This article is meant to serve as a reference for radiologists, orthopedic surgeons, and other physicians to enhance their understanding of progressive collapsing foot deformity, also known as adult acquired flat foot deformity. Pathophysiology, imaging findings, especially on MRI and 3-dimensional MRI are discussed with relevant illustrations so that the readers can apply these principles in their practice for better patient managements.

Background: Pes planus, commonly known as flatfoot, is a condition in which the medial arch of the foot is abnormally low or absent, leading to the inner part of the foot having less curvature than normal. Symptom recognition and errors in diagnosis are problems encountered in daily practice. Therefore, it is important to improve how a diagnosis is made. With the availability of large datasets, deep neural networks have shown promising capabilities in recognizing foot structures and accurately identifying pes planus. Methods: In this study, we developed a novel fusion model by combining the Vgg16 convolutional neural network (CNN) model with the vision transformer ViT-B/16 to enhance the detection of pes planus. This fusion model leverages the strengths of both the CNN and ViT architectures, resulting in improved performance compared to that in reports in the literature. Additionally, ensemble learning techniques were employed to ensure the robustness of the model. Results: Through a 10-fold cross-validation, the model demonstrated high sensitivity, specificity, and F1 score values of 97.4%, 96.4%, and 96.8%, respectively. These results highlight the effectiveness of the proposed model in quickly and accurately diagnosing pes planus, making it suitable for deployment in clinics or healthcare centers. Conclusions: By facilitating early diagnosis, the model can contribute to the better management of treatment processes, ultimately leading to an improved quality of life for patients.

BACKGROUND: Short foot exercise (SFE) can be combined with dynamic functional tasks such as squats; however, it is unclear whether this combination increases intrinsic foot muscle activity.
OBJECTIVE: This study aimed to investigate and compare the abductor hallucis muscle (AbdH) activity during SFE in static and dynamic functional tasks.
METHODS: The AbdH electromyography data of 17 healthy participants with and without SFE were analyzed during static tasks (sitting, double-leg standing, and single-leg standing) and dynamic tasks (double-leg squat, single-leg squat, split squat, and heel-raise). The static tasks were performed with SFE for 5 seconds, and the dynamic tasks were performed while performing SFE. AbdH activity with or without SFE during the task was compared using the Friedman and Wilcoxon signed-rank tests.
RESULTS: AbdH activity was significantly greater in conditions with SFE than in those without SFE for all tasks (P < 0.01) except for heel-raise (P = 0.163). AbdH activity during SFE in single-leg standing was significantly higher than that in sitting, double-leg standing, and double-leg squats (P < 0.05). AbdH activity during SFE in the single-leg squat was also significantly greater than that in the sitting position (P = 0.024). No significant differences were found in any other between-task comparisons of AbdH activity during SFE. AbdH activity during tasks without SFE revealed significantly lower levels for sitting and double-leg standing compared to single-leg squat, split squat, and heel-raise (P < 0.001). Additionally, the activity in double-leg squat was significantly lower than in both single-leg squat and heel-raise (P < 0.05).
CONCLUSIONS: Combining dynamic tasks, except for the heel-raise task, with SFE can increase AbdH activity more than dynamic tasks without SFE. However, clinicians should note that combining dynamic tasks with the SFE may not increase AbdH activity compared to combining static tasks with the SFE.

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.

OBJECTIVE: Distal extremity misalignment may give rise to pelvic floor dysfunctions (PFDs). This study aimed to compare pelvic floor muscle strength (PFMS) and dysfunctions in women with and without pes planus.
METHODS: Women with (pes planus group, n = 30) and without pes planus (control group, n = 30) were included. The presence of PFDs questioned. Pes planus with the Feiss Line Test, PFMS with the Modified Oxford Scale, and the severity of PFDs with the Pelvic Floor Distress Inventory-20 (PFDI-20), including three subscales (Pelvic Organ Distress Inventory-6 (POPDI-6) for pelvic organ prolapse, Colorectal-Anal Distress Inventory-8 (CRADI-8) for colorecto-anal symptoms, and Urinary Distress Inventory-6 (UDI-6) for urinary symptoms, were assessed.
RESULTS: It was seen that no difference was found between groups in terms of PFMS (p > 0.05). However, urinary incontinence and anal incontinence were higher in women with pes planus than in women without pes planus (p < 0.05). Only the PFDI-20, CRADI-8, and UDI-6 scores were higher in women with pes planus compared to controls (p < 0.05). There was no difference was found between groups in terms of POPDI-6 scores (p > 0.05).
CONCLUSIONS: The PFMS did not change according to the presence of pes planus. However, the prevalence of PFDs and their severity were higher in women with pes planus in comparison to controls. Posture assessments of individuals with PFDs, especially examination of foot posture, and pelvic floor assessments of individuals with posture disorders should be considered.

BACKGROUND: Pes planus occurs due to the loss of the longitudinal arch of the foot, resulting in altered gait mechanics. This may lead to increased complications following total hip arthroplasty (THA). Thus, the aim of this study was to assess the effects that pes planus has on rates of falls, implant complications, fall-related injuries, and times to revision among THA patients.
METHODS: A retrospective review of a private insurance claims database was conducted from 2010 to 2021. Patients who had a diagnosis of congenital or acquired pes planus and cases of THA were identified. Patients undergoing THA with a diagnosis of pes planus were matched to control patients 1:5 based on age, sex, and comorbidity profiles. Logistic regression was utilized to assess for differences in complication rates.
RESULTS: A total of 3,622 pes planus patients were matched to 18,094 control patients. The pes planus group had significantly higher rates of falls than the control group (6.93 versus 2.97%, OR [odds ratio]: 2.43; CI [confidence interval]: 2.09 to 2.84; P < .001). Pes planus patients also had significantly greater odds of dislocation (OR: 1.89; CI: 1.58 to 2.27; P < .001), mechanical loosening (OR: 2.43; CI: 2.09 to 2.84; P = .019), and periprosthetic fracture (OR: 2.43; CI: 2.09 to 2.84; P < .001). The pes planus group had significantly greater rates of proximal humerus fractures (P = .008), but no difference was seen in distal radius fractures (P = .102). The time to revision was significantly shorter in the pes planus group (190 versus 554 days, P < .001).
CONCLUSIONS: Pes planus in patients undergoing THA is associated with increased risk of complications and faster time to revision. These findings may allow orthopaedic surgeons to identify those patients at risk and allow for more educated patient counseling and operative planning.

Pes planus, commonly referred to as flatfoot, is a congenital foot deformity characterized by the descent of the medial longitudinal arch, resulting in reduced spring action and increased stress on the foot during ambulation. This condition, opposite to pes cavus, typically lacks symptomatic presentation despite its structural abnormality. This case report discusses a 20-year-old female presenting to the musculoskeletal department of physiotherapy with impaired gait attributed to developmental flatfeet and an underdeveloped heel on one foot since birth. Apart from these foot deformities, no other significant abnormalities were noted upon examination. Orthotic management and ongoing monitoring have been initiated to facilitate functional independence. The prognosis for the patient\'s gait impairment remains optimistic with continued rehabilitation efforts aimed at dispelling misconceptions and barriers surrounding the correction of flatfoot deformities. This report underscores the importance of comprehensive rehabilitation strategies in managing flatfoot conditions to optimize patient outcomes and quality of life.

BACKGROUND: The use of subtalar arthroereisis as an adjunct to the surgical treatment of stage 1 flexible progressive collapsing foot deformity (PCFD) is controversial. The aim was to investigate the clinical outcomes and report the implant removal rate of subtalar arthroereisis as an adjunct for stage 1 PCFD.
METHODS: A retrospective study of 212 consecutive feet undergoing operative management of stage 1 PCFD with adjunctive subtalar arthroereisis between October 2010 and April 2018. The primary outcome was the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included Foot and Ankle Disability Index (FADI), Euroqol-5D-5L Index and implant removal rate.
RESULTS: Post-operative clinical FAOS outcomes were collected for 153 feet (72.2%). At mean 2.5-year follow-up, the mean ± standard deviation FAOS for each domain was as follows; Pain: 81.5 ± 18.5, Symptoms: 79.5 ± 12.9, Activities of Daily Living: 82.5 ± 15.4 and Quality of Life: 64.2 ± 23.7. EQ-5D-5L Index was 0.884 ± 0.152. Pre-operative scores were available for 20 of these feet demonstrating a statistically significant improvement in all FAOS, FADI and EQ-5D-5L domains (p < 0.05). The implant removal rate for persistent sinus tarsi pain was 48.1% (n = 102).
CONCLUSIONS: Use of a subtalar arthroereisis implant as an adjunct to conventional procedures in stage 1 flexible PCFD can result in significant improvement in pain and function. Patients should be counselled as to the relatively frequent rate of subsequent implant removal.
METHODS: IV.

Congenital deformities of the foot significantly challenge the mobility and quality of life of affected individuals. While surgical interventions are common, rehabilitation protocols tailored to address the specific needs of adults with congenital foot deformities are less explored. This case series aims to evaluate the effectiveness of a specialized foot rehabilitation protocol in improving functional outcomes and quality of life in adults with congenital foot deformities. A series of cases involving adults diagnosed with congenital foot deformities were enrolled in a structured rehabilitation program. The protocol incorporated a combination of therapeutic exercises, manual therapy, gait training, and orthotic management tailored to individual needs. Outcome measures included functional assessments, gait analysis, pain levels, and patient-reported outcomes at baseline, midpoint, and endpoint of the rehabilitation program. Preliminary findings from the case series indicate significant improvements in various outcome measures following the foot rehabilitation protocol. Participants demonstrated enhanced gait parameters, reduced pain levels, increased range of motion, and improved functional capacity. Moreover, subjective assessments revealed enhanced satisfaction and perceived improvements in quality of life among participants. The findings suggest that a tailored foot rehabilitation protocol can be beneficial in improving functional outcomes and quality of life in adults with congenital foot deformities. This underscores the importance of integrating comprehensive rehabilitation strategies alongside surgical interventions to optimize long-term outcomes and enhance the overall well-being of individuals with congenital foot deformities. Further research with larger sample sizes and controlled study designs is warranted to validate these findings and establish evidence-based rehabilitation guidelines for this population.

BACKGROUND: Flatfeet in children are common, causing concern for parents due to potential symptoms. Technological advances, like 3D foot kinematic analysis, have revolutionized assessment. This review examined 3D assessments in paediatric idiopathic flexible flat feet (FFF).
METHODS: Searches focused on paediatric idiopathic FFF in PubMed, Web of Science, and SCOPUS. Inclusion criteria required 3D kinematic and/or kinetic analysis during posture or locomotion, excluding non-idiopathic cases, adult feet, and studies solely on pedobarography or radiographs.
RESULTS: Twenty-four studies met the criteria. Kinematic and kinetic differences between FFF and typical feet during gait were outlined, with frontal plane deviations like hindfoot eversion and forefoot supination, alongside decreased second peak vertical GRF. Dynamic foot classification surpassed static assessments, revealing varied movement patterns within FFF. Associations between gait characteristics and clinical measures like pain symptoms and quality of life were explored. Interventions varied, with orthoses reducing ankle eversion and knee and hip abductor moments during gait, while arthroereisis normalized calcaneal alignment and hindfoot eversion.
CONCLUSIONS: This review synthesises research on 3D kinematics and kinetics in paediatric idiopathic FFF, offering insights for intervention strategies and further research.