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Correlation of postoperative midfoot position with outcome following reconstruction of the stage II adult acquired flatfoot deformity.
Foot Ankle Int. 2015 Mar; 36(3):239-47.FA

Abstract

BACKGROUND

No studies investigating the effect of the midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from anteroposterior (AP) radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS).

METHODS

Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors' institution who underwent flatfoot reconstruction for a stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo-first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with 2 or more measurements in the abduction category were classified as the abduction group (n = 30); those with 1 or fewer measurements in the abduction category were placed in the adduction group (n = 25). The preoperative and postoperative FAOS values with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests.

RESULTS

Patients corrected to a position of adduction showed significantly lower improvement in the FAOS daily activities (P = .012) and quality of life subscales (P = .046). The mean improvement in subscale scores for the adducted group was lower for pain (P = .052) and sports activities (P = .085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (P = .372) between groups was found.

CONCLUSION

Correction of the talonavicular joint to a position of adduction following a stage II AAFD was associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in reconstruction of a stage II AAFD.

Authors+Show Affiliations

Hospital for Special Surgery, New York, New York, USA.Hospital for Special Surgery, New York, New York, USA.Hospital for Special Surgery, New York, New York, USA.Hospital for Special Surgery, New York, New York, USA.Hospital for Special Surgery, New York, New York, USA delandj@hss.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25589542

Citation

Conti, Matthew S., et al. "Correlation of Postoperative Midfoot Position With Outcome Following Reconstruction of the Stage II Adult Acquired Flatfoot Deformity." Foot & Ankle International, vol. 36, no. 3, 2015, pp. 239-47.
Conti MS, Chan JY, Do HT, et al. Correlation of postoperative midfoot position with outcome following reconstruction of the stage II adult acquired flatfoot deformity. Foot Ankle Int. 2015;36(3):239-47.
Conti, M. S., Chan, J. Y., Do, H. T., Ellis, S. J., & Deland, J. T. (2015). Correlation of postoperative midfoot position with outcome following reconstruction of the stage II adult acquired flatfoot deformity. Foot & Ankle International, 36(3), 239-47. https://doi.org/10.1177/1071100714564217
Conti MS, et al. Correlation of Postoperative Midfoot Position With Outcome Following Reconstruction of the Stage II Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2015;36(3):239-47. PubMed PMID: 25589542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correlation of postoperative midfoot position with outcome following reconstruction of the stage II adult acquired flatfoot deformity. AU - Conti,Matthew S, AU - Chan,Jeremy Y, AU - Do,Huong T, AU - Ellis,Scott J, AU - Deland,Jonathan T, Y1 - 2015/01/14/ PY - 2015/1/16/entrez PY - 2015/1/16/pubmed PY - 2015/12/17/medline KW - adult acquired flatfoot deformity KW - clinical outcomes KW - midfoot abduction KW - reconstruction KW - talonavicular joint SP - 239 EP - 47 JF - Foot & ankle international JO - Foot Ankle Int VL - 36 IS - 3 N2 - BACKGROUND: No studies investigating the effect of the midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from anteroposterior (AP) radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). METHODS: Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors' institution who underwent flatfoot reconstruction for a stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo-first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with 2 or more measurements in the abduction category were classified as the abduction group (n = 30); those with 1 or fewer measurements in the abduction category were placed in the adduction group (n = 25). The preoperative and postoperative FAOS values with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests. RESULTS: Patients corrected to a position of adduction showed significantly lower improvement in the FAOS daily activities (P = .012) and quality of life subscales (P = .046). The mean improvement in subscale scores for the adducted group was lower for pain (P = .052) and sports activities (P = .085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (P = .372) between groups was found. CONCLUSION: Correction of the talonavicular joint to a position of adduction following a stage II AAFD was associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in reconstruction of a stage II AAFD. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/25589542/Correlation_of_postoperative_midfoot_position_with_outcome_following_reconstruction_of_the_stage_II_adult_acquired_flatfoot_deformity_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100714564217?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -