Adult Acquired Flatfoot

2020 ◽  
Vol 62 (1) ◽  
pp. 55-59
Author(s):  
Krzysztof Mataczyński ◽  
Mateusz Pelc ◽  
Halina Romualda Zięba ◽  
Zuzana Hudakova
Keyword(s):  
Soft Tissues ◽  
Three Dimensional ◽  
Clinical Diagnostics ◽  
Clinical Image ◽  
Tibialis Posterior ◽  
Dynamic Force ◽  
Posterior Tibial ◽  
Flat Feet ◽  
Foot Arch ◽  
Motion Range

Acquired adult flatfoot is a three-dimensional deformation, which consists of hindfoot valgus, collapse of the longitudinal arch of the foot and adduction of the forefoot. The aim of the work is to present problems related to etiology, biomechanics, clinical diagnostics and treatment principles of acquired flatfoot. The most common cause in adults is the dysfunction of the tibialis posterior muscle, leading to the lack of blocking of the transverse tarsal joint during heel elevation. Loading the unblocked joints consequently leads to ligament failure. The clinical image is dominated by pain in the foot and tibiotarsal joint. The physical examination of the flat feet consists of: inspection, palpation, motion range assessment and dynamic force assessment. The comparable attention should be paid to the height of the foot arch, the occurrence of “too many toes” sign, evaluate the heel- rise test and correction of the flatfoot, exclude Achilles tendon contracture. The diagnosis also uses imaging tests. In elastic deformations with symptoms of posterior tibial tendonitis, non-steroidal anti-inflammatory drugs, short-term immobilization, orthotics stabilizing the medial arch of the foot are used. In rehabilitation, active exercises of the shin muscles and the feet, especially the eccentric exercises of the posterior tibial muscle, are intentional. The physiotherapy and balneotherapy treatments, in particular hydrotherapy, electrotherapy and laser therapy, are used as a support. In advanced lesions, surgical treatment may be necessary, including plastic surgery of soft tissues, tendons, as well as osteotomy procedures.

scholarly journals Lateral Column Lengthening Versus Medial Displacement Calcaneal Osteotomy in Stage II Tibialis Posterior Tendon Dysfunction: Randomized Controlled Trial

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0036
Author(s):  
Amr A. Mohammed ◽  
Hossam Abubeih ◽  
Ahmed Osman ◽  
Wael Eladly ◽  
Ahmed Khalifa ◽  
...  
Keyword(s):  
Disease Process ◽  
Stage Ii ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial ◽  
Calcaneal Osteotomy ◽  
Additional Surgery ◽  
Flat Feet ◽  
Significant Difference ◽  
Adult Acquired Flatfoot Deformity

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Adult acquired flatfoot deformity is a complex deformity associated with the collapse of the medial longitudinal arch. Several factors have been proposed in the etiology of adult acquired flatfoot deformity including arthritic, neuromuscular, and traumatic conditions; however, posterior tibial tendon dysfunction remains the most common etiology. A spectrum of conditions affecting the posterior tibial tendon has been identified, with tendinitis occurring early in the disease process and tendon rupture occurring at the more advanced stages. Adult-acquired flatfoot deformity requires a complex operative plan that often utilizes several procedures to correct deformity, at both the hindfoot and midfoot. The objective of this study was to compare the efficacy of two different osteotomies commonly used to correct flexible flat feet. Methods: 42 Patients (21 males and 21 females) with stage II PTTD acquired flexible flatfeet were included with a mean age of 49.62 +- 6.2. Twinty-two patients had medial displacement calcaneal osteotomy (MDCO) while 20 cases had latercal column lenghtening (LCL). Strayer procedure, spring ligament plication and FDL transfer were done in all patients. Pre- and Post-operative clinical assessment was done using AOFAS and FFI questionaire. Six radiographic parameters were analyzed, two in the anteroposterior view ( talo-navicular coverage and talo-calcaneal angle), three in lateral view ( talo- first metatarsus angle, talo- calcaneal angle and calcaneal inclination angle) and tibio-calcanal angle in axial view. Results: At a mean follow up of 12 months, significant improvement in AOFAS and FFI scores in MDCO and LCL groups with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups. LCL group showed significant better correction in TNC and calcaneal inclination angles when compared to MDCO group. However, MDCO procedure showed significantly better correction in axial tibial calcaneal angle. Both techniques correct the deformity, however cases received LCL has better correction than MDCO cases and less reoperation rate. Conclusion: Reconstructions performed with LCL produced a greater change in the realignment of adult acquired flatfoot, maintained more of their initial correction over time, and were associated with a lower incidence of additional surgery than reconstructions with a MDCO of the calcaneus. However, a higher incidence of degenerative change in the hindfoot was observed in the LCL group. The ability of LCL to correct the deformity in anteroposterior and lateral plan and MDCO in lateral and axial plan suggests that proper osteotomy should be planned according to the existing deformity. Combination of both techniques may be required in certain cases.

scholarly journals Outcomes of spring ligament reconstruction for idiopathic flexible flatfoot deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035
Author(s):  
Andrew Molloy ◽  
Eric Swanton ◽  
Lyndon Mason
Keyword(s):  
Prospective Study ◽  
Ligament Reconstruction ◽  
Soft Tissues ◽  
Anatomical Reconstruction ◽  
Tibialis Posterior ◽  
Spring Ligament ◽  
Medial Cuneiform ◽  
Flat Feet ◽  
Gastrocnemius Recession ◽  
A New Technique

Category: Hindfoot Introduction/Purpose: Idiopathic flatfeet are usually caused by attenuation of the medial soft tissues rather than a lateral osseous deficiency. Our prospective study aimed to quantify the functional and radiological outcome of a new technique for spring ligament reconstruction using a hamstring graft for idiopathic flat feet Methods: Our prospective study included 17 feet in 14 patients, from 05/14 to 05/17, on which a spring ligament reconstruction was performed. This pre-tensioned allograft reconstruction was performed using a blind talar tunnel, with the graft being passed deep to the navicular tuberosity, through a tunnel in the medial cuneiform and then sutured back onto its proximal limb to control abduction. Additional procedures included medial head of gastrocnemius recession (17), calcaneal osteotomy (16), FDL transfer (3), tibialis posterior synovectomy (2), peroneus longus to brevis transfer (2). There was a minimum of 6 months follow-up. Radiographic analysis was performed for standardised parameters. Paired t-test was used for analysis Results: The average age was 41 (range 23 -65). The mean BMI was 31.1 (range 24.6 – 37.3). Mearys line improved from a mean of 24.1 (9 – 36.4) to a mean of 13.8 (-3.1 – 26.7). This was statistically significant (p<0.001). Talar uncoverage angle improved from a mean of 39.5 (27.7 – 55.8) to 23.9 (3.5 – 39.7). First metatarsal talar angle improved from a mean of 18.9 (8.4 – 33.9) to 10.3 (-6.1 – 21.5). There were no wound infections. There was one revision (5.9%) to a triple arthrodesis; at revision it was found that the allograft had attenuated to incompetency. Of the patients that improved the least, 80% (4/5) were over the age of 49. Our numbers are insufficient to statistically analyse this Conclusion: This new method of spring ligament reconstruction provides a predictable solution for more anatomical reconstruction of idiopathic flatfoot deformity, with statistically significant improvements in all radiographic parameters. Further numbers will be needed but we would exercise caution in using this technique in older patients.

3D Culture Modelling: An Emerging Approach for Translational Cancer Research in Sarcomas

2020 ◽  
Vol 27 (29) ◽  
pp. 4778-4788 ◽  
Author(s):  
Victoria Heredia-Soto ◽  
Andrés Redondo ◽  
José Juan Pozo Kreilinger ◽  
Virginia Martínez-Marín ◽  
Alberto Berjón ◽  
...  
Keyword(s):  
High Throughput Screening ◽  
Cancer Biology ◽  
Soft Tissues ◽  
Three Dimensional ◽  
3D Culture ◽  
Resistance Mechanisms ◽  
In Vitro Models ◽  
Tumour Spheroids ◽  
Current Therapies

Sarcomas are tumours of mesenchymal origin, which can arise in bone or soft tissues. They are rare but frequently quite aggressive and with a poor outcome. New approaches are needed to characterise these tumours and their resistance mechanisms to current therapies, responsible for tumour recurrence and treatment failure. This review is focused on the potential of three-dimensional (3D) in vitro models, including multicellular tumour spheroids (MCTS) and organoids, and the latest data about their utility for the study on important properties for tumour development. The use of spheroids as a particularly valuable alternative for compound high throughput screening (HTS) in different areas of cancer biology is also discussed, which enables the identification of new therapeutic opportunities in commonly resistant tumours.

scholarly journals A computational framework for modeling cell–matrix interactions in soft biological tissues

2021 ◽  
Author(s):  
Jonas F. Eichinger ◽  
Maximilian J. Grill ◽  
Iman Davoodi Kermani ◽  
Roland C. Aydin ◽  
Wolfgang A. Wall ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Three Dimensional ◽  
Biological Tissues ◽  
Computational Framework ◽  
Cell Matrix ◽  
Physiological Processes ◽  
Matrix Interactions ◽  
Mechanical Homeostasis ◽  
Cell Matrix Interactions ◽  
Short Time

AbstractLiving soft tissues appear to promote the development and maintenance of a preferred mechanical state within a defined tolerance around a so-called set point. This phenomenon is often referred to as mechanical homeostasis. In contradiction to the prominent role of mechanical homeostasis in various (patho)physiological processes, its underlying micromechanical mechanisms acting on the level of individual cells and fibers remain poorly understood, especially how these mechanisms on the microscale lead to what we macroscopically call mechanical homeostasis. Here, we present a novel computational framework based on the finite element method that is constructed bottom up, that is, it models key mechanobiological mechanisms such as actin cytoskeleton contraction and molecular clutch behavior of individual cells interacting with a reconstructed three-dimensional extracellular fiber matrix. The framework reproduces many experimental observations regarding mechanical homeostasis on short time scales (hours), in which the deposition and degradation of extracellular matrix can largely be neglected. This model can serve as a systematic tool for future in silico studies of the origin of the numerous still unexplained experimental observations about mechanical homeostasis.

scholarly journals The Symmetric 3D Organization of Connective Tissue around Implant Abutment: A Key-Issue to Prevent Bone Resorption

Symmetry ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1126
Author(s):  
Giovanna Iezzi ◽  
Francesca Di Lillo ◽  
Michele Furlani ◽  
Marco Degidi ◽  
Adriano Piattelli ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Connective Tissue ◽  
Inflammatory Cell ◽  
Soft Tissues ◽  
Three Dimensional ◽  
Collagen Fibers ◽  
Inflammatory Cell Infiltration ◽  
Cell Infiltration ◽  
Oral Epithelium ◽  
Implant Abutment

Symmetric and well-organized connective tissues around the longitudinal implant axis were hypothesized to decrease early bone resorption by reducing inflammatory cell infiltration. Previous studies that referred to the connective tissue around implant and abutments were based on two-dimensional investigations; however, only advanced three-dimensional characterizations could evidence the organization of connective tissue microarchitecture in the attempt of finding new strategies to reduce inflammatory cell infiltration. We retrieved three implants with a cone morse implant–abutment connection from patients; they were investigated by high-resolution X-ray phase-contrast microtomography, cross-linking the obtained information with histologic results. We observed transverse and longitudinal orientated collagen bundles intertwining with each other. In the longitudinal planes, it was observed that the closer the fiber bundles were to the implant, the more symmetric and regular their course was. The transverse bundles of collagen fibers were observed as semicircular, intersecting in the lamina propria of the mucosa and ending in the oral epithelium. No collagen fibers were found radial to the implant surface. This intertwining three-dimensional pattern seems to favor the stabilization of the soft tissues around the implants, preventing inflammatory cell apical migration and, consequently, preventing bone resorption and implant failure. This fact, according to the authors’ best knowledge, has never been reported in the literature and might be due to the physical forces acting on fibroblasts and on the collagen produced by the fibroblasts themselves, in areas close to the implant and to the symmetric geometry of the implant itself.

scholarly journals Measurement of femoral posterior condylar offset and posterior tibial slope in normal knees based on 3D reconstruction

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Liangxiao Bao ◽  
Shengwei Rong ◽  
Zhanjun Shi ◽  
Jian Wang ◽  
Yang Zhang
Keyword(s):  
Three Dimensional ◽  
Surgical Techniques ◽  
Inverse Correlation ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Lateral Side ◽  
Posterior Condylar Offset ◽  
Posterior Tibial ◽  
Significant Difference ◽  
Posterior Condylar

Abstract Background Femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) are important for postoperative range of motion after total knee arthroplasty (TKA). However, normative data of PCO and PTS and the correlation between them among healthy populations remain to be elucidated. The purpose of this study was to determine PCO and PTS in normal knees, and to identify the correlation between them. Methods Eighty healthy volunteers were recruited. CT scans were performed followed by three-dimensional reconstruction. PCO and PTS were measured and analyzed, as well as the correlation between them. Results PTS averaged 6.78° and 6.11°, on the medial and lateral side respectively (P = 0.002). Medial PCO was greater than lateral (29.2 vs. 23.8 mm, P <  0.001). Both medial and lateral PCO of male were larger than female. On the contrary, male medial PTS was smaller than female, while there was no significant difference of lateral PTS between genders. There was an inverse correlation between medial PCO and PTS, but not lateral. Conclusions Significant differences exhibited between medial and lateral compartments, genders, and among individuals. An inverse correlation exists between PCO and PTS in the medial compartment. These results improve our understanding of the morphology and biomechanics of normal knees, and subsequently for optimising prosthetic design and surgical techniques.

scholarly journals Accuracy and Reliability of Soft Tissue Landmarks Using Three-Dimensional Imaging in Comparison With Two-Dimensional Cephalometrics: A Systematic Review

2020 ◽  
Vol 54 (4) ◽  
pp. 289-296
Author(s):  
Adeeba Ali ◽  
Anil K. Chandna ◽  
Anshul Munjal
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
3D Imaging ◽  
Soft Tissues ◽  
Three Dimensional ◽  
Database Search ◽  
Cochrane Library ◽  
Two Dimensional ◽  
Imaging Tool ◽  
Electronic Database Search

Background: Concerns about the accuracy and reliability of soft tissue landmarks using two-dimensional (2D) and three-dimensional (3D) imaging. Objective: The aim of the systematic review is to estimate accuracy and reliability of soft tissue landmarks with 2D imaging and 3D imaging for orthodontic diagnosis planning and treatment planning purposes. Data Sources: Electronic database search was performed in MEDLINE via PubMed, Embase via embase.com, and the Cochrane library website. Selection Criteria: The data were extracted according to two protocols based on Centre for Evidence-Based Medicine (CEBM) critical appraisal tools. Next, levels of evidence were categorized into three groups: low, medium, and high. Data Synthesis: Fifty-five publications were found through database search strategies. A total of nine publications were included in this review. Conclusion According to the available literature, 3D imaging modalities were more accurate and reliable as compared to 2D modalities. Cone beam computed tomography (CBCT) was considered the most reliable imaging tool for soft tissues.

scholarly journals Polymeric Bioinks for 3D Hepatic Printing

Chemistry ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 164-181
Author(s):  
Joyita Sarkar ◽  
Swapnil C. Kamble ◽  
Nilambari C. Kashikar
Keyword(s):  
Tissue Engineering ◽  
3D Printing ◽  
Soft Tissues ◽  
Three Dimensional ◽  
Stem Cell Differentiation ◽  
Synthetic Polymers ◽  
Bioactive Molecules ◽  
Complex Geometries ◽  
Printing Techniques ◽  
Natural And Synthetic

Three-dimensional (3D) printing techniques have revolutionized the field of tissue engineering. This is especially favorable to construct intricate tissues such as liver, as 3D printing allows for the precise delivery of biomaterials, cells and bioactive molecules in complex geometries. Bioinks made of polymers, of both natural and synthetic origin, have been very beneficial to printing soft tissues such as liver. Using polymeric bioinks, 3D hepatic structures are printed with or without cells and biomolecules, and have been used for different tissue engineering applications. In this review, with the introduction to basic 3D printing techniques, we discuss different natural and synthetic polymers including decellularized matrices that have been employed for the 3D bioprinting of hepatic structures. Finally, we focus on recent advances in polymeric bioinks for 3D hepatic printing and their applications. The studies indicate that much work has been devoted to improvising the design, stability and longevity of the printed structures. Others focus on the printing of tissue engineered hepatic structures for applications in drug screening, regenerative medicine and disease models. More attention must now be diverted to developing personalized structures and stem cell differentiation to hepatic lineage.

Magnetic Resonance Imaging in the Diagnosis of Disruption of the Posterior Tibial Tendon

Foot & Ankle ◽  
1987 ◽  
Vol 8 (3) ◽  
pp. 144-147 ◽  
Author(s):  
Ian J. Alexander ◽  
Kenneth A. Johnson ◽  
Thomas H. Berquist
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Soft Tissues ◽  
Diagnostic Technique ◽  
Clinical Findings ◽  
The Body ◽  
Posterior Tibial Tendon ◽  
Resonance Imaging ◽  
Posterior Tibial ◽  
Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI), a useful technique of studying soft tissues of the body, can be very effective in assessing the integrity of tendons. Usually a patient with a complete tear of the posterior tibial tendon has characteristic physical findings. In the patient presented, MRI demonstrated a complete disruption of the posterior tibial tendon, despite the absence of the commonly associated clinical findings. In view of the difficulties encountered with attempted tenography of the completely torn posterior tibial tendon, MRI provides a sensitive alternative diagnostic technique.

The Effect of Closed Septorhinoplasty on Nasal Functions and on External and Internal Nasal Valves: A Prospective Study

2017 ◽  
Vol 31 (5) ◽  
pp. 323-327 ◽  
Author(s):  
Giancarlo Pecorari ◽  
Giuseppe Riva ◽  
Francesca Antonella Bianchi ◽  
Giovanni Cavallo ◽  
Francesca Revello ◽  
...  
Keyword(s):  
Prospective Study ◽  
Nasal Obstruction ◽  
Laser Scanning ◽  
Soft Tissues ◽  
Statistical Significance ◽  
Three Dimensional ◽  
Subjective Assessment ◽  
Nasal Airflow ◽  
Nasal Valve ◽  
Objective Reduction

Background Because nasal function and shape are so closely intertwined, quantitative assessments can better define their relationship and how they are affected by septorhinoplasty. Objective The aim of this prospective study was to perform an analysis of the nasal airflow resistances and a three-dimensional (3D) evaluation of the soft-tissue changes after closed septorhinoplasty. Methods Before surgery (TO) and 6 months after closed septorhinoplasty (Tl), 30 patients underwent symptoms evaluation by means of the Italian version of the Nasal Obstruction Symptom Evaluation scale, endoscopic fiberoptic nasal examination, and visual analog scale for subjective assessment of nasal obstruction. Nasal airflow resistances were investigated with active anterior active rhinomanometry. A 3D laser scanner was used to evaluate facial soft-tissues, with specific nasal points and angles. Results Subjective nasal obstruction decreased. Anterior active rhinomanometry demonstrated a reduction in total inspiratory and expiratory resistances between T0 and T1 but without statistical significance. The significance was still absent after decongestion, excluding turbinate hypertrophy as a cause of failed objective amelioration of nasal resistance. Facial laser scanning showed statistically significant reduction of the superior nasal width and superior alar angle, and a weak negative correlation between the superior alar angle and nasal resistances. Conclusion The absence of objective reduction of nasal airflow resistances could be the result of concurrent surgery on nasal septum and nasal valve. In particular, the ameliorating effect on nasal airflow resistances is counterbalanced by the worsening effect of the narrowing of nasal valve.

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