Flexible flatfoot alters plantar loading and may necessitate surgery. Medializing calcaneal osteotomy (MCO) aims to restore the foot tripod. We compared dynamic pedobarographic parameters in children with flexible flatfoot after MCO with those of matched controls, with the arch index as the primary outcome. This matched-pair comparative study included children who underwent MCO ≥12 months previously and healthy controls matched 1 : 1 by sex, age, and BMI. Dynamic plantar pressure was recorded. Outcomes included arch index, regional plantar impulse, relative loading index across hindfoot/midfoot/forefoot, foot axis angle, and plantar phase-times normalized to stance. Mixed-effects multivariable linear regression was utilized, adjusted for age, sex, and BMI. Twenty-one children with flexible flatfoot were matched to 21 controls (38 feet per group). The mean follow-up after MCO was 3.45 years; 17/21 patients underwent concomitant gastrosoleus recession. Adjusted arch index remained higher in the flexible flatfoot group [mean difference = 0.06; 95% confidence interval (CI) = 0.03-0.08; P < 0.001], and equivalence within ±0.05 was not demonstrated (90% CI = 0.031-0.079). Midfoot impulses and regional foot loading were comparable between groups, whereas the flexible flatfoot group showed a more externally rotated foot axis angle. Total stance time did not differ, but the forefoot push-off phase (FFPOP) was 7.49% shorter in the flexible flatfoot group. A higher BMI was independently associated with a higher arch index and midfoot impulse. After MCO, children demonstrated residual differences in arch index and foot axis angle despite balanced plantar load-sharing and preserved stance timing. A shorter FFPOP suggests subtle late-stance propulsive adaptation, potentially influenced by calf lengthening.

A personal view of over 25 years of surgical management of flatfoot deformity. The reader will gain insight on procedural selection, philosophy on columnar approach, and keys to successful treatment of flatfoot deformity.

The Evans calcaneal osteotomy is a powerful lateral column lengthening procedure that creates multiplanar correction in the flexible flatfoot deformity. The procedure was popularized within podiatric medicine and surgery by Dr James V. Ganley. The Podiatry Institute faculty modified the procedure over the years. It has stood the test of time as a reliable procedure with good bone healing and predictable radiographic correction. This article describes its history along with its indications, surgical technique, and possible complications.

Flexible flatfoot (pes planus) alters lower-limb biomechanics and plantar-pressure distribution, raising the risk of pain and injury. Laboratory gait analysis with optical motion capture and force plates is the reference standard but is costly, space-constrained, and ecologically limited. We present the design, fabrication, and validation of a low-cost, sustainable smart insole for Internet-of-Things (IoT) remote body-load monitoring. The device pairs a dual-layer natural-rubber body-a silica-filled sponge-rubber upper for comfort and a carbon-black-reinforced solid outsole for durability-with four load cells per insole at high-pressure plantar landmarks, read through a 24-bit amplifier by an ESP32 that calibrates and streams left/right load over Wi-Fi to the ThingSpeak cloud, with a wrist-worn OLED for real-time feedback. Against reference weights in 25 participants, the system measured total body weight with a mean absolute error of 2.94%, a maximum error of 4.18%, and an RMSE of 1.94 kg (Pearson r = 0.99); the residual was an almost purely systematic proportional bias (slope 0.966, R2 = 0.98) removable by a single in-sample scalar recalibration. In 30 adults (15 normal-arch; 15 flexible flatfoot), spatiotemporal gait parameters were compared while both groups wore the smart insole. Forward-progression parameters, including step length, stride length, and walking velocity, did not differ significantly between groups during comfortable walking (all p > 0.18). The flatfoot group showed a wider mediolateral base-greater stance width during standing (+14%, p = 0.008) and step width during comfortable walking (+23%, p = 0.040, uncorrected). After correction for multiple comparisons, only the reduction in fast-walking cadence remained statistically significant. A sustainably sourced, affordable smart insole can thus deliver clinically meaningful remote body-load monitoring. The findings also point to a dissociation: forward propulsion was comparable between the groups while the insole was worn, whereas the mediolateral base remained wider in flatfoot. Controlled trials pairing orthotic support with active gait retraining are therefore warranted.

Flatfoot (pes planus) is common in children and adults. Although often asymptomatic, it may alter lower-limb biomechanics and contribute to pain or injury. Patients and caregivers increasingly use artificial intelligence chatbots such as chat generative pretrained transformer (ChatGPT) and Google Gemini for medical information, yet their responses on flatfoot remain insufficiently studied. This study compared the factual accuracy, added value, omissions, and readability of responses generated by ChatGPT and Google Gemini to standardized patient-oriented questions. In this cross-sectional comparative study, 15 standardized patient-oriented questions were developed from clinical guidelines, peer-reviewed literature, and educational resources from established orthopedic societies, then refined by 2 orthopedic surgeons. Each question was submitted to ChatGPT (OpenAI) and Google Gemini (Google LLC) in July 2025 using identical wording in independent chat sessions. Responses were anonymized and independently rated by 2 board-certified orthopedic surgeons for factual accuracy, added value, and omissions using an investigator-developed 5-point rubric. Discrepant assessments were reviewed by a 3rd senior orthopedic surgeon. Primary analyses used mean scores of the 2 reviewers. Readability was assessed using the Flesch-Kincaid grade level and Flesch reading ease score. Paired differences were analyzed using the Wilcoxon signed-rank test, with P < .05 considered significant. Both models produced generally accurate responses, with mean factual accuracy scores above 4/5. Gemini scored higher than ChatGPT for factual accuracy (4.7 ± 0.2 vs 4.2 ± 0.3, P = .01), added value (4.6 ± 0.3 vs 4.0 ± 0.4, P = .02), and omissions (4.8 ± 0.2 vs 3.9 ± 0.4, P < .001), with higher scores indicating fewer clinically relevant omissions. Gemini also generated longer responses (165 ± 20 vs 120 ± 15 words, P < .001) and showed better readability, with lower Flesch-Kincaid grade level (9.2 ± 1.1 vs 11.8 ± 1.4, P < .001) and higher Flesch reading ease score (59.4 ± 6.2 vs 42.5 ± 5.3, P < .001). Both models generated generally accurate answers to standardized flatfoot questions. Gemini performed better across evaluation domains and readability measures. As these findings are time-specific, repeated assessments and direct patient and caregiver evaluations are needed before broader patient-facing use can be recommended.

Adult acquired flatfoot deformity (AAFD) results from the collapse of the medial longitudinal arch (MLA), often managed conservatively with foot orthoses. While 3D printing enables rapid and cost-effective production of insoles, the biomechanical impact of different printing materials remains unclear. This study combined material testing, finite element (FE) simulation, and compression testing to evaluate four materials commonly used for 3D-printed insoles: PLA (polylactic acid), resin, EVA (ethylene vinyl acetate), and TPU (thermoplastic polyurethane). Tensile tests provided material properties for FE modeling of balanced standing using a validated healthy foot model. Outcome measures included MLA deformation (navicular drop), plantar stress distribution, and von Mises stress within the insole. A commercial semi-custom insole was tested for comparison. PLA and resin exhibited high stiffness (2228 and 880 MPa) and reduced navicular drop by 55-60%, compared with <30% reductions by EVA and TPU. Plantar stress distribution shifted from forefoot and hindfoot toward the midfoot, with PLA increasing midfoot load share to 38%. Compression testing confirmed that PLA and resin exhibited greater arch support ability than the semi-custom insole within a 10 mm displacement threshold. Material stiffness strongly influenced the biomechanical performance of 3D-printed insoles. Within this static simulation baseline, PLA and resin provided superior arch stabilization and stress redistribution compared with EVA, TPU, and a semi-custom reference. These findings suggest that material choice is critical to optimizing 3D-printed orthotic support, providing a valuable biomechanical baseline to guide future orthotic designs for flatfoot.

Background: Adult acquired flat foot deformity (AAFD) is a triplanar deformity characterised by collapse of the medial longitudinal arch. The most frequently used surgical method is the Evans calcaneal osteotomy. It is usually used in the paediatric age group and there are very few studies related to the use of the modified calcaneal osteotomy procedure in adults. The aim of this study was to evaluate the radiographic improvements after this procedure in the adult age group and to investigate whether or not there was real probability of increased arthritis in the STJ and CCJ. Methods: The study included 20 patients who presented at our clinic between January 2020 and June 2022 with the complaint of foot pain and were diagnosed with Grade 2 AAFD. This retrospective study was based on the data in the hospital records system and the patient follow-up forms. Preoperatively and at 1, 6, 12, and 24 months postoperatively, a record was made of calcaneus length, calcaneal slope angle, talocalcaneal angle, medial longitudinal arch angle, and the time to removal of the Kirschner wire. The presence of arthritis in the joint regions was calculated according to the Kellgren-Lawrence classification. Results: According to the data recorded preoperatively and at the postoperative follow-up examinations (mean 1-6-12-24 months), the difference in calcaneal length, calcaneal slope angle, and change in medial longitudinal arch angle were statistically significant (p < 0.001). No statistical significance was found in respect of the development of arthritis according to the preoperative and postoperative measurements for the CCJ and STJ (p = 1.00). Conclusions: The Modified Evans Osteotomy procedure is beneficial and effective in the correction of pes planovalgus. The surgeon must have a good knowledge of anatomy and it must not be forgotten that there could be variations. The probability of arthritis is not as high as has been assumed.