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
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 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
BACKGROUND Pes planus(flatfoot)and pes cavus(high arch foot)are common foot deformities,often requiring clinical and radiographic assessment for diagnosis and potential subsequent management.Traditional diagnostic met...BACKGROUND Pes planus(flatfoot)and pes cavus(high arch foot)are common foot deformities,often requiring clinical and radiographic assessment for diagnosis and potential subsequent management.Traditional diagnostic methods,while effective,pose limitations such as cost,radiation exposure,and accessibility,particularly in underserved areas.AIM To develop deep learning algorithms that detect and classify such deformities using smartphone cameras.METHODS An algorithm that integrated a deep convolutional neural network(CNN)into a smartphone camera was utilized to detect pes planus and pes cavus deformities.This case control study was conducted at a tertiary hospital with participants recruited from two orthopaedic foot and ankle clinics.The CNN was trained and tested using photographs of the medial aspect of participants’feet,taken under standardized conditions.Participants included subjects with standard foot alignment,pes planus,or pes cavus determined by an expert clinician using the foot posture index.The model’s performance was assessed in comparison to clinical assessment and radiographic measurements,specifically lateral tarsal-first metatarsal angle and calcaneal inclination angle.RESULTS The CNN model demonstrated high accuracy in diagnosing both pes planus and pes cavus,with an optimized area under the curve of 0.90 for pes planus and 0.90 for pes cavus.It showed a specificity and sensitivity of 84%and 87%for pes planus detection,respectively;and 97%and 70%for pes cavus,respectively.The model’s prediction correlated moderately with radiographic lateral Meary’s angle measurements,indicating the model’s excellent reliability in assessing food arch deformity(P<0.05).CONCLUSION This study highlights the potential of using a smartphone-based CNN model as a screening tool that is reliable and accessible for the detection of pes planus and pes cavus deformities,which is especially beneficial for underserved communities and patients with pain generated by subtle foot arch deformities.展开更多
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 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BACKGROUND Pes planus(flatfoot)and pes cavus(high arch foot)are common foot deformities,often requiring clinical and radiographic assessment for diagnosis and potential subsequent management.Traditional diagnostic methods,while effective,pose limitations such as cost,radiation exposure,and accessibility,particularly in underserved areas.AIM To develop deep learning algorithms that detect and classify such deformities using smartphone cameras.METHODS An algorithm that integrated a deep convolutional neural network(CNN)into a smartphone camera was utilized to detect pes planus and pes cavus deformities.This case control study was conducted at a tertiary hospital with participants recruited from two orthopaedic foot and ankle clinics.The CNN was trained and tested using photographs of the medial aspect of participants’feet,taken under standardized conditions.Participants included subjects with standard foot alignment,pes planus,or pes cavus determined by an expert clinician using the foot posture index.The model’s performance was assessed in comparison to clinical assessment and radiographic measurements,specifically lateral tarsal-first metatarsal angle and calcaneal inclination angle.RESULTS The CNN model demonstrated high accuracy in diagnosing both pes planus and pes cavus,with an optimized area under the curve of 0.90 for pes planus and 0.90 for pes cavus.It showed a specificity and sensitivity of 84%and 87%for pes planus detection,respectively;and 97%and 70%for pes cavus,respectively.The model’s prediction correlated moderately with radiographic lateral Meary’s angle measurements,indicating the model’s excellent reliability in assessing food arch deformity(P<0.05).CONCLUSION This study highlights the potential of using a smartphone-based CNN model as a screening tool that is reliable and accessible for the detection of pes planus and pes cavus deformities,which is especially beneficial for underserved communities and patients with pain generated by subtle foot arch deformities.
