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 shou...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.展开更多
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 stan...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.展开更多
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 influen...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.展开更多
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 sympto...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.展开更多
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...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.展开更多
成人平足症在临床十分常见,以局部疼痛、影响运动为主要表现,目前对患者的治疗措施仍存在较大争议。为此,本研究搜索了Pubmed、Web of Science、The Cochrane Library以及中国生物医学文献数据库、维普信息资源系统数据库。对文献进行...成人平足症在临床十分常见,以局部疼痛、影响运动为主要表现,目前对患者的治疗措施仍存在较大争议。为此,本研究搜索了Pubmed、Web of Science、The Cochrane Library以及中国生物医学文献数据库、维普信息资源系统数据库。对文献进行全面分析,发现胫后肌腱功能不全或者弹簧韧带损伤是导致平足的主要病因,症状性平足可以先尝试保守治疗,而针对疾病不同阶段的特点,联合使用多种术式,通常可以取得良好的手术疗效,提高患者生活质量。本文对此现状进行全面综述,为规范化临床治疗提供依据。展开更多
目的:探讨火龙罐联合距下关节制动术治疗柔性平足症合并跟腱挛缩的临床疗效和安全性。方法:将2023年7月至2025年2月收治的72例柔性平足症合并跟腱挛缩患者随机分为2组,每组36例,分别采用火龙罐联合距下关节制动术治疗(火龙罐组)和跟腱...目的:探讨火龙罐联合距下关节制动术治疗柔性平足症合并跟腱挛缩的临床疗效和安全性。方法:将2023年7月至2025年2月收治的72例柔性平足症合并跟腱挛缩患者随机分为2组,每组36例,分别采用火龙罐联合距下关节制动术治疗(火龙罐组)和跟腱松解术联合距下关节制动术治疗(跟腱松解组)。火龙罐组在距下关节制动术后第1天开始火龙罐治疗,每次治疗35 min,隔天治疗1次,7 d为1个疗程,共4个疗程。分别于术前及术后3个月、6个月、12个月,记录并比较2组患者的足踝部疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分及简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评分;分别于术前及术后12个月,测量并比较2组患者的跟骨倾斜角、距骨-第1跖骨角、距舟覆盖角、踝关节外翻角度、踝关节背伸活动度、踝关节背伸峰值力矩、步态时间、步长及双支撑期;观察并比较2组患者的并发症发生情况。结果:①足踝部疼痛VAS评分。2组足踝部疼痛VAS评分随时间变化均呈下降趋势(F=995.560,P=0.000;F=873.277,P=0.000);术后3个月、6个月,火龙罐组足踝部疼痛VAS评分均低于跟腱松解组(t=-9.917,P=0.000;t=-6.609,P=0.000)。②AOFAS踝与后足评分。手术前后AOFAS踝与后足评分总体随时间呈上升趋势(F=846.986,P=0.000);火龙罐组AOFAS踝与后足评分高于跟腱松解组(F=8.378,P=0.004)。③SF-36评分。2组SF-36评分随时间变化均呈上升趋势(F=398.198,P=0.000;F=372.795,P=0.000);术后3个月,火龙罐组SF-36评分高于跟腱松解组(t=12.401,P=0.000)。④影像学指标。术后12个月,2组跟骨倾斜角均大于术前(t=-38.292,P=0.000;t=-32.414,P=0.000),距骨-第1跖骨角及距舟覆盖角均小于术前(t=-41.976,P=0.000;t=-30.378,P=0.000;t=-18.481,P=0.000;t=-12.777,P=0.000),火龙罐组跟骨倾斜角大于跟腱松解组(t=2.588,P=0.012)、距骨-第1跖骨角及距舟覆盖角均小于跟腱松解组(t=-6.128,P=0.000;t=-3.115,P=0.002)。⑤生物力学参数。术后12个月,2组踝关节外翻角度均小于术前(t=8.642,P=0.000;t=4.890,P=0.000),踝关节背伸活动度均大于术前(t=-6.372,P=0.000;t=-13.711,P=0.000),步长均大于术前(t=-50.300,P=0.000;t=-41.169,P=0.000),双支撑期均短于术前(t=17.482,P=0.000;t=4.808,P=0.000);火龙罐组踝关节背伸峰值力矩小于术前(t=71.900,P=0.000),跟腱松解组背伸峰值力矩与术前的差异无统计学意义(t=0.058,P=0.954);火龙罐组步态时间短于术前(t=8.110,P=0.000),跟腱松解组步态时间长于术前(t=-12.161,P=0.000);火龙罐组踝关节外翻角度和踝关节背伸活动度均小于跟腱松解组(t=-1.346,P=0.043;t=-4.853,P=0.000),步长大于跟腱松解组(t=1.503,P=0.014),双支撑期短于跟腱松解组(t=-1.795,P=0.016),踝关节背伸峰值力矩和步态时间与跟腱松解组的组间差异均无统计学意义(t=-4.302,P=0.284;t=-0.158,P=0.907)。⑥安全性。2组患者的并发症发生率比较,差异无统计学意义(χ^(2)=0.633,P=0.426)。结论:火龙罐联合距下关节制动术治疗柔性平足症合并跟腱挛缩,可有效矫正足部畸形、缓解足踝部疼痛、改善步态和足踝部功能、提高患者生活质量,疗效优于跟腱松解术联合距下关节制动术,但在增加踝关节背伸活动度方面疗效不及跟腱松解术联合距下关节制动术,二者在恢复患者基本步行功能、消除足踝部异常生物力学负荷及安全性方面相当。展开更多
文摘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.
基金the Class IV Peak Discipline Project of Shanghai Jiao Tong University School of Medicine—“3D Snowball”Project(No.Ggxq03)。
文摘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.
文摘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.
文摘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.
基金The work was supported by the Key R&D Program granted by the Ministry of Science and Technology of China(number:2018YFB1107000)the National Natural Science Foundation of China(numbers:11732015,11972315)General Research Fund granted by the Hong Kong Research Grant Council(number:PolyU152065/17E).
文摘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.
文摘成人平足症在临床十分常见,以局部疼痛、影响运动为主要表现,目前对患者的治疗措施仍存在较大争议。为此,本研究搜索了Pubmed、Web of Science、The Cochrane Library以及中国生物医学文献数据库、维普信息资源系统数据库。对文献进行全面分析,发现胫后肌腱功能不全或者弹簧韧带损伤是导致平足的主要病因,症状性平足可以先尝试保守治疗,而针对疾病不同阶段的特点,联合使用多种术式,通常可以取得良好的手术疗效,提高患者生活质量。本文对此现状进行全面综述,为规范化临床治疗提供依据。
文摘目的:探讨火龙罐联合距下关节制动术治疗柔性平足症合并跟腱挛缩的临床疗效和安全性。方法:将2023年7月至2025年2月收治的72例柔性平足症合并跟腱挛缩患者随机分为2组,每组36例,分别采用火龙罐联合距下关节制动术治疗(火龙罐组)和跟腱松解术联合距下关节制动术治疗(跟腱松解组)。火龙罐组在距下关节制动术后第1天开始火龙罐治疗,每次治疗35 min,隔天治疗1次,7 d为1个疗程,共4个疗程。分别于术前及术后3个月、6个月、12个月,记录并比较2组患者的足踝部疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分及简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评分;分别于术前及术后12个月,测量并比较2组患者的跟骨倾斜角、距骨-第1跖骨角、距舟覆盖角、踝关节外翻角度、踝关节背伸活动度、踝关节背伸峰值力矩、步态时间、步长及双支撑期;观察并比较2组患者的并发症发生情况。结果:①足踝部疼痛VAS评分。2组足踝部疼痛VAS评分随时间变化均呈下降趋势(F=995.560,P=0.000;F=873.277,P=0.000);术后3个月、6个月,火龙罐组足踝部疼痛VAS评分均低于跟腱松解组(t=-9.917,P=0.000;t=-6.609,P=0.000)。②AOFAS踝与后足评分。手术前后AOFAS踝与后足评分总体随时间呈上升趋势(F=846.986,P=0.000);火龙罐组AOFAS踝与后足评分高于跟腱松解组(F=8.378,P=0.004)。③SF-36评分。2组SF-36评分随时间变化均呈上升趋势(F=398.198,P=0.000;F=372.795,P=0.000);术后3个月,火龙罐组SF-36评分高于跟腱松解组(t=12.401,P=0.000)。④影像学指标。术后12个月,2组跟骨倾斜角均大于术前(t=-38.292,P=0.000;t=-32.414,P=0.000),距骨-第1跖骨角及距舟覆盖角均小于术前(t=-41.976,P=0.000;t=-30.378,P=0.000;t=-18.481,P=0.000;t=-12.777,P=0.000),火龙罐组跟骨倾斜角大于跟腱松解组(t=2.588,P=0.012)、距骨-第1跖骨角及距舟覆盖角均小于跟腱松解组(t=-6.128,P=0.000;t=-3.115,P=0.002)。⑤生物力学参数。术后12个月,2组踝关节外翻角度均小于术前(t=8.642,P=0.000;t=4.890,P=0.000),踝关节背伸活动度均大于术前(t=-6.372,P=0.000;t=-13.711,P=0.000),步长均大于术前(t=-50.300,P=0.000;t=-41.169,P=0.000),双支撑期均短于术前(t=17.482,P=0.000;t=4.808,P=0.000);火龙罐组踝关节背伸峰值力矩小于术前(t=71.900,P=0.000),跟腱松解组背伸峰值力矩与术前的差异无统计学意义(t=0.058,P=0.954);火龙罐组步态时间短于术前(t=8.110,P=0.000),跟腱松解组步态时间长于术前(t=-12.161,P=0.000);火龙罐组踝关节外翻角度和踝关节背伸活动度均小于跟腱松解组(t=-1.346,P=0.043;t=-4.853,P=0.000),步长大于跟腱松解组(t=1.503,P=0.014),双支撑期短于跟腱松解组(t=-1.795,P=0.016),踝关节背伸峰值力矩和步态时间与跟腱松解组的组间差异均无统计学意义(t=-4.302,P=0.284;t=-0.158,P=0.907)。⑥安全性。2组患者的并发症发生率比较,差异无统计学意义(χ^(2)=0.633,P=0.426)。结论:火龙罐联合距下关节制动术治疗柔性平足症合并跟腱挛缩,可有效矫正足部畸形、缓解足踝部疼痛、改善步态和足踝部功能、提高患者生活质量,疗效优于跟腱松解术联合距下关节制动术,但在增加踝关节背伸活动度方面疗效不及跟腱松解术联合距下关节制动术,二者在恢复患者基本步行功能、消除足踝部异常生物力学负荷及安全性方面相当。
