Does the Nonweightbearing Foot Position Replicate the Neutral Calcaneal Stance Position in an Adult Population?

Background The neutral calcaneal stance position (NCSP), despite its known issues, is currently used as an “ideal” measure compared with the resting stance position in clinical podiatric medicine. The nonweightbearing (NWB) foot position, as used in the foot mobility magnitude (FMM), can provide an alternative comparative position, which is partially validated, if a significant correlation between the NCSP and the NWB position exists. This study aimed to establish the correlation between the component measures of the FMM in the NCSP and the NWB foot position of the FMM. Methods Eighty participants were recruited. Measures of dorsal arch height (DAH) and midfoot width (MFW) were obtained at the 50% total foot length mark in the NCSP and the NWB position by two examiners using the apparatus described by McPoil et al. Results Reliability analysis with intraclass correlation coefficients (ICCs) indicated intrarater results of 0.90 to 0.99 for DAH and 0.96 to 0.99 for MFW and interrater results of 0.90 for DAH and 0.96 for MFW in the NWB position. Using a Pearson product moment correlation coefficient analysis, there was a significant correlation between the NCSP and the NWB position for DAH (r = 0.82) and MFW (r = 0.86). Conclusions A significant correlation between the NCSP and the NWB position was evident when the measures of DAH and MFW were conducted. Therefore, clinically, the NWB position can potentially replace the NCSP as the ideal position for clinical treatment.

COMPARATIVE EVALUATION OF SURGICAL TREATMENT METHODS OF RIGID FLAT FEET IN CHILDREN WITH DYSFUNCTION OF THE POSTERIOR TIBIALIS TENDON

Introduction.The rigid form of static flat feet in children occurs in 18-20 % of cases of the musculoskeletal system pathology. Nowadays, neither objective diagnostic methods have been developed, nor algorithms for treating the rigid form of flat feet depending on the severity, deformity of the tarsal bones, foot mobility and dysfunction of the posterior tibialis tendon (PTT) have been found. Objective. To develop objective evaluation methods of rigid flat feet surgical treatment in children depending on the joints’ mobility, compression ratio, and PTT dysfunction stage. Methods and materials. The effectiveness of the rigid form of static stage II-III flat feet treatment was analysed in 15 children aged 14 to 18 years, who were divided into control and main groups. Clinical and radiological diagnostic methods were used. Patients of the control group (8 children) were operated using subtalar arthroereisis method. Patients of the main group (7 children) underwent surgery on bones and soft tissues. Results. Surgical treatment showed no effect using subtalar arthroereisis method in cases of the tarsal bone deformity, advanced stage of PTT dysfunction, and significant impairment of foot mobility. Positive results were also achieved using two-joint arthrodesis with the formation of navicular-tibial ligament with severe foot rigidity, stage III-IV of PTT dysfunction and navicular bone deformity. Conclusion. During treatment of rigid flat feet in children it’s necessary to take into consideration severity, compression ratio of the navicular bone, the mobility index, the stage of the posterior tibialis tendon dysfunction and the angle of its tension. Long-term results indicate the effectiveness of surgery on bones and soft tissues in the treatment of severe rigid flat feet.

Optimization of surgical treatment of rigid flat feet in children with posterior tibialis tendon dysfunction

The rigid form of static flatfeet occurs in 18 to 20% of cases of the musculoskeletal system pathology. To date, no objective diagnostic methods have been developed, no algorithms for treating the rigid form of flatfeet depending on the severity, deformity of the tarsal bones, foot mobility and dysfunction of the posterior tibialis tendon (hereinafter PTT). Objective. To develop objective evaluation methods for mobility in the joints and changes in the tarsal bones. Create algorithms for surgical treatment of rigid foot. Materials and methods. The effectiveness of the rigid form of static flatfeet treatment in 32 children (64 feet) aged 14 to 18 years, which were divided into main and control groups, was analyzed. Clinical and radiological diagnostic methods were used. Patients in the main group (15 patients) underwent surgery on bones and soft tissues.Patients in the control group (17 patients) were operated using subtalar arthroereisis method. Results. Surgical treatment was ineffective in the use of subtalar arthroereisis in cases of the tarsal bone deformity and significant impairment of foot mobility. Positive results were also achieved using two-joint arthrodesis with the formation of naviculo-tibial ligament with severe foot rigidity, stage III–IV of PTT dysfunction and navicular bone deformity. Conclusions. Treatment of rigid foot should take into account the severity, the compression ratio of the navicular bone, the mobility index, the stage of the posterior tibialis tendon dysfunction and the angle of its tension. Long-term results indicate the effectiveness of surgery on bones and soft tissues in the treatment of severe rigid flat feet. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: flatfeet, children, surgical treatment.