Flat Feet Research Today is a free monthly online journal that collates and summarizes the latest research about Flat Feet, including details on flatfoot, fallen arches, children, treatment, arthrodesis.

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull.

Blackman AJ, Blevins JJ, Sangeorzan BJ, Ledoux WR

Department of Veterans Affairs, RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Health Care System, Seattle, Washington 98108.

Flatfoot deformity is characterized by loss of the medial longitudinal arch, forefoot abduction, hindfoot eversion, and often Achilles tendon contracture. Our objectives were to validate a cadaveric flatfoot model that involves selective ligament attenuation and to determine if Achilles tendon overpull is associated with increased pes planus severity. We measured the three-dimensional (3D) orientation of the bones of interest in the unloaded, loaded, and Achilles tendon overpull conditions. A flatfoot model was created by attenuating ligaments involved in the pes planus deformity followed by cyclic axial loading, and bone orientations were acquired in the three conditions. Significant differences seen between normal feet and flat feet were consistent with those seen with the pes planus deformity. The first metatarsal dorsiflexed and abducted relative to the talus. The navicular abducted relative to the talus. The calcaneus everted relative to the tibia. The talus plantar flexed and adducted. Achilles overpull resulted in first metatarsal-to-talus dorsiflexion and navicular-to-talus abduction. Thus, selective ligament attenuation followed by cyclic axial loading can create a cadaveric flatfoot model consistent with the in vivo deformity. Longitudinal arch depression, hindfoot eversion, talonavicular joint abduction, forefoot abduction, and talar plantar flexion were seen. Simulated Achilles tendon contracture increased the severity of the deformity, particularly in arch depression and forefoot abduction. (c) 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Published 16 June 2009 in J Orthop Res.
Full-text of this article is available online (may require subscription).

Articles on Flat Feet published 26 May 2009:

Talonavicular joint arthrodesis for the treatment of pes planus valgus in older children and adolescents with cerebral palsy.   J Child Orthop, 3(3): 179-83.

PURPOSE: The purpose of this report is to review our experience with talonavicular joint arthrodesis for the treatment of severe valgus foot deformities in older children and adolescents with cerebral palsy (CP). METHODS: The clinical, radiographic, and gait parameters results after talonavicular joint arthrodesis were retrospectively reviewed in 32 patients (59 feet) with valgus deformities of the foot. The surgery was performed as part of multiple simultaneous surgeries for the treatment of ... [Abstract] [Full-text]

Articles on Flat Feet published 5 May 2009:

Pre-operative irreducible C1-C2 dislocations: intra-operative reduction and posterior fixation. The "always posterior strategy".   Acta Neurochir (Wien), 151(5): 551-9; discussion 560.

BACKGROUND: According to Menezes' algorithm, pre-operative dynamic neuroradiological investigation in C1-C2 dislocations (C1C2D) instability is strongly advocated in order to exclude those patients not eligible for posterior fixation and fusion without previous anterior trans-oral decompression. Anterior irreducible compression due to C1C2D instability, it is said, needs trans-oral anterior decompression. We reviewed our experience in order to refute such a paradigm. METHODS: The study involves ... [Abstract] [Full-text]

Articles on Flat Feet published 4 May 2009:

The effect of platelet-rich plasma and bone marrow on murine posterolateral lumbar spine arthrodesis with bone morphogenetic protein.   J Bone Joint Surg Am, 91(5): 1199-206.

BACKGROUND: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has had limited success in stimulating osteogenesis at the site of posterolateral lumbar spine arthrodesis when used at the currently approved human dose for anterior lumbar interbody arthrodesis. The objective of the present study was to investigate the effect of co-administration of fresh harvested autologous bone marrow aspirate and platelet-rich plasma on rhBMP-2-mediated in vivo murine posterolateral lumbar spine ... [Abstract] [Full-text]

Six-year outcomes of anterior lumbar interbody arthrodesis with use of interbody fusion cages and recombinant human bone morphogenetic protein-2.   J Bone Joint Surg Am, 91(5): 1181-9.

BACKGROUND: Twenty-four-month outcomes have been reported for patients with degenerative lumbar disc disease who were treated with stand-alone anterior lumbar interbody arthrodesis with use of dual tapered interbody fusion cages and recombinant human bone morphogenetic protein-2. This report represents an update of the clinical and radiographic results of this treatment at six years. METHODS: Two hundred and seventy-seven patients with single-level degenerative disc disease with up to grade-I ... [Abstract] [Full-text]

Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures. a five to seven-year prospective randomized study.   J Bone Joint Surg Am, 91(5): 1033-41.

BACKGROUND: The impact of fusion as a supplement to short-segment instrumentation for the treatment of thoracolumbar burst fractures is unclear. We conducted a controlled clinical trial to define the effect of fusion on lumbar spine and patient-related functional outcomes. METHODS: From 2000 to 2002, seventy-three consecutive patients with a single-level Denis type-B burst fracture involving the thoracolumbar spine and a load-sharing score of <or=6 were managed with posterior pedicle screw ... [Abstract] [Full-text]

Articles on Flat Feet published 1 May 2009:

Clinical or radiologic measurements and 3-D gait analysis in children with pes planus.   Pediatr Int, 51(2): 201-5.

BACKGROUND: Static measurement in clinical and radiologic evaluation is often used in assessment of pes planus, but it is important to know whether pes planus leads to abnormal gait pattern. The purpose of the present study was to assess the clinical and radiologic findings of children with pes planus and the relationship between clinical, radiologic findings and parameters obtained in 3-D gait analysis. METHODS: Thirteen children with pes planus were selected. Physical measurements included ... [Abstract] [Full-text]

Percutaneous fusion of the sacroiliac joint with hollow modular anchorage screws: clinical and radiological outcome.   J Bone Joint Surg Br, 91(5): 627-31.

We reviewed 15 consecutive patients, 11 women and four men, with a mean age of 48.7 years (37.3 to 62.6), who between July 2004 and August 2007 had undergone percutaneous sacroiliac fusion using hollow modular anchorage screws filled with demineralised bone matrix. Each patient was carefully assessed to exclude other conditions and underwent pre-operative CT and MR scans. The diagnosis of symptomatic sacroiliac disease was confirmed by an injection of local anaesthetic and steroid under image ... [Abstract] [Full-text]

Subtalar and talonavicular arthrodesis through a single medial approach for the correction of severe planovalgus deformity.   J Bone Joint Surg Br, 91(5): 612-5.

We describe a retrospective review of the clinical and radiological parameters of 32 feet in 30 patients (10 men and 20 women) who underwent correction for malalignment of the hindfoot with a modified double arthrodesis through a medial approach. The mean follow-up was 21 months (13 to 37). Fusion was achieved in all feet at a mean of 13 weeks (6 to 30). Apart from the calcaneal pitch angle, all angular measurements improved significantly after surgery. Primary wound healing occurred without ... [Abstract] [Full-text]

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