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THE PEDIATRIC FLAT FOOT: PRE AND POST SURGICAL CORRECTION 3D KINEMATICS DATA
Full text linkIntroduction: aim of this study was to establish normality parameters and analyze 3D kinematic data before and after surgical correction of the pediatric flexible flat foot
Materials and methods: study population was composed of 2 groups: 10 children (20 feet, 5M/5F)without any disorders of the foot were evaluated to obtain normal reference data; 20 children with bilateral flexible flatfoot candidate to bilateral surgical correction (40 feet, 13M/7F) The RFM -3D kinematics protocol was used. Clinical, radiographic and instrumental evaluation were performed preoperatively and at 12 months by the same surgeon An arthroereisis of the subtalar joint was performed by the same surgeon. Patients were divided in 3 groups:1:normality;2:before surgery;3: after surgery. For all the variables and for the three planes of the space comparison between groups were performed.
Results: 3D rotational joint variables and planar angles were defined for normality, before and after sur-gery at the upright standing position. Differences were observed: hind foot , frontal plane; Chopart Joint ,transverse plane; Lisfanc Joint, frontal/transverse planes; ratio between 1rst and 2nd metatarsal, transverse plane; 2nd and 5th metatarsal versus ground respectively, sagittal plane; MLA, transverse plane
Discussion/conclusions:: different variables, normalized after correction, suggest that surgery performed at the hind foot can also improves mid foot pronation, increases the medial longitudinal arch and im-proves ratio between metatarsal bones, allowing to quantify changes that clinical and radiological evaluation cannot provide. The pediatric foot is similar to the adults and pediatric flexible flat foot could be corrected surgically, even if painless
D.D.S.H. : developmental displasia of the spastic hip : strategies of management in cerebral palsy : a new suggestive algoritm
No full textHip problems in cerebral palsy are relatively frequent (25-75%). Subluxation and dislocation of the hip is proportional to the neuromuscular involvement and is often due to alteration caused by spastic muscle forces acting on the femoral head in the acetabular cavity. The EMMA approach (Early Multilevel Minimally-invasive Approach) has been designed to restore muscle balance, decrease hip migration and prevent bone deformities thereby avoiding future pain with minimal biological cost to the patient. EMMA is suitable for most patients, especially those with increased tone, poor muscle control and selectivity, Reimer Index (R.I.) 20%. We consider age and R.I crucial prerequisites for treatment steps. EMMA 1) age 2-4 years, RI 20%: multilevel injection of botulinum toxin in case of muscular hyperactivity without morphological alterations of the couple muscle-tendon (contractures). EMMA 2) age 4-6, RI 20%: multilevel aponeurectomies in case of muscular hyperactivity with morphological alterations of the couple muscle-tendon (retraction). EMMA 3) early bone surgery (growth plates). This approach has been adopted in the last 4 years to prevent bone deformities and give early mobilisation and early control of the pain. EMMA is simple to apply even in infants, both for hip containment and to decrease spasticity
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