Current concepts and correction in the valgus foot.
01 May 1970-Clinical Orthopaedics and Related Research (Clin Orthop Relat Res)-Vol. 70, Iss: 70, pp 43-55
About: This article is published in Clinical Orthopaedics and Related Research.The article was published on 1970-05-01. It has received 81 citations till now. The article focuses on the topics: Valgus.
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TL;DR: Thirty-one severe, symptomatic valgus deformities of the hindfoot in twenty children who had flatfoot (twenty-five feet) or skewfoot (six feet) were corrected with a modification of the calcaneal lengthening osteotomy described by Evans, avoiding the need for an arthrodesis and the many short and long-term complications associated with it.
Abstract: Thirty-one severe, symptomatic valgus deformities of the hindfoot in twenty children who had flatfoot (twenty-five feet) or skewfoot (six feet) were corrected with a modification of the calcaneal lengthening osteotomy described by Evans. Despite prolonged non-operative treatment, all patients had pain, a callus, ulceration, or a combination of these signs and symptoms under the head of the plantar flexed talus; they could not tolerate a brace, and shoe wear was excessive. Twenty-six of the deformities were secondary to an underlying neuromuscular disorder. The calcaneal lengthening was combined with an opening-wedge osteotomy of the medial cuneiform to correct the deformities of both the hindfoot and the forefoot in the patients who had a skewfoot. Other concurrent osseous and soft-tissue procedures were frequently performed in the flatfeet and skewfeet to correct adjacent deformities or to balance the muscle forces. Allograft bone was used in twenty-four feet and autogenous bone, in seven. The patients ranged in age from four years and seven months to sixteen years at the time of the operation. The duration of follow-up ranged from two years to three years and seven months after the operation. Satisfactory clinical and radiographic correction of all components of the deformity of the hindfoot was achieved in all but the two most severely deformed feet. These two feet had sufficient correction to eliminate the symptoms despite a small persistent callus under the head of the talus. The pain and callus were eliminated in all of the other feet, the patients were able to tolerate a brace, and shoe wear was improved. Subtalar motion was preserved in all feet except for the four that had had a limited joint arthrodesis performed previously or simultaneously for pre-existing degenerative osteoarthrosis. Calcaneal lengthening is effective for the correction of severe, intractably symptomatic valgus deformities of the hindfoot in children. My patients had resolution of the signs and symptoms associated with the deformity while avoiding the need for an arthrodesis and the many short and long-term complications associated with it.
416 citations
TL;DR: Joint-preserving, deformity-correcting surgery is indicated in flexible flatfeet with short Achilles tendons when conservative measurements fail to relieve pain under the head of the plantar flexed talus or in the sinus tarsi area.
Abstract: Flexible flatfoot is a normal foot shape that is present in most infants and many adults. The arch elevates spontaneously in most children during the first decade of life. There is no evidence that a longitudinal arch can be created in a child’s foot by any external forces or devices. Flexible flatfoot with a short Achilles tendon, in contrast to simple flexible flatfoot, is known to cause pain and disability in some adolescents and adults. Joint-preserving, deformity-correcting surgery is indicated in flexible flatfeet with short Achilles tendons when conservative measurements fail to relieve pain under the head of the plantar flexed talus or in the sinus tarsi area. Osteotomy is the fundamental and central procedure of choice. In almost all cases, Achilles tendon lengthening is required. In some cases, rigid supination deformity of the forefoot is present, requiring identification and concurrent treatment.
217 citations
Cites methods from "Current concepts and correction in ..."
...were introduced between 1946 and 1977 as variations on a method to restrict excessive subtalar joint eversion by placing a bone block in the sinus tarsi [17, 82–84]....
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TL;DR: Sex differences in LEA indicate that females, on average, have greater anterior pelvic tilt, thigh internal rotation, knee valgus, and genu recurvatum than males.
Abstract: Study Design Descriptive, cohort design. Objectives To comprehensively examine sex differences in clinical measures of static lower extremity alignment (LEA). Background Sex differences in LEA have been included among a myriad of risk factors as a potential cause for the increased prevalence of knee injury in females. While clinical observations suggest that sex differences in LEA exist, little empirical data are available to support these sex differences or the normal values that should be expected in a healthy population. Methods And Measures The right and left static LEA of 100 healthy college-age participants (50 males [mean ± SD age, 23.3 ± 3.6 years; height, 177.8 ± 8.0 cm, body mass, 80.4 ± 11.6 kg] and 50 females [mean ± SD age, 21.8 ± 2.5 years; height, 164.3 ± 6.9 cm; body mass, 67.4 ± 15.2 kg]) was measured. Each alignment characteristic was analyzed via separate repeated-measures analyses of variance, with 1 between-subject factor (sex) and 1 within-subject factor (side). Results There were no...
184 citations
TL;DR: Patients with posterior tibial tendon dysfunction can be treated by aggressive nonoperative management using molded ankle-foot orthoses or University of California Biomechanics Laboratory shoe inserts with medial posting.
Abstract: Forty-nine patients with posterior tibial tendon dysfunction (4 patients had bilateral involvement) were treated with orthoses. Forty feet were treated with molded ankle-foot orthoses, and 13 feet were treated with University of California Biomechanics Laboratory shoe inserts with medial posting. A total of 37 women and 12 men were included in the study. The mean follow-up period was 20.3 months (range, 8-60 months). The average age of the patients was 66 years (range, 42-89 years). Sixty-seven percent of patients had good to excellent results, according to a functional scoring system based on pain, function, use of assistive device, distance of ambulation, and patient satisfaction. The average period of orthosis use was 14.9 months (range, 1.5-29 months), with an average length of daily orthosis wear of 12.3 hours. One patient elected to undergo surgical treatment rather than continuing with long-term orthosis use. Thirty-three percent of patients had discontinued using the orthosis at the time of follow-up evaluation. Three patients were unable to wear the orthosis because of concurrent medical conditions. Nine patients stopped wearing the orthosis after experiencing discomfort and inconvenience. Although these patients continued to exhibit signs and symptoms of posterior tibial tendon dysfunction, they were not disabled enough to consider further treatment. Four patients tolerated orthosis treatment poorly and were treated surgically. Patients with posterior tibial tendon dysfunction can be treated by aggressive nonoperative management using molded ankle-foot orthoses or University of California Biomechanics Laboratory shoe inserts with medial posting. Surgical treatment can be reserved for patients who fail to respond to an adequate trial of brace treatment. Nonoperative management using an orthosis is particularly useful for elderly patients with a sedentary lifestyle or for patients at high risk because of medical problems.
130 citations
TL;DR: The study found the existence of a relationship between the two measures of the MLA and found the NH changed with age, suggesting it provides a useful, easily obtained clinical measure.
Abstract: Both feet of two hundred and seventy two children aged between five years six months and ten years and eleven months were studied using a footprint technique called the arch index (Al), and the vertical height of the navicular (NH) as non invasive techniques of objective measures of the medial longitudinal arch (MLA). In addition to age the study investigated the influence of gender, limb dominance, and body weight. The study found the existence of a relationship between the two measures of the MLA. There was no significant difference in NH measures between males and females and body weight did not affect the NH. The NH changed with age, suggesting it provides a useful, easily obtained clinical measure. The Al measures were slightly more reliable than the NH but showed less change with age.
118 citations