between plantar fascia and bulk soft tissue.These configurations could ignore the impact of superoinferior loading induced by arch support and underestimate the plantar fascia loading.This study aims to investigate how the fascia-bulk soft tissue interaction affects the internal foot biomechanics in the flatfoot FE analysis with a three-dimensional plantar fascia model,which included both fascia-bone and fascia-bulk soft tissue interactions(3DBPT).To evaluate the effect of fascia-bulk soft tissue interaction on internal foot mechanics,this study compared the 3DBPT model with the other two plantar fascia models,including linear fascia(BPL)and three-dimensional plantar fascia without fascia-bulk soft tissue interaction(3DBP).The predicted foot contact pressure in the 3DBPT model was compared with the measured value obtained by the F-Scan pressure measurement system in balanced standing.Peak von Mises stresses in the plantar fascia and foot ligaments were reported.The stress of the plantar fascia in the 3DBPT model was higher than that of 3DBP.In the 3DBPT model,the superoinferior loading exerted on the bulk soft tissue could be directly transferred to the plantar fascia.The proposed model,including the plantar fascia and bulk soft tissue interaction,could reveal relatively reliable plantar fascia loading in flatfoot deformity,thereby contributing to the development of orthotic designs for the flatfoot deformity.

扁平足合并特发性脊柱侧凸的影像学特征及危险因素分析

目的探讨扁平足病人中特发性脊柱侧凸(idiopathic scoliosis,IS)的发病情况及影像学特征,分析扁平足病人合并IS的危险因素。方法回顾性分析2021年10月至2023年3月于武汉儿童医院就诊的608例扁平足病人的一般情况和影像学资料,统计扁平足病人中IS的发病率,采用秩和检验比较IS病人与非IS病人、IS中Cobb角>20°病人与Cobb角≤20°病人的一般情况及足影像学参数。采用单因素分析IS病人与非IS病人、IS中Cobb角>20°病人与Cobb角≤20°病人左足外翻角(hallux valgus angle,HVA)、右足HVA、左足(侧位)距骨第1跖骨角(Meary’s angle,MA)、右足MA、HVA差值、MA差值等指标,将P<0.20的指标纳入多因素Logistic回归分析,评估扁平足病人发生IS的危险因素,扁平足合并IS病人Cobb角>20°的危险因素。结果608例扁平足病人中,发生IS的有67例(67/608,11.01%)。扁平足合并IS病人与非IS病人比较,存在双侧外翻角不对称和双侧足弓不对称,差异均有统计学意义(P<0.05)。大于10岁病人(OR=2.866,95%CI:1.683~4.881,P<0.001),女性病人(OR=1.892,95%CI:1.121~3.193,P=0.017),双侧足弓不对称的扁平足病人(OR=1.194,95%CI:1.023~1.393,P=0.025),有更高的IS患病风险。IS病人Cobb角>20°病人左足足弓水平低于Cobb角≤20°病人(P=0.019)。结论IS在扁平足病人中的发病率可能较正常人群发病率高。扁平足合并IS病人存在双侧足形态不对称,包括双侧外翻角不对称及双侧足弓不对称,且双侧足弓不对称是扁平足合并IS的危险因素。

短足运动联合足弓支撑鞋垫在柔韧性扁平足的应用价值

目的:探讨短足运动联合足弓支撑鞋垫对柔韧性扁平足患者足内侧纵弓(MLA)、动态平衡和近端关节功能的影响。方法:选择2017年3月~2023年3月我院收治的186例柔韧性扁平足患者,采用随机数字表法将患者分为2组,每组各93例。对照组穿戴足弓支撑鞋垫12周,观察组采用短足运动联合穿戴足弓支撑鞋垫12周。比较2组干预前后影像学指标、足姿势指数(FPI)、足内侧纵弓(MLA)高度变化、动态平衡、近端关节功能、疼痛程度、生活质量的变化。结果:2组干预后距骨-第一跖骨角角度(Meary's角)、前后位距跟角(Kite角)、FPI、MLA、平均轨迹误差(ATE)、完成耗时、视觉模拟评分法(VAS)评分均较干预前降低(P<0.05),跟骨倾斜角(pitch角)、国足与踝关节协会(AOFAS)、Maryland足部评分、健康状况调查简表(SF-36)评分较干预前增高(P<0.05)。观察组干预后Meary's角、Kite角、FPI、MLA、ATE、完成耗时、VAS评分低于对照组(P<0.05),pitch角、AOFAS评分、Maryland足部评分、SF-36评分高于对照组(P<0.05)。结论:短足运动联合足弓支持鞋垫可有效维持MLA高度,改善动态平衡以及足关节功能,减轻疼痛程度,提高生活质量。

Clinical Observation of 3D Printing Technology in Insoles for Flexible Flatfoot Patients

Flatfoot is defined as the flattening of the medial arch of the foot,and it is classified into flexible flatfoot and rigid flatfoot based on whether the flattening of the medial arch of the foot can be reset when standing on toes.The insole is the most basic and common treatment,which is relatively cheaper and easier to adopt.Three-dimensional(3D)printing,an emerging technology characterized by high machining accuracy and use of various materials,can be utilised in personalised insoles,which have good application prospects.Further research on the clinical effects of 3D-printed insoles is still needed.In this study,64 cases of 3D-printed insoles were clinically observed.The results showed that 3D-printed insoles had statistically positive effects in treating flatfoot(P=0.00017),and with adjustment and adaptation,their comfort and clinical effect can be improved.This study provides an empirical reference for further large-scale clinical control research.

基于运动生物力学特征的扁平足运动鞋研究

当前市场上并未出现专门针对扁平足者设计的运动鞋,多数扁平足者只能穿着普通运动鞋参与体育活动,以此既容易导致其足部疲劳,又会在一定程度上加重病情。对此,基于运动生物力学特征,科学合理选择最佳材料,针对性设计与扁平足运动生物力学规律明确相符的运动鞋,是现今体育科研与制鞋行业的共同目标。据此,本文概述了扁平足足弓异常结构特征与运动生物力学特征,分析了扁平足运动鞋性能要求,并对基于运动生理学特征的扁平足运动鞋进行了详细探究。

截骨矫形术与距下关节制动术治疗儿童柔韧性平足症的比较研究

目的比较截骨矫形术与距下关节制动术治疗儿童柔韧性平足症的临床疗效和手术安全性。方法回顾性分析2014年2月至2020年9月期间,在西安交通大学附属红会医院足踝外科分别接受截骨矫形术和距下关节制动术治疗的41例(61足)儿童柔韧性平足症患者的临床资料,年龄8~14岁,截骨矫形术组21例(31足),男11例,女10例;单侧11例,双侧10例;左足15例,右足16例;平均年龄(12.87±1.12)岁。距下关节制动组20例(30足),男12例,女8例;单侧10例,双侧10例;左足17例,右足13例;平均年龄(11.56±1.73)岁。对患儿术前和末次随访分别进行影像学评估,负重正位X线片上测量距骨第1跖骨角(talar 1st metatarsal angle,T1MT)和距舟覆盖角(talonavicular coverage angle,TNCA);负重侧位X线片上测量距骨第1跖骨角(Meary’s角)、跟骨倾斜角(calcaneal pitch angle,CPA)和后足力线Saltzman位X线片上测量跟骨外翻角(calcaneus valgus angle,CVA)。采用疼痛视觉模拟评分(visual analogue scale,VAS)、美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足功能评分评估两种手术治疗儿童柔韧性平足症的临床疗效。结果41例患者均得到有效随访,随访时间12~24个月,平均(18.1±7.3)个月。截骨矫形术组的跟骨倾斜角和跟骨外翻角改善幅度与距下关节制动术组比较,差异有统计学意义(P<0.05),其他指标差异无统计学意义(P>0.05)。结论截骨矫形术和距下关节制动术治疗儿童柔韧性平足症在影像学及功能改善方面均能取得满意的结果。

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.

基于“脾-肾-肌-骨”相关理论探讨先天性扁平足的中医发病病机及治疗思路

文章通过梳理和总结中医经典中对“脾-肾-肌-骨”相关理论的阐释,结合临床实践,创新性提出先天性扁平足的中医发病机制及中医治疗思路,以期为中医整体治疗扁平足提供理论依据和有益借鉴。

Subtalar dislocations:Mechanisms,clinical presentation and methods of reduction

Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints,without major fracture of the talus.They are usually classified as medial(most common),lateral,anterior and posterior dislocations,based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury.They are usually diagnosed by X rays,but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively.Majority being closed injuries,can be managed in ED by closed reduction and cast immobilisation,but if they are open,have poor outcomes.Complications that ensue open dislocations are post-traumatic arthritis,instability and avascular necrosis.

多排螺旋CT对青少年扁平足支具个性化打印的指导价值

目的 探讨多排螺旋CT(MSCT)扫描对青少年扁平足支具个性化打印的指导价值。方法 回顾40例扁平足患者的MSCT影像表现与临床资料,分析病变骨质结构及形态,测量内外侧足弓角,并与X线测量结果对比。将测得数据用于支具的个性化打印,询问患者穿戴舒适性。结果 40例患者均顺利完成X线和MSCT成像检查,基于MSCT,所有扁平足患者均得到明确定性诊断,诊断符合率100%。40例患者经查,3例症状较为严重,患者足弓低平、基本消失,后足外翻;13例患者出现足外翻,步态改变;24例内侧足弓角变大。MSCT测得的内、外侧纵弓角度数均小于X线测得的结果,差异有统计学意义(P<0.05)。MSCT指导打印支具的舒适性得分高于X线指导打印的支具,差异有统计学意义(P<0.05)。结论 MSCT测量青少年扁平足内、外侧纵弓角准确度较X线高,指导打印个性化支具佩戴更舒适。