Matheis Erika A, Spratley E Meade, Hayes Curtis W, Adelaar Robert S, Wayne Jennifer S
Graduate Student, Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA.
Professor, Department of Radiology, Virginia Commonwealth University, Richmond, VA.
J Foot Ankle Surg. 2014 Sep-Oct;53(5):562-6. doi: 10.1053/j.jfas.2014.03.020. Epub 2014 May 3.
Adult acquired flatfoot deformity is a degenerative disease causing medial arch dysfunction. Surgical correction has typically involved tendon reconstruction with calcaneal osteotomy; however, the postoperative changes have not been fully characterized. The present study assessed the success of surgical correction of Stage IIb adult acquired flatfoot deformity through changes in plantar pressures and patient-generated outcome scores. With Institutional Review Board approval, 6 participants were evaluated before and after surgery using pedobarography, the Foot and Ankle Outcome Score, and the Medical Outcomes Study 36-item short-form questionnaire. The plantar pressures were recorded using a TekScan HRMat(®) during walking and in a 1- and 2-foot stance. The resulting contour maps were segmented into 9 regions, with the peak pressure, normalized force, and arch index calculated. Surgical effects were analyzed using paired t tests. Postoperatively, the Foot and Ankle Outcome Score and Medical Outcomes Study 36-item short-form questionnaire scores increased significantly from 180 ± 78 to 360 ± 136 (p < .03) and 47 ± 18 to 71 ± 19 (p = .06), respectively. During the 2-foot stance, the normalized force had increased significantly in the lateral midfoot (p < .03), although no significant differences were found in peak pressures. No significant differences were observed in the 1-foot stance. During walking, the normalized force increased significantly in the lateral mid- and forefoot (p < .05). The peak pressure increased significantly in the lateral forefoot (p < .01). The arch index values demonstrated no significant changes. The increased questionnaire scores indicated that surgical correction improved the self-perceived health of the participants. Lateral shifts in the peak pressure and normalized force suggest that forefoot and midfoot loading is altered postoperatively, consistent with the goal of offloading the dysfunctional arch. Thus, the present study has demonstrated that surgical treatment of adult acquired flatfoot deformity can be accurately assessed using patient-reported outcome measures and plantar pressures.
成人获得性平足畸形是一种导致内侧足弓功能障碍的退行性疾病。手术矫正通常包括跟骨截骨术的肌腱重建;然而,术后变化尚未得到充分描述。本研究通过足底压力变化和患者生成的结果评分评估IIb期成人获得性平足畸形手术矫正的成功率。经机构审查委员会批准,使用足底压力测量法、足踝结果评分和医学结果研究36项简式问卷对6名参与者在手术前后进行了评估。在行走、单脚站立和双脚站立时,使用TekScan HRMat(®)记录足底压力。将所得的等高线图分割为9个区域,计算峰值压力、归一化力和足弓指数。使用配对t检验分析手术效果。术后,足踝结果评分和医学结果研究36项简式问卷评分分别从180±78显著提高到360±136(p<.03)和47±18提高到71±19(p=.06)。在双脚站立时,中足外侧的归一化力显著增加(p<.03),尽管峰值压力未发现显著差异。在单脚站立时未观察到显著差异。在行走时,中足外侧和前足外侧的归一化力显著增加(p<.05)。前足外侧的峰值压力显著增加(p<.01)。足弓指数值未显示出显著变化。问卷评分的提高表明手术矫正改善了参与者的自我感知健康状况。峰值压力和归一化力的外侧移位表明术后前足和中足负荷发生了改变,这与减轻功能障碍足弓负荷的目标一致。因此,本研究表明,使用患者报告的结果测量和足底压力可以准确评估成人获得性平足畸形的手术治疗效果。