The primary objective of the minimally invasive Cotton osteotomy is to correct sagittal malalignment of the medial column by targeted plantarflexion, thereby restoring alignment and contributing to the reconstruction of complex pes planovalgus deformities within a joint-preserving surgical approach.

(1) Background: Gait analysis technologies have advanced; however, traditional systems like optical motion capture are lab-bound and costly, limiting rehabilitation monitoring. This cross-sectional study evaluates self-powered triboelectric nanogenerator (TENG) insoles combined with IMU sensors to assess gait asymmetry, plantar pressure signatures, age effects and injury history in rehabilitation patients, aiming to enable portable, battery-free phenotyping. (2) Methods: Fifty-three patients (22 females, 31 males; age, 29 ± 26 years) from Astana clinics with trauma histories (e.g., spine, ankle, fractures) and 10 healthy references underwent a 2 min walk test (2MWT). TENG insoles captured plantar loading; ankle/knee IMUs measured spatiotemporal parameters (cadence, asymmetry). The data were normalized; the analyses used an ANOVA and correlations (Python 3.14.3). (3) Results: The TENG sensors showed force/frequency linearity (up to 10 V at 20 N). The cadence averaged 101 ± 10 steps/min, declining with age (r = -0.31, p = 0.03) and fractures (r = -0.23, p = 0.04). The asymmetry varied (-54% to +31%) without category differences. Flatfoot (55%) was linked to lateral loading shifts; condition-specific waveform signatures emerged (e.g., lateral heel in ankle issues). (4) TENG-IMU systems feasibly capture gait phenotypes in heterogeneous cohorts, supporting out-of-lab monitoring for personalized rehabilitation without batteries. Prospective validation is required for further practical implications.

Background/Objectives: Subtalar arthroereisis (STA) is widely used for symptomatic pediatric flexible flatfoot and provides consistent radiographic correction. However, return to sport (RTS) after STA is less well defined, and the relative role of early postoperative pain versus radiographic correction remains unclear. Methods: We performed a retrospective observational cohort study of consecutive skeletally immature patients treated with STA using a non-absorbable endosinotarsal screw at a single tertiary center. Inclusion criteria were symptomatic flexible flatfoot refractory to >6 months of conservative treatment, complete pre-/postoperative weight-bearing radiographs, complete functional data, and minimum follow-up of 6 months. The primary endpoint was RTS to the pre-symptom primary sport at final follow-up. Secondary outcomes were UCLA Activity Score, FAAM Sport subscale, and postoperative VAS. Radiographic correction was quantified as delta change (Δ) in Meary, Costa-Bertani, and Kite angles. Group comparisons used nonparametric tests. A parsimonious multivariable logistic regression model (EPV-constrained) included UCLA at 3 months, VAS pain, and ΔMeary. Results: Fifty patients were included (mean follow-up 9.2 ± 2.5 months; range 6-14); 27/50 (54%) resumed their primary sport. Baseline characteristics were comparable between Returners and Non-Returners. Returners showed higher early postoperative UCLA scores than Non-Returners (8.0 [7.0-8.5] vs. 6.0 [5.0-7.0], p = 0.005). FAAM Sport and VAS pain did not differ significantly between groups (p = 0.224 and p = 0.493, respectively). Radiographic correction magnitude was similar between groups (ΔMeary p = 0.938; ΔCosta-Bertani p = 0.984; ΔKite p = 0.108). In multivariable analysis, UCLA at 3 months was the only independent correlate of RTS (OR 2.65 per point, 95% CI 1.34-6.15; p = 0.009), whereas VAS pain (OR 0.98, 95% CI 0.76-1.25; p = 0.892) and ΔMeary (OR 1.01, 95% CI 0.91-1.13; p = 0.875) were not significant. Conclusions: In this cohort, STA achieved substantial radiographic correction, but neither correction magnitude nor early postoperative pain independently correlated with RTS at short-term follow-up. Early postoperative activity level was the strongest independent correlate of sport resumption, supporting a function-centered postoperative assessment beyond radiographic alignment alone.

The purpose of this clinical practice guideline is to provide evidence-based recommendations for the treatment of pediatric flexible flatfoot, developed in accordance with the Appraisal of Guidelines for Research and Evaluation II framework and with evidence certainty assessed using the GRADE framework and the Oxford Centre for Evidence-Based Medicine levels of evidence system. A multidisciplinary guideline development group under the Limb Reconstruction Committee of the Orthopedics Branch of China International Exchange and Promotion Association for Medical and Health Care systematically searched and reviewed evidence from primary studies including randomized controlled trials, cohort studies, and comparative studies, supplemented by existing systematic reviews and expert society surveys, to evaluate the effectiveness of conservative and surgical interventions and to guide clinicians and families on the content of an optimal treatment pathway. The guideline targets children and teenagers with flexible flatfoot and addresses interventions available to orthopedic surgeons, podiatrists, rehabilitation physicians, and orthotists, including observation, rehabilitative exercises, foot orthoses, subtalar arthroereisis, calcaneal osteotomy, and criterion-based progression to surgery. Structured conservative management should be considered the mainstay of care for all symptomatic children, with a minimum 6-month trial before surgical referral. However, there is limited evidence on the optimal type, dose, and duration of conservative treatment, and what constitutes an adequate trial of nonoperative care remains undefined. Foot orthoses can be helpful for symptomatic relief when pain or functional limitation is present, and rehabilitative exercise programs may allow superior normalization rates compared to orthoses alone. Pain-free ambulation and return to unrestricted sport are key milestones for both conservative and surgical pathways. However, no validated progression or discharge criteria exist to guide the transition from one treatment phase to the next. While the certainty of evidence was low to very low for most components of the treatment pathway, all 15 recommendation statements were formulated through two rounds of Delphi consensus polling, with 13 achieving the predefined ≥75% agreement threshold. This guideline also highlights the need for standardized diagnostic definitions, multicenter registry data, and age-stratified surgical indications not systematically addressed in previously published literature.

The calcaneo-stop procedure is a minimally invasive surgical technique widely used to treat symptomatic flexible flatfoot (FFF) in pediatric patients. Although generally considered safe, complication rates vary across studies, and no quantitative synthesis has specifically evaluated its adverse event profile. A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Five databases were searched up to May 2025. Studies reporting postoperative complications after calcaneo-stop in patients younger than 18 years were included. Pooled complication rates were calculated using random-effects models, with subgroup analyses based on age, sex, screw type, and diameter. Twenty-two studies involving 1777 patients and 3082 operated feet were included. The overall pooled complication rate was 7.97% (95% confidence interval: 5.96-9.97%). The most frequent complications were postoperative pain (2.79%), reintervention (2.27%), incision-site symptoms (2.23%), peroneal spasm (1.72%), screw breakage (1.42%), superficial infection (1.37%), and screw loosening (0.72%). Higher complication rates were observed in patients older than 13 years (15.84%; P < 0.001), in cortical screws (13.2%), and in screws greater than or equal to 4.5 mm in diameter (13.9%; P = 0.0019). Bioabsorbable screws and 6.5 mm implants showed the lowest complication rates. The calcaneo-stop procedure appears to be a safe and effective treatment for symptomatic pediatric FFF, with complication risk influenced by patient age and implant characteristics.

Background: Flatfoot deformity is associated with altered lower extremity biomechanics and functional impairment during gait. However, evidence describing spatio-temporal gait alterations remains heterogeneous and has not been consistently synthesized across studies. Methods: A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (via PubMed) and Scopus were searched through 24 March 2025 for studies evaluating gait characteristics in individuals with flatfoot or progressive collapsing foot deformity. Studies reporting spatio-temporal parameters in both flatfoot and healthy control cohorts were included in quantitative synthesis. Random-effects meta-analyses were performed to evaluate gait velocity, stance duration, stride length, and cadence. Results: Fifteen studies met inclusion criteria, of which five provided sufficient data for meta-analysis. Compared with healthy controls, individuals with flatfoot demonstrated longer stance duration and shorter stride length. No differences were observed in gait velocity or cadence. Substantial heterogeneity was present across all pooled outcomes (I2 > 80%), reflecting variability in study populations, disease characteristics, and gait analysis methodologies. Conclusions: Flatfoot is associated with consistent spatio-temporal gait adaptations characterized by longer stance duration and reduced stride length. Despite heterogeneity among included studies, these findings suggest consistent spatio-temporal gait adaptations that may serve as clinically relevant markers of altered gait mechanics and functional impairment. Further studies with standardized protocols are needed to refine the role of gait analysis in the assessment and management of flatfoot.