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Adult flatfoot.
Orthop Traumatol Surg Res. 2015 Feb; 101(1 Suppl):S11-7.OT

Abstract

Adult flatfoot is defined as a flattening of the medial arch of the foot in weight-bearing and lack of a propulsive gait. The 3 lesion levels are the talonavicular, tibiotarsal and midfoot joints. The subtalar joint is damaged by the consequent rotational defects. Clinical examination determines deformity and reducibility, and assesses any posterior tibialis muscle deficit, the posterior tibialis tendon and spring ligament being frequently subject to degenerative lesions. Radiographic examination in 3 incidences in weight-bearing is essential, to determine the principal level of deformity. Tendon (posterior tibialis tendon) and ligamentous lesions (spring ligament and interosseous ligament) are analyzed on MRI or ultrasound. In fixed deformities, CT explores for arthritic evolution or specific etiologies. 3D CT reconstruction can analyze bone and joint morphology and contribute to the planning of any osteotomy. Medical management associates insoles and physiotherapy. Acute painful flatfoot requires strict cast immobilization. Surgical treatment associates numerous combinations of procedures, currently under assessment for supple flatfoot: for the hindfoot: medial slide calcaneal osteotomy, calcaneal lengthening osteotomy, or arthroereisis; for the midfoot: arthrodesis on one or several rays, or first cuneiform or first metatarsal osteotomy; for the ankle: medial collateral ligament repair with tendon transfer. Fixed deformities require arthrodesis of one or several joint-lines in the hindfoot; for the ankle, total replacement after realignment of the foot, or tibiotalocalcaneal fusion or ankle and hindfoot fusion; and, for the midfoot, cuneonavicular or cuneometatarsal fusion. Tendinous procedures are often associated. Specific etiologies may need individualized procedures. In conclusion, adult flatfoot tends to be diagnosed and managed too late, with consequent impact on the ankle, the management of which is complex and poorly codified.

Authors+Show Affiliations

Polyclinique de Bordeaux-Tondu, 151, rue du Tondu, 33082 Bordeaux, France. Electronic address: toullec.eric2@wanadoo.fr.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25595429

Citation

Toullec, E. "Adult Flatfoot." Orthopaedics & Traumatology, Surgery & Research : OTSR, vol. 101, no. 1 Suppl, 2015, pp. S11-7.
Toullec E. Adult flatfoot. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S11-7.
Toullec, E. (2015). Adult flatfoot. Orthopaedics & Traumatology, Surgery & Research : OTSR, 101(1 Suppl), S11-7. https://doi.org/10.1016/j.otsr.2014.07.030
Toullec E. Adult Flatfoot. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S11-7. PubMed PMID: 25595429.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adult flatfoot. A1 - Toullec,E, Y1 - 2015/01/13/ PY - 2014/01/10/received PY - 2014/07/08/revised PY - 2014/07/08/accepted PY - 2015/1/18/entrez PY - 2015/1/18/pubmed PY - 2015/7/30/medline KW - Calcaneal osteotomy KW - Flatfoot KW - Posterior tibialis tendon SP - S11 EP - 7 JF - Orthopaedics & traumatology, surgery & research : OTSR JO - Orthop Traumatol Surg Res VL - 101 IS - 1 Suppl N2 - Adult flatfoot is defined as a flattening of the medial arch of the foot in weight-bearing and lack of a propulsive gait. The 3 lesion levels are the talonavicular, tibiotarsal and midfoot joints. The subtalar joint is damaged by the consequent rotational defects. Clinical examination determines deformity and reducibility, and assesses any posterior tibialis muscle deficit, the posterior tibialis tendon and spring ligament being frequently subject to degenerative lesions. Radiographic examination in 3 incidences in weight-bearing is essential, to determine the principal level of deformity. Tendon (posterior tibialis tendon) and ligamentous lesions (spring ligament and interosseous ligament) are analyzed on MRI or ultrasound. In fixed deformities, CT explores for arthritic evolution or specific etiologies. 3D CT reconstruction can analyze bone and joint morphology and contribute to the planning of any osteotomy. Medical management associates insoles and physiotherapy. Acute painful flatfoot requires strict cast immobilization. Surgical treatment associates numerous combinations of procedures, currently under assessment for supple flatfoot: for the hindfoot: medial slide calcaneal osteotomy, calcaneal lengthening osteotomy, or arthroereisis; for the midfoot: arthrodesis on one or several rays, or first cuneiform or first metatarsal osteotomy; for the ankle: medial collateral ligament repair with tendon transfer. Fixed deformities require arthrodesis of one or several joint-lines in the hindfoot; for the ankle, total replacement after realignment of the foot, or tibiotalocalcaneal fusion or ankle and hindfoot fusion; and, for the midfoot, cuneonavicular or cuneometatarsal fusion. Tendinous procedures are often associated. Specific etiologies may need individualized procedures. In conclusion, adult flatfoot tends to be diagnosed and managed too late, with consequent impact on the ankle, the management of which is complex and poorly codified. SN - 1877-0568 UR - https://www.unboundmedicine.com/medline/citation/25595429/Adult_flatfoot_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1877-0568(14)00331-4 DB - PRIME DP - Unbound Medicine ER -