Search Results (77)

Background: Plantar pressure distribution is a valuable tool for studying how the ground reaction forces are transmitted from the feet to the body and for detecting abnormalities in foot biomechanics. Objectives: The objective of this study was to determine the effect of the foot type (normal foot, flatfoot, and cavus foot) on plantar pressure distribution in healthy Mexican men and women aged from 3 to 74 years. Methods: A database of the plantar pressure distribution under dynamic and static conditions for both feet was studied using descriptive statistics, regression analysis, and statistical factorial design. The database contained images of the soles of the feet and pressure distribution of 996 persons between 3 and 74 years old (53.9% females and 46.1% males). Two different conditions were evaluated; the first was in a static condition, and the second was during walking. The Chippaux–Smirak Index (CSI) was used to classify the type of feet. Results: In the left foot, a linear regression analysis of the soles of the feet shows that the prevalence of flatfoot (p-value = 3.45 × E⁻⁵) decreased with age, while the normal foot (p-value = 7.39 × E⁻⁵) increased. When people are standing (static), the hindfoot (55.64 ± 18.80%) presents more pressure than the forefoot (45.18 ± 19.50%), while in dynamic, the forefoot (55.95 ± 13.36%) supports more pressure than the hindfoot (44.05 ± 13.36%). Similar behavior occurs in the right foot. A statistical factorial design ANOVA shows that the plantar pressure in the forefoot and hindfoot regions is significantly different (p < 0.05). Conclusions: The prevalence of flatfoot decreased with age, while the proportion of normal foot type increased. Under static conditions, the hindfoot bore more load than the forefoot, whereas under dynamic conditions, the forefoot bore more load than the hindfoot. This research contributes to generating a comprehensive database of reference values of the plantar pressure of different foot types in a Mexican population; this will be useful to podiatrists, clinicians, and physiotherapists for the analysis or treatment of abnormal foot postures. Full article

Background: Idiopathic painful flexible flatfoot (FFF) in childhood can persist into adulthood, yet long-term data on subtalar arthroereisis via the calcaneo-stop (C-Stop) procedure are scarce. We aimed to evaluate clinical and functional outcomes at ≥10 years post-surgery and compare them with age-matched normative values in healthy populations. Methods: We conducted a single-time-point long-term follow-up on a subset of 232 children (age 10–14 years) selected from a retrospective cohort of 494 patients who underwent bilateral anterograde C-Stop between 2010 and 2014. Inclusion required idiopathic symptomatic FFF refractory to conservative care and a minimum 10-year follow-up. At a mean follow-up of 12.1 ± 2.5 years, patients completed the Foot and Ankle Ability Measure (FAAM) and Tegner Activity Scale (TAS). Secondary data included anthropometrics, implant details, accessory procedures, screw removal, and complications. Results: Respondents demonstrated excellent function: FAAM total 98.8 ± 3.7 (range 75–100) with 87.5% achieving the ceiling score; FAAM–ADL 99.3 ± 3.2; FAAM–Sport 98.0 ± 6.4. The mean TAS was 3.7 ± 2.0, with 53% active in sports—72% low-impact, 12% high-impact non-competitive, and 4% competitive. Sex and history of complications produced statistically significant but clinically small differences (<3% on FAAM total; <6 points on subscales). No outcome differences were observed by age or BMI, accessory procedures, or screw removal status. Conclusions: Ten years after C-Stop arthroereisis in childhood, patients exhibit functional scores comparable to normative values, high rates of ceiling effect on FAAM, and a modest level of physical activity predominantly in low-impact sports. Full article

Background: Spring ligament (SL) injuries are primarily associated with progressive collapsing flatfoot deformity, but can also occur due to trauma. It remains unclear whether the morphological changes following trauma differ from those caused by chronic overload. The aim of this study was (1) to analyze whether a relationship exists between the injury pattern and foot deformity and (2) to evaluate whether there is a distinction between trauma-related and non-trauma-related injuries. Method: We prospectively enrolled 198 patients with a median age of 57 years (range, 13 to 86 years; female, 127 (64%); male, 71 (36%)) who had a clinically diagnosed, surgically confirmed, and classified SL injury. We used weight-bearing standard X-rays to assess foot deformity. The control group consisted of 30 patients (median age 51 years, range, 44–66; female, 21 (70.0%); male, 9 (30.0%)) with no foot deformities or prior foot surgeries. Results: A 41.9% incidence of trauma was identified as the cause of these injuries, accounting for 16 (20.8%) of isolated injuries to the SL, 30 (42.9%) of SL injury accompanied by a posterior tibial (PT) tendon avulsion, and 37 (72.5%) of SL injury alongside a bony avulsion at the navicular injuries. The odds of being post-traumatic decreased with each year of age by a factor of 0.97 (95% CI: 0.95–0.99). Conclusions: While all radiographic measurements for flatfoot deformity became pathological after an injury to the SL, they did not accurately predict the injury patterns of the SL and distal PT tendon. Generally, post-traumatic cases exhibited lower severity of foot deformity, suggesting that other structures beyond the SL may contribute to the development of flatfoot deformity. Full article

Background/Objectives: Subtalar arthroereisis (STA) is a widely used surgical procedure for symptomatic pediatric flexible flatfoot. However, implant migration remains a concern due to its potential impact on long-term correction and complications. This study evaluated the migration pattern of STA implants and assessed long-term clinical and radiographic outcomes. Methods: This retrospective cohort study included 47 feet from children aged 8–13 years who underwent STA with adjunctive soft tissue procedures between 2014 and 2018, following ≥6 months of failed conservative treatment, with a minimum follow-up of 5 years. Exclusion criteria included neuromuscular or rigid flatfoot. Weight-bearing radiographs assessed anteroposterior (AP) and lateral Meary’s angles, reflecting forefoot-to-hindfoot alignment, and calcaneal pitch, indicative of longitudinal arch height. Implant migration was recorded and clinical outcomes were measured by the American Orthopedic Foot and Ankle Society (AOFAS) score. Measurements were recorded preoperatively, immediately postoperatively, and at 1 month, 3 months, 6 months, 1 year, and 5 years. Results: Radiographic correction was significant and sustained at 5 years. The AP Meary’s angle improved from 13.09° to 5.26° at 1 month and 6.69° at 5 years (p < 0.001); lateral Meary’s angle from 9.77° to 4.06° and 4.88° (p < 0.001); and calcaneal pitch from 14.52° to 16.87° and 16.89° (p < 0.001), respectively. AOFAS scores increased from 67.52 to 90.86 at 1 month and 96.33 at 5 years (p < 0.001). Implant migration peaked within the first postoperative month (mean: 3.2 mm on ankle AP view; 3.0 mm on foot AP view) and stabilized thereafter. Four cases of complications included implant dislodgement, subsidence, and persistent sinus tarsi tenderness, which were successfully resolved after appropriate management. No recurrence of deformity was observed. Conclusions: STA implant migration is most pronounced during the first month, likely due to physiological settling as the foot adapts to altered biomechanics. With appropriate implant selection, technique, and follow-up, migration does not compromise long-term correction or outcomes. In general, symptomatic cases can often be managed conservatively prior to implant removal. Full article

Athletic Tape is widely used as an immediate and cost-effective intervention for flexible flat feet, offering a practical alternative to orthotic devices and exercise therapies. This study aimed to compare the effects of low-dye and anti-pronation taping (elastic and inelastic) on ankle strength, gait parameters, and balance control in women with flexible flat feet. Thirty women were evaluated under four conditions: no taping, low-dye taping, elastic anti-pronation taping, and inelastic anti-pronation taping. Each condition was tested at 3-day intervals. Outcome measures included ankle muscle strength, step length, stride length, balance control ability assessed using the Romberg and limits of stability tests. Repeated-measures analysis of variance and post hoc least significant difference analyses were used to determine statistical significance. Additionally, effect sizes (η²) were calculated for the primary outcomes. Dorsiflexion strength significantly improved with elastic taping (p < 0.05). Step length increased with both elastic and inelastic taping, whereas stride length improved only with elastic taping. All taping methods significantly reduced the limits of stability compared with the no-taping condition (p < 0.05). Athletic Tape interventions, especially elastic anti-pronation taping, may reduce excessive foot pronation and improve ankle strength and gait performance in women with flexible flat feet. Full article

Flatfoot, or pes planus, is a condition where the foot’s arch collapses, leading to complications such as pain, gait abnormalities, and an increased risk of injury. Accurate and early diagnosis is critical for effective treatment. Traditional diagnostic methods, including radiographic imaging, footprint analysis, and plantar pressure measurement, often require specialized equipment and are subjective. This study proposes a novel diagnostic device that captures 2D plantar foot images to calculate key morphological indices, including the Staheli Index, Clark’s Angle, and Chippaux–Smirak Index, for flatfoot detection. The device, designed with off-the-shelf components, includes a transparent toughened glass platform and LED illumination to capture images using web cameras. A Python-based application was developed for image acquisition, segmentation, and stitching. The device was tested on 55 participants aged 18–28, and the extracted morphological indices were validated against established thresholds for flatfoot diagnosis. The results showed that the Staheli Index, Chippaux–Smirak Index, and Clark’s Angle reliably detected flatfoot in participants. The study highlights the potential of this device for non-invasive, accurate, and rapid flatfoot diagnosis. Future advancements in deep learning could enhance its capabilities, making it a valuable tool for proactive healthcare in foot deformity detection. Full article

(1) Background: Flexible flatfoot is characterized by medial arch collapse, leading to musculoskeletal impairments. We examined the effects of single-arch foot orthosis (SFO) and dual-arch foot orthosis (DFO) on arch height, kinematics, and kinetics in young females during walking and jogging. (2) Methods: Healthy females (n = 19) with flexible flatfoot were tested under three conditions: regular shoes, SFO, and DFO. Motion capture and a 3D force plate gathered biomechanical data. We also used a high-speed dual fluoroscopic imaging system (DFIS) to assess dynamic foot morphology. Outcomes included normalized truncated navicular height, medial arch angle, angles and moments at the metatarsophalangeal, subtalar, ankle, knee, and hip joints. (3) Results: Both types of orthoses improved the normalized navicular height and reduced the medial arch angle, with DFO vs. SFO showing greater effects (p < 0.001). DFO vs. SFO was also more effective in limiting the range of motion (ROM) of the metatarsophalangeal joint and dorsiflexion (p < 0.001). Additionally, DFO reduced the ankle range of motion and the maximum knee flexion during walking. Both orthoses reduced subtalar plantarflexion moments during stance (p < 0.001) and modulated ankle plantarflexion moments throughout different phases of gait. DFO uniquely enhanced metatarsophalangeal plantarflexion moments during jogging (p < 0.001). (4) Conclusions: Dual vs. single transverse arch foot orthosis is more effective in improving gait biomechanics in females with flexible flatfoot. Longitudinal studies are needed to confirm these benefits. Full article

Background/Objectives: Flatfoot is a common pediatric foot deformity characterized by a reduced or absent medial longitudinal arch (MLA). The condition can lead to altered gait, pain, and potential long-term morbidity if untreated. Identifying potential risk factors—such as body mass index (BMI), ligamentous or joint instability, shoe choices, and physical activity—is crucial for prevention and management. The objectives are to systematically review and synthesize current evidence on how flatfoot severity correlates with BMI and other risk factors in children and adolescents, and to highlight methodological considerations essential for future research. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched five electronic databases from inception to February 2024. Flatfoot severity was measured by various clinical or radiographic indices. Two reviewers independently screened and assessed the risk of bias. Results: Thirty-seven studies met the inclusion criteria. Children with high BMI had increased odds of flatfoot (pooled Odds Ratio = 2.3, 95% Confidence Interval: 1.6–3.1), with one outlier reporting an OR of 9.08. Heterogeneity (I² up to 70%) stemmed from varied diagnostic methods. Other factors, including joint instability, shoe choices, and physical activity, showed mixed associations. Conclusions: Elevated BMI strongly correlates with pediatric flatfoot severity, highlighting the importance of proactive weight management and foot assessments. Future standardized, longitudinal studies are needed to clarify causality and refine interventions. Full article

The first metatarsal has the greatest inclination of all metatarsals and carries about 40% of body weight during the static stance. The rearfoot and the first ray (FR) are two distinct structures, but they are strongly related to the latest studies in the literature; however, their mutual involvement in the foot biomechanics appears not to be fully explored. Understanding their interdependence is essential to approaching the patient in his totality. This overview aims to analyze the current evidence from the latest studies that examine the correlation between FR insufficiency (FRI) and hindfoot valgus (HV), focusing on their biomechanical interaction, clinical implications, and treatment approaches. All analyzed studies showed that plantarflexion of the first metatarsophalangeal (MTP1) joint in correct alignment increased by 26% compared to a deviated articulation. In FRI, the “windlass” mechanism appears compromised, and FR lacks the necessary stability and plantarflexion; consequently, the medial arch collapses, and the foot moves into excessive pronation. On the other hand, in HV condition, the pulley system is significantly diminished, and peroneus longus contraction cannot stabilize the FR with resultant FRI and dorsal migration. A significant correlation was found between hindfoot alignment and first metatarsal rotation (86% of patients) and between HV and hallux valgus. Foot orthoses, physical therapy, and exercise programs, especially in the initial stages of symptomatic HV, provide satisfactory results in 67% to 90% of cases, improving foot alignment and pain relief in FRI patients. In more severe cases, surgical intervention to realign the hindfoot is indicated with a very low complication rate (1–4%), which can vary from 24% to 55% in stage 4 flatfoot. No study in the literature has been found to address both pathologies simultaneously from a treatment point of view, and, although not all HV patients are affected by FRI, most patients seem to benefit from surgical stabilization of the FR in 80% of individuals with symptomatic HV. However, despite a predominance of FRI among HV individuals, not all clinical studies have confirmed this correlation. Full article

Hallux limitus pathology is defined as a limitation of the dorsiflexion movement of the first toe without degenerative involvement of the first metatarsophalangeal joint, which produces pain and generates functional impairment, especially in the propulsive phase of gait. It is very common to find this pathology in adulthood accompanied by other compensations at a biomechanical level as a consequence of blockage of the main pivot in the sagittal plane. The aim was to determine the symmetry index that occurs in dynamics affiliated with other gait parameters in subjects with and without hallux limitus. A total of 70 subjects were part of the sample, and these were separated into two groups, each consisting of 35 subjects, depending on whether they had bilateral hallux limitus or if they were healthy subjects. In this study, a platform was used to assess the load symmetry index and walking phases. The results showed significant differences in the symmetry index for lateral load (p = 0.023), the initial contact phase (p = 0.003), and the flatfoot phase (p < 0.001). The adults who had bilateral hallux limitus exhibited changes in the symmetry index during the lateral load as well as in the initial contact and flatfoot contact phases, demonstrating increased instability when compared to individuals with normal feet. Full article

Background: Calcaneal osteotomies are a common procedure in foot and ankle surgery for the treatment of the painful flexible Progressive Collapsing Foot Deformity (PCFD). The lateral calcaneal lengthening osteotomy (LCLOT) allows a three-dimensional foot and ankle flatfoot correction with a single osteotomy. The purpose of this article is to review the types of calcaneal lengthening osteotomies. Methods: Review of anatomical, biomechanical and clinical studies and reviews. Results: The LCLOT shall be differentiated from the Evans osteotomy or Z-shaped calcaneal lengthening osteotomy. The LCLOT is performed at the sinus tarsi and corrects at the subtalar joint axis biomechanically the pathological hindfoot valgus, foot abduction, and medial arch collapse. The LCLOT technique might vary regarding graft and fixation type. The LCLOT has good clinical results with high union rates. Conclusions: The LCLOT is a powerful and successful single-site osteotomy for the triplanar correction of the painful flexible flatfoot/PCFD. Full article

Relating continuously collected inertial data to the activities or postures performed by the sensor wearer requires pattern recognition or machine-learning-based algorithms, accounting for the temporal and scale variability present in human movements. The objective of this study was to develop a sensor-based framework for the detection and measurement of high-flexion postures frequently adopted in occupational settings. IMU-based joint angle estimates for the ankle, knee, and hip were time and scale normalized prior to being input to a multi-dimensional Dynamic Time Warping (mDTW) distance-based Nearest Neighbour algorithm for the identification of twelve postures. Data from 50 participants were divided to develop and evaluate the mDTW model. Overall accuracies of 82.3% and 55.6% were reached when classifying movements from the testing and validation datasets, respectively, which increased to 86% and 74.6% when adjusting for imbalances between classification groups. The highest misclassification rates occurred between flatfoot squatting, heels-up squatting, and stooping, while the model was incapable of identifying sequences of walking based on a single stride template. The developed mDTW model proved robust in identifying high-flexion postures performed by participants both included and precluded from algorithm development, indicating its strong potential for the quantitative measurement of postural adoption in real-world settings. Full article

Introduction: Management strategies for stage II tibialis posterior tendon dysfunction are centered on tendon transfers and osteotomies. One of the most commonly used tendon transfers is flexor digitorum longus (FDL) tendon to navicular, but its superiority over transfers to other locations or transfers of other tendons, along with the role of spring ligament and tibialis posterior tendons, have not been objectively evaluated. Aims: We aimed to quantify both the location and magnitude of secondary stresses that develop as a consequence of the initial pathology. Methods: In this study, we used a computational model to study flat foot development and evaluate the effects of various tendon transfers and failures of passive structural elements, as well as their effect on the biomechanics of the foot. Results: We found that both FDL and FHL transfers have biomechanical advantages and disadvantages. Neither of these transfers decrease the stress on the tibialis posterior tendon if the underlying pathologies such as spring ligament failure are not addressed. Conclusions: Of the tendon transfers evaluated, FDL transfer to the navicular had the most profound effect on reducing the stresses on the spring ligament. Full article

Background: Flexible pediatric flatfoot is an anatomical presentation of the foot that is common in children, and its functional impact raises long-term uncertainty. Functional re-education includes strengthening and stretching exercises for the intrinsic and extrinsic musculature of the foot, proposed as an effective conservative treatment. However, to date, there is no systematic review examining its effectiveness in the pediatric population. This systematic review aims to evaluate the effectiveness of functional re-education as a conservative treatment for flexible pediatric flatfoot, determining which exercises are most effective. Methods: A search (PROSPERO: CRD42023391030) was conducted across six databases, resulting in an initial total of 327 studies. Of these, 11 randomized controlled trials (RCTs) met the inclusion criteria, resulting in a sample of 419 children aged 6 to 14 years with a diagnosis of flexible flatfoot. The evaluated studies present variations in diagnostic criteria, types of exercises, and treatment duration. Results: The results indicate that functional re-education is effective in improving the symptomatology and functionality of the foot in children. In particular, exercises targeting the intrinsic musculature proved to be among the most effective treatments, improving the structural development of the medial longitudinal arch. The reviewed literature recommends a minimum treatment duration of eight weeks. Conclusions: Functional re-education represents an effective conservative treatment option for flexible flatfoot in children, positioning it as the treatment of choice for this condition. Full article

Background: Advances in prosthetic technology, especially microprocessor-controlled knees (MPKs), have helped enhance gait symmetry and reduce fall risks for individuals who have undergone transfemoral amputation. However, challenges remain in walking in constrained situations due to the limitations of passive prosthetic feet, lacking ankle mobility. This study investigates the benefits of SYNSYS^®, a new microprocessor-controlled knee–ankle–foot system (MPKA_NEW), designed to synergize knee and ankle movements. Methods: A randomized crossover trial was conducted on 12 male participants who had undergone transfemoral amputation who tested both the MPKA_NEW and their usual MPK prosthesis. Biomechanical parameters were evaluated using quantitative gait analysis in various walking conditions. Participants also completed self-reported questionnaires on their quality of life, locomotor abilities, and prosthesis satisfaction. Results: The MPKA_NEW showed a significant reduction in the risk of slipping and tripping compared to standard MPK prostheses, as evidenced by increased flat-foot time and minimum toe clearance during gait analysis. The MPKA_NEW also improved physical component scores in quality-of-life assessments (Short-Form 36 General Health Questionnaire), suggesting enhanced stability and reduced cognitive load during walking. Conclusions: The MPKA_NEW offers significant improvements in gait safety and quality of life for people who have undergone TFA, particularly in challenging conditions. Further studies are needed to assess the long-term benefits and adaptability across diverse amputee populations. Full article