We used finite element analysis to study the mechanical stress distribution of a new intramedullary implant used for proximal interphalangeal joint (PIPJ) arthrodesis (PIPJA) to surgically correct the claw-hammer toe deformity that affects 20% of the population. After geometric reconstruction of the foot skeleton from claw toe images of a 36-year-old male patient, two implants were positioned, in the virtual model, one neutral implant (NI) and another one 10° angled (10°AI) within the PIPJ of the second through fourth HT during the toe-off phase of gait and results were compared to those derived for the non-surgical foot (NSF). A PIPJA was performed on the second toe using a NI reduced tensile stress at the proximal phalanx (PP) (45.83 MPa) compared to the NSF (59.44 MPa; p < 0.001). When using the 10°AI, the tensile stress was much higher at PP and middle phalanges (MP) of the same toe, measuring 147.58 and 160.58 MPa, respectively, versus 59.44 and 74.95 MPa at corresponding joints in the NSF (all p < 0.001). Similar results were found for compressive stresses. The NI reduced compressive stress at the second PP (-65.12 MPa) compared to the NSF (-113.23 MPa) and the 10°AI (-142 MPa) (all p < 0.001). The von Mises stresses within the implant were also significantly lower when using NI versus 10°AI (p < 0.001). Therefore, we do not recommend performing a PIPJA using the 10°AI due to the increase in stress concentration primarily at the second PP and MP, which could promote implant breakage.

UNASSIGNED: The study aimed to determine the efficacy of foot muscle exercises in children with DS having pes planus.
UNASSIGNED: Forty-seven subjects randomly assigned to foot muscle exercises (study group) or an arch support insole with one-leg balance exercises (control group), thrice weekly intervention for 12-weeks followed by a home program with residual effect assessed after 24-weeks from baseline.
UNASSIGNED: The motor functions were significantly improved in both groups (p = 0.00). A positive residual effect was found in the study group for both parameters. Whilst in the control group it failed to give a positive residual effect for GMFM-88, while PBS yielded positive outcomes. The study group showed significantly better results than the control group in comparison.
UNASSIGNED: The novel finding suggests that the foot muscle exercise has the potential to improve motor functions in children with Down syndrome and it can be used as an alternative therapeutic approach to the conventional method.

UNASSIGNED: Ankylosing spondylitis (AS) is a chronic, inflammatory, and autoimmune disease. This condition primarily affects the axial skeleton and presents direct foot involvement, such as Achilles enthesitis or plantar fascia involvement.
UNASSIGNED: This study aimed to investigate the impact of foot health on the quality of life of individuals with AS compared to a control group without AS.
UNASSIGNED: A sample of 112 subjects was recruited, with a mean age of 46.80 ± 10.49 years, divided into two groups: 56 individuals with AS (cases) and 56 individuals without AS (controls). Demographic data were collected, and the scores obtained in the Foot Health Status Questionnaire domains were recorded.
UNASSIGNED: Of the participants, 27.79% (N = 30) were men and 73.21% (N = 82) were women. The mean age in the group was 46.80 ± 10.49. Significant differences (p < 0.05) were found in the domains of foot function, foot pain, footwear, overall foot health, general health-related physical activity, and social capacity between the AS group and the control group.
UNASSIGNED: Individuals with AS exhibited a decreased quality of life, as indicated by their Foot Health Status Questionnaire scores.

UNASSIGNED: Although operative treatment of the flexible progressive collapsing foot deformity (PCFD) remains controversial, correction of residual forefoot varus and stabilization of the medial column are important components of reconstruction. A peroneus brevis (PB) to peroneus longus (PL) tendon transfer has been proposed to address these deformities. The aim of our study was to determine the effect of an isolated PB-to-PL transfer on medial column kinematics and plantar pressures in a simulated PCFD (sPCFD) cadaveric model.
UNASSIGNED: The stance phase of level walking was simulated in 10 midtibia cadaveric specimens using a validated 6-degree of freedom robot. Bone motions and plantar pressure were collected in 3 conditions: intact, sPCFD, and after PB-to-PL transfer. The PB-to-PL transfer was performed by transecting the PB and advancing the proximal stump 1 cm into the PL. Outcome measures included the change in joint rotation of the talonavicular, first naviculocuneiform, and first tarsometatarsal joints between conditions. Plantar pressure outcome measures included the maximum force, peak pressure under the first metatarsal, and the lateral-to-medial forefoot average pressure ratio.
UNASSIGNED: Compared to the sPCFD condition, the PB-to-PL transfer resulted in significant increases in talonavicular plantarflexion and adduction of 68% and 72%, respectively, during simulated late stance phase. Talonavicular eversion also decreased in simulated late stance by 53%. Relative to the sPCFD condition, the PB-to-PL transfer also resulted in a 17% increase (P = .045) in maximum force and a 45-kPa increase (P = .038) in peak pressure under the first metatarsal, along with a medial shift in forefoot pressure.
UNASSIGNED: The results from this cadaver-based simulation suggest that the addition of a PB-to-PL transfer as part of the surgical management of the flexible PCFD may aid in correction of deformity and increase the plantarflexion force under the first metatarsal.
UNASSIGNED: This study provides biomechanical evidence to support the addition of a PB-to-PL tendon transfer in the surgical treatment of flexible PCFD.

BACKGROUND: Reduced hindfoot eversion motion has been proposed as a cause of increased lateral foot pressure following lateral column lengthening (LCL) for progressive collapsing foot deformity (PCFD). A subjective intraoperative assessment of passive eversion has been suggested to help evaluate correction; however, it is unclear how passive eversion correlates with objective measurements of foot stiffness. Our objectives were to quantify the relationship between the maximum passive eversion in hindfoot joints following LCL with plantar pressure during stance and to determine the influence of wedge size on these outcomes.
METHODS: Ten cadaveric specimens extending from the mid-tibia distally were tested on a 6-degrees-of-freedom robot to simulate the stance phase of level walking. Five conditions were tested: intact, simulated PCFD, and 3 LCL wedge conditions (4, 6, and 8 mm). Outcomes included the lateral-to-medial forefoot plantar pressure (LM) ratio during stance and the maximum passive eversion measured in the hindfoot joints. Simple linear regressions were performed to evaluate relationships between outcomes and wedge sizes.
RESULTS: A strong negative relationship was found between passive subtalar eversion and the LM ratio during stance (r[38] = -0.46; p = 0.0007), but not between passive talonavicular eversion and the LM ratio (r[38] = -0.02; p = 0.37). Wedge size was strongly related to subtalar eversion (r[38] = -0.77; p < 0.0001), talonavicular eversion (r[38] = -0.55; p = 0.0003), and the LM ratio (r[38] = 0.70; p < 0.0001). Increased wedge size resulted in average decreases in subtalar and talonavicular eversion of 1.0° (95% confidence interval [CI]: 0.8° to 1.3°) and 1.2° (95% CI: 0.6° to 1.6°), respectively. Increased wedge size also increased the LM ratio by 0.38 (95% CI: 0.25 to 0.50), indicating a lateral shift in plantar pressure.
CONCLUSIONS: Decreased hindfoot eversion following LCL was related to increased lateral plantar pressure during stance. Increasing wedge size correlated with decreasing passive hindfoot eversion and increasing lateral plantar pressure, suggesting that intraoperative preservation of eversion motion may be important for preventing excessive lateral loading.
CONCLUSIONS: To avoid overcorrection or undercorrection of the deformity, hindfoot eversion assessment in addition to radiographic evaluation may be important for optimizing the amount of lengthening to achieve successful LCL.

BACKGROUND: Diabetes foot deformity is among the major causes of diabetic foot ulceration, resulting in lower limb amputation. However, the study on the distribution of foot deformity and its risk factor among diabetic patients in Ethiopia is limited. This study determined the overall prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.
METHODS: Hospital-based cross-sectional study was conducted among 392 diabetic patients using a systematic random sampling technique at Debre Markos Comprehensive Specialized Hospital. Data were collected by pre-tested, semi-structured questionnaires and diabetic foot assessment format. Multivariable binary logistic regression was used to determine the association between dependent and independent variables. Adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the strength of the association, and a variable with a p-value < 0.05 was statistically significant factors of diabetes foot deformity.
RESULTS: The overall prevalence of foot deformity was 33.4% [95% CI: 28.9-38.3]. In the final logistic regression analysis, rural residency [AOR = 2.64, 95% CI: 1.31, 5.31], poor glycemic control [AOR = 2.41; 95% CI: 1.34, 4.33], diabetes duration ≥ 10 years [AOR = 2.74; 95% CI: 1.50, 5.02], inadequate footwear [AOR = 2.11; 95% CI: 1.17, 3.82] and presence of peripheral neuropathy [AOR = 8.21; 95% CI: 4.54, 14.84] were statistically significant associated factors with diabetes foot deformity.
CONCLUSIONS: The prevalence of foot deformity among adult diabetic patients was high. It is recommended to incorporate foot deformity screening in routine diabetic patient follow-ups especially for those with poor glycaemic control, rural residency, long diabetes duration, inadequate footwear, and diabetic peripheral neuropathy.

BACKGROUND: Talocalcaneal coalition is the most common cause of rigid flat foot in adolescents. It presents with recurrent ankle sprains, foot and ankle pain, and foot deformity. Management is still controversial. Multiple options were utilized during the last 40 years, including coalition excision only or coalition excision with hind foot arthrodesis or corrective osteotomies. However, the effect of arthroereisis after coalition excision is still questionable.
METHODS: Thirty feet in 28 patients with rigid flat foot due to talocalcaneal coalition, who presented to our institution between September 2018 and April 2020, were prospectively analyzed. Randomization was performed by random allocation using a computer-based system into two groups: group A for coalition excision and arthroereisis, group B for coalition excision and osteotomies. Functional and radiological outcomes and complications were recorded and analyzed using Statistical Package for the Social Sciences software.
RESULTS: Thirty feet in 28 patients were included in the final analysis (15 feet in each group). One patient in each group had bilateral affection. The mean age was 14.5 years, and the mean follow-up duration was 24 months. At final follow-up, the mean AOFAS was 78.8 ± 4.04 in group A and 76.73 ± 4.66 in group B, while the FAAM scores were 80 ± 5 and 79 ± 3 in groups A and B, respectively. The complication rate was higher in group A, however with no statistical significance.
CONCLUSIONS: The combination of talocalcaneal coalition resection with either corrective osteotomies or arthroereisis had a significant improvement of functional and radiological outcomes in the management of rigid pes planovalgus.

UNASSIGNED: The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch.
UNASSIGNED: This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period.
UNASSIGNED: No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle.
UNASSIGNED: NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic. Level of Evidence I; Randomized clinical trial.
UNASSIGNED: Os músculos extrínsecos, como o tibial posterior e flexor longo do hálux e os intrínsecos do pé fazem parte do subsistema ativo do foot core system e exercem papel essencial no controle do arco longitudinal medial. Devido à dificuldade na contração desses músculos, a eletroestimulação neuromuscular (EENM) torna-se um recurso aliado ao fortalecimento e é recomendada para reabilitação. O objetivo desse trabalho é avaliar a eficácia da EENM associada ao exercício na deformação do arco longitudinal medial.
UNASSIGNED: Este é um ensaio clínico randomizado cego. 60 participantes assintomáticos foram divididos em três grupos: EENM, exercício e controle. O grupo EENM e exercício realizaram sete exercícios para os músculos intrínsecos e extrínsecos duas vezes por semana por seis semanas, sendo o grupo EENM utilizou a EENM associada a cinco exercícios. A altura do navicular e o ângulo do arco longitudinal medial foram medidos antes e após o período de intervenção.
UNASSIGNED: Não houve diferenças estatisticamente significativas entre os grupos para a altura do navicular e ângulo do arco longitudinal medial.
UNASSIGNED: A EENM associada ao exercício não altera as características do arco longitudinal medial em indivíduos assintomáticos. Nível de Evidência I; Estudo Clínico Randomizado.

UNASSIGNED: Orthotic devices may be prescribed for the management of foot and ankle deformities caused by Charcot-Marie-Tooth disease (CMT). However, the actual use of these devices is variable. No studies have evaluated the impact of prescription, delivery and follow-up of orthotic devices on their use.We aimed to describe the relationship between the pathways followed by individuals with CMT and orthotic device use.
UNASSIGNED: Exploratory, cross-sectional, 35-item survey of orthotic device management. Individuals with CMT were recruited from CMT-France Association.
UNASSIGNED: Of the 940 respondents, 795 were included, mean age of 52.9 (SD 16.9) years. Rate of orthotic device use was 49.2% (391/795). The most frequent reason for non-use was a poor fit. Non-use was related to the orthotic device type, the health professionals consulted, and the severity of the CMT-related impairments. Follow-up visits (38.7%), re-evaluation of orthotic devices (25.3%) and consultations with the Physical and Rehabilitation Medicine physician were infrequent (28.3%).
UNASSIGNED: Orthotic devices are massively underused. Follow-up and re-evaluation are infrequent. Care pathways, prescription and delivery of orthotic devices must be optimized to meet the expectations of people with CMT. Device fitting, individual needs, and changes in the clinical state must be re-evaluated regularly by specialists to improve orthotic device use.
Foot deformities and foot drop contribute to disability in people with Charcot Marie Tooth Disease but use of orthotic devices is poor.To improve orthotic device use, regular multidisciplinary consultations and regular re-evaluation of the device by specialists in neuro-orthopaedics are important.The device fit should be regularly re-evaluated by the prescribing doctor or the practitioner who made the device.Regular multimodal evaluation of foot deformity, including muscle strength and length, and the individual’s needs and expectations is also important to improve orthotic device use.

Progressive collapsing foot deformity (PCFD) is a complex pathology associated with tendon insufficiency, ligamentous failure, joint malalignment, and aberrant plantar force distribution. Existing knowledge of PCFD consists of static measurements, which provide information about structure but little about foot and ankle kinematics during gait. A model of PCFD was simulated in cadavers (sPCFD) to quantify the difference in joint kinematics and plantar pressure between the intact and sPCFD conditions during simulated stance phase of gait.
In 12 cadaveric foot and ankle specimens, the sPCFD condition was created via sectioning of the spring ligament and the medial talonavicular joint capsule followed by cyclic axial compression. Specimens were then analyzed in intact and sPCFD conditions via a robotic gait simulator, using actuators to control the extrinsic tendons and a rotating force plate underneath the specimen to mimic the stance phase of walking. Force plate position and muscle forces were optimized using a fuzzy logic iterative process to converge and simulate in vivo ground reaction forces. An 8-camera motion capture system recorded the positions of markers fixed to bones, which were then used to calculate joint kinematics, and a plantar pressure mat collected pressure distribution data. Joint kinematics and plantar pressures were compared between intact and sPCFD conditions.
The sPCFD condition increased subtalar eversion in early, mid-, and late stance (P < .05), increased talonavicular abduction in mid- and late stance (P < .05), and increased ankle plantarflexion (P < .05), adduction (P < .05), and inversion (P < .05). The center of plantar pressure was significantly (P < .01) medialized in this model of sPCFD and simulated stance phase of gait.
Subtalar and talonavicular joint kinematics and plantar pressure distribution significantly changed with the sPCFD and in the directions expected from a PCFD foot. We also found that ankle joint kinematics changed with medial and plantar drift of the talar head, indicating abnormal talar rotation. Although comparison to an in vivo PCFD foot was not performed, this sPCFD model produced changes in foot kinematics and indicates that concomitant abnormal changes may occur at the ankle joint with PCFD.
This study describes the dynamic kinematic and plantar pressure changes in a cadaveric model of simulated progressive collapsing foot deformity during simulated stance phase.