Efficacy of Ankle Arthodesis with Retrograde Sign Nail

Aim: To evaluate the efficacy of ankle arthrodesis by using Retrograde SIGN Nail. Study Design: Retrospective study. Place and Duration of the Study: Department of Orthopaedic & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore from 1st January 2018 to 30th June 2020. Methodology: Thirty patients were enrolled for arthrodesis by using retrograde nails. Clinical and radiological examination confirmed the severe arthritis of the subtalar joints in all cases. Surgical procedure was initiated by using lateral incision fibula segment of 1.5 cm was excised 6-8 cm proximal to the fibula tip. After adequate exposure, from proximal lateral to distal medial, approximately 5-6 cm transaction of the fibula was made obliquely. Soft tissue was the initiating point of dissection and the portion was placed on the back table for further use as an autogenous bone graft. To expose the medial gutter, approximately 2-3 cm incision was carefully made at medial to the tibialis anterior tendon without indulging saphenous nerve and vein. Results: A weak positive Pearson correlation was found between BMI and FAAM score but a significant (P=0.00001). Conclusion: Retrograde nailing techniques help to achieve the goals of the union. It also assists in the preservation of hind foot alignment. Keywords: Ankle deformity, Ankle arthrodesis, Ankle arthritis, Retrograde nailing

Influence of BMI on foot posture alignment in resting gait of secondary school children in Lagos metropolis aged 10 to 18 years

The study was to determine the influence of BMI on foot posture alignment in the resting gait of secondary school children. A localized, two-stage, stratified, cross-sectional, and descriptive survey was carried out in 10 secondary schools involving a sample secondary student population of 518 students, 235 males, and 283 females. The result shows that there was a statistically significant association (X2=32.4345, p=0.000) between the BMI of student’s cohort and their age. There was also a statistically significant association between different age groups and gender at p<0.046. Using the statistics of Pearson chi-square analysis, age-dependent variability of BMI (X2=32.4345, p=0.000) was established amongst the study population. The BMI of students for the varying foot alignment was not normally distributed, instead, it was skewed to the right. According to the Kruskal-Wallis H test, there was no statistically significant difference in BMI between the three age cohorts of student’s foot alignment in resting gait; Pearson chisquare, X2 (2) = 4.575, p=0.1015. The distribution of the left foot posture alignment according to the FPI scale indicates that overall, 82.13% of males and 84.40% of females showed normal foot alignment whereas 10.64% and 9.22% of male and female students respectively confirmed slight foot pronation while 7.23% of male students and 6.38% of female students showed slightly supinated feet. This study shows that BMI has no influence on FPI in resting gait. The high incidence of underweight amongst the students’ population could be a reflection of the low socioeconomic status of many families.

FOOT ALIGNMENT IN SYMPTOMATIC NATIONAL FOOTBALL LEAGUE (NFL) ATHLETES: A WEIGHTBEARING CT ANALYSIS

ABSTRACT Objective: Our aim was to describe the foot alignment in National Football League (NFL) players with different symptomatic foot and ankle pathologies using weightbearing cone-beam computed tomography (WBCBCT), comparing them to normally aligned feet as control group. Methods: 41 feet (36 active NFL players) were assessed using WBCBCT and compared to 20 normally aligned controls from a normal population. Measurements included: Foot and Ankle Offset (FAO); Calcaneal Offset (CO); Hindfoot Alignment Angle (HAA); angle between inferior and superior facets of the talus (Inftal-Suptal); angle between inferior facet of the talus and the horizontal/floor (Inftal-Hor); Forefoot Arch Angle (FAA); navicular- and medial cuneiform-to-floor distance. Results: NFL athletes showed a neutrally aligned hindfoot when compared to controls (FAO: 1% vs 0.5%; CO: 2.3 mm vs 0.8 mm; HAA: 2.9° vs 0.8° in two groups, with all p > 0.05) and a normal morphology of the subtalar joint (no difference in Inftal-Suptal and Inftal-Hor angles). Conversely, in athletes we found a decreased medial longitudinal arch (FAA: 15° vs 18.3°, p = 0.03) with smaller navicular (38.2 mm vs 42.2 mm, p = 0.03) and medial cuneiform (27 mm vs 31.3 mm, p = 0.01) mean distances to the floor when compared to controls. Conclusion: In our series, NFL players presented a lower medial longitudinal arch than controls but a neutrally aligned hindfoot. WBCBCT may help shed light on anatomical risk factors for injuries in professional players. Level of Evidence III, Retrospective comparative study.

Comparison of 3D Hip Joint Kinematics in People with Asymptomatic Pronation of the Foot and Non-Pronation Controls

Background: The impact of asymptomatic pronation on proximal joints during motion has not been well understood, and research on it remains limited. Therefore, the current study determines the effect of asymptomatic pronation of the foot on hip joint kinematics during gait. Methods: Forty participants were recruited for the study (20 with asymptomatic pronated feet and 20 with non-pronated feet). Foot assessment was conducted by navicular drop and rear- foot angle tests. Hip joint kinematics were measured via MVN Xsens system 3D-motion capture from sagittal, frontal and transverse planes during gait. An independent t-test was used to identify differences in kinematic variables. Results: Both groups were similar in characteristics, and there were no significant differences between the groups in age (P = 0.674) and BMI (P = 0.459). However, there was a significant difference in arch height (P = 0.001) and rear-foot angle (P = 0.001). Our findings showed there were insignificant differences between the asymptomatic pronated foot and non- pronated foot control groups in hip joint kinematics of sagittal (P = 0.618), frontal (P = 0.276), and transverse (P = 0.337) planes during a full gait cycle. Conclusion: Patients with asymptomatic pronation of the foot and non-pronation of the foot showed similar movement patterns of hip kinematics in all three planes. The findings of the present study highlight the need for clinicians to consider foot alignment when examining patients with asymptomatic pronation of the foot and non-pronation of the foot.

Minimally Invasive Flat Foot Alingment: A New Method

Medializing calcaneal osteotomy is one of the most common procedures in flat foot alignment. Recently it has been done percutaneously with several different techniques, most of them made in lateral position. Our paper aims to describe the minimally invasive calcaneal medializing osteotomy in ventral position, easier for x-ray control, faster to patient positioning with technical tips to more precise bone cut and reduction. Between April 2019 and September 2019, 10 patients were operated using this technique. Patients in ventral position, sciatic nerve block, percutaneous Achilles lengthening, transcutaneous k-wire passage for drill cut control. Straight calcaneal cut, reduction in medial and plantar position and control both in lateral and axil views. 15 patients were operated using this technique. 67% were woman. Median age were 38.9 years and median BMI was 23.5.

Validity of two-dimensional analyses for the assessment of dynamic foot alignment during walking

Background Several studies indicate that static foot posture bears a low relevance to dynamic foot alignment during walking. Thus, dynamic alignment assessment capable of being utilized in a clinical practice is required for an accurate estimation of foot function. This study aimed to examine the validity of two-dimensional analysis using a tablet computer for estimation of foot alignment during walking, by making a comparison with a motion capture system and static foot alignment screenings.Methods Validity of two-dimensional (2D) analysis of foot alignment during walking using a tablet computer, by making a comparison with a motion capture system and static screenings in healthy subjects. Fourteen healthy males and 15 healthy females participated in this study. Arch height of the right foot while walking was measured using a tablet computer and a motion capture system simultaneously. Arch height at the mid-stance (Mst) and pre-swing (PSw) phase were calculated from kinematic data measured by the tablet computer and motion analysis system, respectively. Static foot alignment also was assessed through the use of a screening test including arch height index and foot posture index. To examine the validity of foot assessment using 2D analysis, we conducted correlation analysis between the arch height at Mst and PSw as measured by a tablet computer and a motion capture system. Meanwhile, FPI and AHI were used to test the relation to arch height at Mst as measured by a motion capture system.Results Arch height, as measured by the motion capture system, showed a significant correlation with that measured using a tablet computer at Mst (r = 0.90, p < 0.001) and PSw (r = 0.94, p < 0.001), and arch height index (r = 0.50, p = 0.005), especially the former. Meanwhile, foot posture index (r = − 0.34, p = 0.075) showed no relation to arch height as measured by the motion capture system.Conclusion These results demonstrate the high validity of 2D analysis using a tablet computer for estimation of foot alignment during walking. Such gait analysis can be effective in assessing dynamic foot alignment in clinical practice.