Progressive collapsing foot deformity (PCFD) is a common condition with an estimated prevalence of 3.3% in women greater than 40 years. Progressive in nature, symptomatic flatfoot deformity can be a debilitating condition due to pain and limited physical function; it has been shown to have one of the poorest preoperative patient reported outcome scores in foot and ankle pathologies, second to ankle arthritis. Operative reconstruction of PCFD can be performed in a single-stage manner or through multiple stages. The purpose of this study is to compare costs for non-staged (NS) flatfoot reconstructions, which typically require longer hospital stays, with costs for staged (S) reconstructions, where patients usually do not require hospital admission. To our knowledge, the comparison between single-staged and multi-staged flatfoot reconstructions has not been previously done. This study will run in conjunction with one that compares rates of complications and reoperation, as well as patient reported outcomes on function and pain associated with S and NS flatfoot reconstruction. Overall, the goal is to optimize surgical management of PCFD, by addressing healthcare costs and patient outcomes.

At our academic centre with foot and ankle specialists, we selected one surgeon who primarily performs NS flatfoot reconstruction and another who primarily performs S procedures. Retrospective chart reviews of patients who have undergone either S or NS flatfoot reconstruction were performed from November 2011 to August 2021. Length of operating time, number of primary surgeries, length of hospital admission, and number of reoperations were recorded. Cost analysis was performed using local health authority patient rates for non residents as a proxy for health system costs. Rates of operating room per hour and hospital ward stay per diem in Canadian dollars were used. The analysis is currently ongoing.

72 feet from 66 patients were analyzed in the S group while 78 feet from 70 patients were analyzed in the NS group. The average age in the S and NS group are 49.64 +/− 1.76 and 57.23 +/− 1.68 years, respectively. The percentage of female patients in the S and NS group are 63.89% and 57.69%, respectively. All NS patients stayed in hospital post-operatively and the average length of stay for NS patients is 3.65 +/− 0.37 days. Only 10 patients from S group required hospital admission.

The average total operating room cost including all stages for S patients was $12,303.12 +/− $582.20. When including in-patient ward costs for patients who required admission from S group, the average cost for operating room and in-patient ward admission was $14,196.00 +/− $1,070.01 after flatfoot reconstruction.

The average in-patient ward admission cost for NS patients was $14,518.83 +/− $1,476.94 after flatfoot reconstruction. The cost analysis for total operating room costs for NS patients are currently ongoing. Statistical analysis comparing S to NS flatfoot reconstruction costs are pending.

Preliminary cost analysis suggests that multi-staged flatfoot reconstruction costs less than single-staged flatfoot reconstruction. Once full assessment is complete with statistical analysis, correlation with patient reported outcomes and complication rate can guide future PCFD surgical management.

We report our experience at the Pediatric Hospital “Ricardo Gutierrez” in Buenos Aires. 11 diplegic patients (8 male, 3 female) who presented severe neurological valgus feet were treated with the Dennyson Fulford technique between 1996 and 2000. 7 patients had a bilateral deformity and 4 unilateral deformity . Patients’ ages averaged 9.5 years (range, 7–12 years). The average follow up was 2 years and 3 months (range, 7 months–5 years).

We took into consideration the following parameters to evaluate the results: 1- hind foot position, 2- adaptation to the orthosis 3- pain. The results were excellent in 10 feet, good in 6 feet and poor in 2 feet.

The results obtained with the subtalar fusion using a screw for fixation coupled with bone graft were considered satisfactory on obtaining 88% of good and fair results and a good acceptance among patients. We consider that the Dennyson Fulford technique allows an proper reduction with few complications and we emphasize it as the best option among other current surgical techniques for this pathology.

Introduction: Hypermobility is a common finding, however, it lacks diagnostic parameters and is poorly understood, especially in the foot.

Aim: To quantify medial column/first ray mobility in patients with midfoot arthritis and planovalgus feet.

Methods: We compared first ray mobility in patients with radiologically defined midfoot tarsometatarsal osteoarthritis, a radiologically normal first ray and planovalgus feet, with control subjects who had normal feet and first rays. An all female group of 20 patients (mean age of 70) and 20 controls (mean age of 53) met the criteria. Analysis of patients’ x-rays identified the site of their arthritis and allowed angular measurements of their flat foot deformity. Patient and control subjects underwent identical examinations, recording hindfoot correctability, medial longitudinal arch appearance, hindfoot prontion and supination, forefoot supination and degrees of flexion/extension and abduction/adduction with an electronic goniometer. Each subject was graded by the AOFAS and SF-36 outcome scores.

Results: There was a significant difference in first ray mobility between the patient and control subjects for all positions adopted (P=< 0.001), except when dorsiflexed and weight bearing (P=0.052). Patients with a neutral non-weight bearing ankle exhibited greatest mobility of 16.8 +/− 4.7 degrees compared to 9.4 +/− 2.6 degrees in controls. This was a significant difference, P=< 0.001, as was the difference between patients adopting the NWB plantarflexed, dorsiflexed and WB neutral positions. P=0.002, P=0.014, P=0.001 respectively. Patients’ median score for 5 out of 8 SF36 domains were considerably less than controls, as were patients’ AOFAS. Reduced physical and social functioning were shown to be linked to poor foot scores.

Conclusion: Patients with planovalgus feet and tarsometatarsal OA have greater first ray mobility than controls with normal feet. Recognising this may help plan orthotic or surgical treatment.

Purpose of the study: Gait in patients with severe pes planovalgus is generally compromised by the excessive medial force. The altered gait pattern affects the overall static and the opposite lower limb. Dynamic baropodometry can be used to measure the lateromedial force in pes planovalgus before and after corrective surgery.

Material and methods: This series included 26 patients (28 feet), mean age 54.4 years (range 15–75 years), ten males and 16 females. All of the patients had stage 2 pes planovalgus due to posterior tibial tendinopathy without lower limb misalignment. The emed-SF gait platform (Novel) was used to make three consecutive measurements with recording of the second step while walking on the platform. Measurements were made before and after conservative surgery for pes planoval-gus which combined lengthening of the calcaneum (Evans), systematic percutaneous lengthening of the Achilles tendon, lengthening of the peroneal tendons, and reconstruction of the medial arch by lowering the first metatarsal in most cases. The force index (lateral over medial force) was calculated by the Novel-ortho software which also displayed the curve of the force index during the step movement.

Results: The force index (lateral over medial) was 0.87 in this series of pes planovalgus (normal = 1.07). This index remained below 1 throughout the step movement for 13 of 28 feet. For the others, medial force increased uniquely during weight bearing phases: taligrade, plantigrade or digitigrade. After surgery, the index increased to 1.25 with normalization of the force index curve in 15 of 28 feet. A comparative study on the first ray was not very significant: scarf lowering (9 cases from 0.81 to 1.16), basal lowering by dorsal addition (8 cases from 0.87 to 1.14), arthrodesis of the first cuneometatarsal (5 cass from 0.89 to 1.15); three cases did not have lowering procedures with less favorable clinical results but with an index which changed from 0.75 to 1.05.

Discussion: This study enabled an assessment of the lat-eromedial balance of the planovalgus foot without misalignment of the lower limbs. We were able to show that realigning the foot lessens the stress on the posterior tibial tendon which did not always have to be repaired to achieve a good clinical result. This re-balancing of the muscle stabilizing the rear foot occurs progressively, as was noted on the successive baropodometric examinations. This points out the importance of not starting proprioceptive rehabilitation exercises before four months postop. On the other hand, active reinforcement of the toe flexors should be started early. This study was conducted with a very small sample but did show that a postoperative force index below 0.9 is a sign of under correction and that an index above 1.8 corresponds to overcorrection.

Conclusion: Functional management requires good knowledge of the pathological processes and the therapeutic implications. This study shows that baropodometry, even without footprint analysis or pressure distribution measurements, enables definition of functional parameters which can be helpful in achieving more precise management for foot and ankle surgery.

Introduction: A retrospective evaluation of early results of arthroereisis.

Material and Methods: Eight feet in five patients with pathological flexible planovalgus deformity that had failed non-operative management were treated with subtalar arthroereisis using the Kalix prosthesis. Diagnosis include oblique talus (2), vertical talus (1), diplegia secondary to head injury (1) and type I neurofibromatosis (1). The average age of patients was 6.4 years (range 4–12), and average follow-up was 9.9 months(range 4–20). Outcome was assessed using clinical assessment of the foot axis and functional improvement and radiographic measurements of change in the talocalcaneal angle and talonavicular sag.

Results: Arthroereisis was never performed in isolation, additional procedure included achilles tendon lengthening (2), gastrocnemius recession (6), talonavivular and spring ligament plication (5) and split tibialis anterior tendon transfer (1). All patients had improvement of foot function and restoration of foot axis to a position parallel to the axis of progression. Restoration and maintenance of the talocalcaneal angle was excellent in all cases with preoperative average of 42 degrees (range 20–70), improved to a postoperative average of 23 (range, 0 – 40). Talonavicular sag improved from preoperative average of 16.5 degrees (range 0–32), to post operative average of 26 degrees (range 18–35). Complications include persistent first ray extension which required a Lapidus procedure (1), Ongoing minor discomfort (1). No patients or parents were dissatisfied.

Discussion: The preliminary report supports the use of this technique in selected cases. Sizing of the implant and intraoperative assessment of correction of deformity and balanced surgery are critical to success. It is a simple and rapid procedure with advantages over alternatives such as Osteotomy and fusion. Long term results need further evaluation.

Purpose: Mediotarsal arthrodesis can correct the deformation and relieve pain in adults with reducible talipes planovalgus. We assess clinical and radiological outcome.

Material and methods: This retrospective analysis involved 22 cases of reducible talipes planovalgus (Johson stage 2) in 19 patients (eleven men and eight women), mean age 43 years (15–75). Clinical assessment was based on pain, function and motion (AOFAS and Mann). AP and lateral weight-bearing radiographs with Meary cerclage were used to determine the Djian angle, talometatarsal alignment, talar tilt, calcaneal valgus, and stage of osteoarthritis in adjacent joints.

Results: Mean follow-up was 88 months (6–243). Two non-unions evolved favourably after cancellous graft. The Kitaoka score was 73.5 points/94 (53–94). Pain and function improved respectively from 2.8 to 1.1/4 points and 3.5 to 1.6/4 points on the de Mann scale. Flexion-extension remained unchanged. The foot was well aligned in 68% of the cases (7.5 points). Mean talar tilt and talocalcaneal divergence were normalised but defective Djian angle persisted with a broken de Meary line in 98% and 41% of cases respectively. Calcaneal valgus was reduced 6.6° (16.6 to 10°) and podoscopy showed that flat foot persisted in 86% of the cases. In 50%, neighbouring joints presented progressive osteoarthritic degeneration with clinical impact in only one patient (4.5%). Subjectively, 73% of the patients were satisfied or very satisfied and none of the patients were disappointed. The objective outcome was excellent or good in 68% of cases.

Discussion: Pain, function, motion, complications and rate of satisfaction were comparable with data in the literature (Mann, Baxter, Steinhäuser). Mediotarsal arthrodesis is effective against pain and allows satisfactory recovery of function without morbidity greater than talonavicular arthrodesis (Harper). However, while the foot is well aligned in the majority of the cases, the plantar vault is poorly restored clinically and radiologically. Compensatory over-motion of the adjacent joints probably leads to bone remodelling and moderate asymptomatic osteoarthritis seven years after the procedure.

Introduction: Planovalgus is a clinical deformity on weightbearing. Extra-articular calcaneal lengthening osteotomy, is a recognised surgical treatment for symptomatic flat feet. The aim of this study was to assess the difference in pedal pressures and radiographic parameters in the assessment of patients undergoing lateral column lengthening for planovalgus deformity. Methods: Operative records of one surgeon were reviewed over a 5 year period to identify those who had undergone a lateral column lengthening procedure. 10 patients, 14 feet were identified. Patients were recalled for post-operative pedobarography and pre- and post-operative X-rays were identified. Peak plantar pressures were measured at 8 sites and a line plotted to show maximum deviation of pressure progression from the anatomical axis of the foot. 5 angles on X-rays were measured by 2 observers on 2 occasions. Results: Difference in pressure under the 3. rd. metatarsal head (p=0.0004), hallux (p=0.02) and medial midfoot (0.001) suggested a highly significant change. Results for the first (p=0.41) and second (p=0.91) metatarsal heads showed no change. The centre of pressure maximum deviation, plotted using a line drawn between the second toe and the rear of the heel was found to be highly significant postoperatively (p=0.00051) indicating that load bearing shifted from medial to lateral. Changes in X-ray angles of the lateral talo-1. st. metatarsal angle(p=0.006), calcaneal pitch(p=0.002), AP talocalcaneal angle(0.0001) and talonavicular coverage(p=0.003) were all highly significant. Discussion: Lateral lengthening in adolescent feet changes the pedal pressures in an advantageous way