Search Results (19)

Background/Objectives: Charcot-Marie-Tooth (CMT) disease, the most common hereditary peripheral neuropathy, often causes cavovarus foot deformity in children. Surgical interventions to correct deformity or improve function can involve either primary fusion or reconstruction. However, the optimal surgical approach remains contested. This systematic review aims to present and evaluate existing data on both fusion and reconstruction surgical interventions in treating pediatric CMT cavus foot. Methods: A PRISMA-guided search of five electronic databases was conducted (from inception to 17 February 2025). Studies were eligible if they reported surgical outcomes for CMT pediatric patients ($\le$18 years) with cavovarus foot treated by primary fusion or reconstruction. Titles, abstracts and full texts were screened by four independent reviewers, and data were extracted on patient demographics, procedures, follow-up, functional scores, radiographic correction and complications. Results: Fourteen studies met inclusion criteria, encompassing 169 patients and 276 feet, with a mean age at surgery of ~13.5 years. Nine studies evaluated joint-sparing reconstruction, three assessed primary fusion, and two combined both reconstruction and fusion. Both interventions yielded improved outcomes post-operatively. Reconstruction generally produced high patient satisfaction and near-normal radiographic parameters but carried recurrence or reoperation rates of 10–40%. Fusion provided durable correction of rigid deformities but was associated with nonunion, adjacent joint arthritis and higher revision rates. Conclusions: Joint-sparing reconstruction is an effective first-line approach for flexible cavovarus deformities in pediatric CMT patients, while fusion should be reserved for severe, rigid or recurrent cases. A patient-specific staged approach is recommended, and higher-quality comparative studies are needed to refine surgical decision-making. Full article

Background: Cavus foot, defined by an increased medial longitudinal arch and often forefoot plantarflexion, alters biomechanics and increases peak plantar pressures, raising the risk of musculoskeletal disorders such as metatarsalgia, Achilles tendinopathy, and gait instability. Custom foot orthoses are the preferred conservative treatment, offering plantar support, pressure redistribution, and reduction in compensatory muscle activity. This study evaluated the medium- and long-term effectiveness of custom orthoses in 71 patients with cavus feet using surface electromyography (sEMG) and the same shoes. Methods: Muscle activity of the peroneus longus, peroneus brevis, and gastrocnemius was recorded during treadmill gait after one and four months of orthotic use. Results: Significant reductions in muscles were observed, especially after four months, confirming greater long-term effectiveness. No residual benefits were found when participants walked without orthoses. Conclusions: These findings support the clinical value of insoles in reducing the compensatory muscle activity in cavus feet and emphasize the importance of investigating their long-term role in biomechanics and potential pathology risk reduction. Full article

Introduction: Numerous overuse injuries affecting the lower limbs of elite athletes have been associated with biomechanical alterations in plantar loading of the foot. This study aimed to analyze the plantar pressure distribution in elite male soccer players and its relationship with various morphological and functional factors, including foot type, metatarsal and digital alignment, and on-field position. Material and Method: Dynamic foot pressure measurements were obtained from 21 soccer players who participated in the UEFA Champion League. The participants had an average age of 27 years, with an average height of 180.9 cm, weight of 76.9 kg, and BMI of 23.4. An insole system (BioFoot/IBV) with telemetry transmission was employed to record plantar loading patterns during normal gait and running. Results: During the support or contact phase, the central and medial metatarsal areas exhibited the highest peak pressure under both walking and running conditions. When walking, the right foot exerted 13–60% more pressure on the outer metatarsal and toe areas. The left foot experienced up to 13% more peak pressure in the middle metatarsal area. During running, the total pressure difference between the feet ranged from −8% to +19%. The right foot usually had more peak pressure on the heel and first toe. In players with valgus feet, the pressure in the central metatarsal area increased from 1086 kPa (walking) to 1490 kPa (running), representing a 37% increase. Conversely, in players with cavus-varus feet, the pressure in this central area increased from 877 kPa to 1804 kPa, a 105% increase. Conclusions: Foot morphology and playing position significantly influenced the plantar pressure patterns in elite soccer players. The central metatarsal region bears the highest load, particularly during running, with distinct variations across foot types and field positions. These findings highlight the need for individualized biomechanical assessments to prevent overuse injuries and optimize performance. Full article

Plantar fasciitis (PFS) is a leading cause of heel pain, yet its clinical course varies widely. Although plantar fascia thickness (PFT) is often used as a pain marker, its prognostic value remains unclear. Objective: This study investigates whether foot arch morphology underlies distinct biomechanical profiles in PFS patients, potentially explaining the variability in its presentation. Methods: The cross-sectional study included 30 patients with PFS and 10 healthy controls. PFS patients were classified by arch type (pes rectus, pes planus, pes cavus) using the Arch Height Index (AHI). Baseline comparisons between healthy controls and PFS subgroups assessed PFT, Foot Function Index (FFI), joint stiffness ratio, and gait parameters. Results: PFT differed across groups but was not significantly associated with FFI scores (p = 0.233). The pes cavus group exhibited a lower metatarsophalangeal (MTP) stiffness ratio compared with healthy (p < 0.05). Pes planus and pes rectus groups showed excessive pronation, and the pes cavus group showed limited ankle dorsiflexion, indicating distinct gait mechanisms (p < 0.05). Conclusions: Foot arch morphology influences gait biomechanics, stiffness, and PFT in individuals with PFS. Incorporating individual arch types into clinical decision-making may facilitate more personalized interventions and improve treatment outcomes. Full article

Background. PMP22-related neuropathies comprise a spectrum of predominantly demyelinating disorders, most commonly Charcot–Marie–Tooth type 1A (CMT1A; 17p12 duplication) and hereditary neuropathy with liability to pressure palsies (HNPP; 17p12 deletion), with rarer phenotypes due to PMP22 sequence variants (CMT1E, Dejerine–Sottas syndrome [DSS]). Methods. We conducted a PRISMA-compliant systematic review (PROSPERO ID: 1139921) of PubMed and Scopus (January 2015–August 2025). Eligible studies reported genetically confirmed PMP22-related neuropathies with clinical and/or neurophysiological data. Owing to heterogeneous reporting, we synthesized pooled counts and proportions without meta-analysis, explicitly tracking missing denominators. Results. One hundred twenty-seven studies (n = 4493 patients) were included. Sex was available for 995 patients (males 53.8% [535/995]; females 46.2% [460/995]); mean age at onset was 23.7 years in males and 16.4 years in females. Phenotypic classification was reported for 4431/4493 (75.4% CMT1A, 20.9% HNPP, 2.6% CMT1E, 1.2% DSS). Across phenotypes, weakness/foot drop was the leading presenting symptom when considering only cohorts that explicitly reported it (e.g., 65.3% in CMT1A; 76.0% in HNPP); sensory complaints (numbness, paresthesia/dysesthesia) were variably documented. Neurophysiology consistently showed demyelinating patterns, with median and ulnar nerves most frequently abnormal among assessed nerves; in HNPP, deep peroneal and sural involvement were also common in evaluated subsets. Comorbidities clustered by phenotype: orthopedic/neuromuscular features (pes cavus/hammer toes, scoliosis/kyphosis, tremor) in CMT1A and DSS; broader metabolic/autoimmune and neurodevelopmental associations in HNPP; and higher syndromic/ocular/hearing involvement in CMT1E. Genetically, 75.6% (3241/4291) had 17p12 duplication, 19.6% (835/4291) 17p12 deletion, and 4.8% (215/4291) PMP22 sequence variants with marked allelic heterogeneity. Among 2571 cases with available methods, MLPA was most used (41.9%), followed by NGS (20.4%) and Sanger sequencing (17.8%). Main limitations include heterogeneous and incomplete reporting across studies (especially symptoms and nerve-specific data) and the absence of a formal risk-of-bias appraisal, which preclude meta-analysis and may skew phenotype proportions toward more frequently reported entities (e.g., CMT1A). Conclusions. Recent literature confirms that PMP22 copy-number variants account for the vast majority of cases, while sequence-level variants underpin a minority with distinct phenotypes (notably CMT1E/DSS). Routine MLPA, complemented by targeted/NGS, optimizes diagnostic yield. Standardized reporting of nerve-conduction parameters and symptom denominators is urgently needed to enable robust cross-study comparisons in both pediatric and adult populations. Full article

Background: Congenital talipes equinovarus (clubfoot) affects 1–2 per 1000 newborns worldwide. The Ponseti method, based on staged manipulations and casting, is the gold standard for correction. However, the biomechanical processes underlying these corrections remain poorly understood, as infants rarely undergo imaging. Computational modeling may offer a non-invasive approach to studying correction pathways and exploring novel applications, such as customized casts. Methods: We developed a proof-of-concept framework using iterative finite element analysis (iFEA) to approximate the surface-level geometric corrections targeted in Ponseti treatment. A 3D surface model of a training clubfoot foot was scanned, meshed, and deformed stepwise under applied computational loads. The model was assumed to be homogeneous and hyperelastic, and correction was quantified using Cavus, Adductus, Varus, Equinus, and Derotation angles. We also introduced a secondary adult leg 3D surface model to assess whether model simplification influences correction outcomes, by comparing a homogeneous soft tissue model with a non-homogeneous model incorporating bone structure. Results: In the training model, iFEA generated progressive deformations consistent with Ponseti correction, with mean angular deviations of ±3.2°. In the adult leg model, homogeneous and non-homogeneous versions produced comparable correction geometries, differing by <2° in outcomes. The homogeneous model required less computation, supporting its use for feasibility testing. Applied loads were computational drivers, not physiological forces. Conclusions: This feasibility study shows that iFEA can reproduce surface-level geometric changes consistent with Ponseti correction, independent of model homogeneity. While not replicating clinical biomechanics, this framework lays the groundwork for future work that incorporates clinician-applied forces, pediatric tissue properties, and patient-specific geometries, with potential applications in customized 3D-printed casts. Full article

Background: Plantar pressure distribution is a valuable tool for studying how the ground reaction forces are transmitted from the feet to the body and for detecting abnormalities in foot biomechanics. Objectives: The objective of this study was to determine the effect of the foot type (normal foot, flatfoot, and cavus foot) on plantar pressure distribution in healthy Mexican men and women aged from 3 to 74 years. Methods: A database of the plantar pressure distribution under dynamic and static conditions for both feet was studied using descriptive statistics, regression analysis, and statistical factorial design. The database contained images of the soles of the feet and pressure distribution of 996 persons between 3 and 74 years old (53.9% females and 46.1% males). Two different conditions were evaluated; the first was in a static condition, and the second was during walking. The Chippaux–Smirak Index (CSI) was used to classify the type of feet. Results: In the left foot, a linear regression analysis of the soles of the feet shows that the prevalence of flatfoot (p-value = 3.45 × E⁻⁵) decreased with age, while the normal foot (p-value = 7.39 × E⁻⁵) increased. When people are standing (static), the hindfoot (55.64 ± 18.80%) presents more pressure than the forefoot (45.18 ± 19.50%), while in dynamic, the forefoot (55.95 ± 13.36%) supports more pressure than the hindfoot (44.05 ± 13.36%). Similar behavior occurs in the right foot. A statistical factorial design ANOVA shows that the plantar pressure in the forefoot and hindfoot regions is significantly different (p < 0.05). Conclusions: The prevalence of flatfoot decreased with age, while the proportion of normal foot type increased. Under static conditions, the hindfoot bore more load than the forefoot, whereas under dynamic conditions, the forefoot bore more load than the hindfoot. This research contributes to generating a comprehensive database of reference values of the plantar pressure of different foot types in a Mexican population; this will be useful to podiatrists, clinicians, and physiotherapists for the analysis or treatment of abnormal foot postures. Full article

Background/Objectives: Commonly known as clubfoot, congenital talipes equinovarus (CTEV) is a structural deformity characterized by cavus, adductus, varus, and equinus (CAVE) positioning of the foot. Idiopathic clubfoot requires prompt treatment to achieve functional, pain-free, and aesthetically normal feet. The Ponseti method is a conservative treatment involving serial manipulation, casting, and Achilles tenotomy, which has demonstrated high success rates. The purpose of this study is to report 10 years of experience using the Ponseti method. Methods: A retrospective and follow-up analysis were conducted with 72 patients (118 feet) with idiopathic clubfoot were treated between 2011 and 2023 who met the minimum follow-up requirement of 12 months (mean follow-up: 54.15 months). The severity of deformities was assessed using the Pirani score. Data collection included demographic details, number of casts, tenotomy procedures, adherence to the Denis Browne brace protocol, and complications. Results: Initial correction of deformities was achieved in all 91 patients (100%). Outcomes were measured using the Ponseti functional scoring system. The average number of casts applied was 9.51 per patient. Percutaneous Achilles tenotomy was performed in 91.21% of cases. Relapse occurred in 22.2% of patients, which required additional treatments. The outcomes were excellent in 77.7% of cases, good in 13.88%, fair in 6.94%, and poor in 1.38%. Discussion: The Ponseti method is effective for idiopathic clubfoot treatment and achieves high rates of initial correction, favorable mid-term outcomes, and minimal complications. These results confirm its reliability and align with previously reported success rates. Full article

The aim of this study was to analyze the joint characteristics of the foot and ankle in competitive swimmers aged 16–18 and 19–24 years and their relationship with the presence of muscle pain during swimming. A total of 74 swimmers were evaluated: 38 ‘junior’ (16–18 years) and 36 ‘senior’ (19–24 years). The following parameters were recorded: ankle dorsiflexion, rearfoot mobility, first metatarsophalangeal dorsiflexion, presence of hallux valgus, foot posture, first ray mobility, arch height, and plantar pressure. Additionally, the frequency and location of muscle pain in the triceps surae were analyzed. A cluster analysis was performed to identify variables that differentiated both groups. Ankle dorsiflexion was limited in both groups, with a greater restriction observed in adults (p < 0.001 with an extended knee; p < 0.014 with a flexed knee). The predominant foot type was the cavus foot. The most common pain was localized in the triceps surae, followed by the plantar musculature, with no significant differences between groups. Swimmers exhibited gastrocnemius shortening, which could limit ankle dorsiflexion and contribute to the onset of muscle pain in the leg and foot. These findings suggest the importance of incorporating lower limb flexibility strategies into the training of competitive swimmers. Full article

Background: In this study, we hypothesized that safety footwear (SF) impacts gait patterns, potentially contributing to the podiatric symptoms reported by workers. The purpose of this work was to compare the gait analyses of workers wearing SF and sneakers using inertial sensors while also examining the occurrence of foot problems. Methods: A consecutive cohort of workers from different occupational sectors who wore SF during their work shifts were prospectively assessed through a gait analysis. The gait analysis was conducted under two conditions: first, while wearing SF, and second, while wearing sneakers. In both conditions, inertial sensors were used (Wiva^® MOB). Participants also underwent a podiatric physical examination to evaluate foot problems. Results: This study shows that SF resulted in a worsening gait pattern compared to sneakers in both genders. The impact was particularly pronounced in female participants, resulting in a significant decline in walking speed and cadence. Discomfort was reported by 83.3% of participants, with a higher prevalence in females (46.6% vs. 36.6%). The SF group exhibited an elevated prevalence of foot problems, with no significant gender variations. It seems that foot problems are more likely to occur when a foot deformity, such as flat or cavus foot or hallux valgus, is present. Conclusions: This study suggests that SF may contribute to the reported podiatric symptoms among workers. Certain footwear characteristics, including weight, mis-fit, and inadequate design, may be factors associated with footwear discomfort and adverse gait patterns, potentially leading to increased foot problems among workers. Full article

Background: Classifications of AAFD/PCFD have evolved with an increased understanding of the pathology involved. A review of classification systems helps identify deficiencies and respective contributions to the evolution in understanding the classification of AAFD/PCFD. Methods: Using multiple electronic database searches (Medline, PubMed) and Google search, original papers classifying AAFD/PCFD were identified. Nine original papers were identified that met the inclusion criteria. Results: Johnson’s original classification and multiple variants provided a significant leap in understanding and communicating the pathology but remained tibialis posterior tendon-focused. Drawbacks of these classifications include the implication of causality, linearity of progression through stages, an oversimplification of stage 2 deformity, and a failure to understand that multiple tendons react, not just tibialis posterior. Later classifications, such as the PCFD classification, are deformity-centric. Early ligament laxity/instability in normal attitude feet and all stages of cavus feet can present with pain and instability with minor/no deformity. These may not be captured in deformity-based classifications. The authors developed the ‘Triple Classification’ (TC) understanding that primary pathology is a progressive ligament failure/laxity that presents as tendon reactivity, deformity, and painful impingement, variably manifested depending on starting foot morphology. In this classification, starting foot morphology is typed, ligament laxities are staged, and deformity is zoned. Conclusions: This review has used identified deficiencies within classification systems for AAFD/PCFD to delink ligament laxity, deformity, and foot type and develop the ‘Triple classification’. Advantages of the TC may include representing foot types with no deformity, defining complex secondary instabilities, delinking foot types, tendon reactivity/ligament instability, and deformity to represent these independently in a new classification system. Level of Evidence: Level V. Full article

Background: Foot deformities in children are common, and the majority can be treated conservatively. Nevertheless, there are deformities that require surgical treatment. These include rigid clubfeet, severe forms of pes planovalgus, pes cavus and several more. We retrospectively analysed the pseudarthrosis rate of surgical treatment of foot deformities with transcutaneous K-wire osteosynthesis in neurologically healthy children and adolescents. The aim of the study was to show that the results with K-wires are comparable to those with other osteosynthesis methods in the literature. Methods: A total of 46 paediatric patients aged 6 to 17 years treated between January 2010 and December 2015 met the inclusion criteria. Depending on the diagnosis, different surgical interventions were necessary. In clubfoot and pes planovalgus, representing n = 81, 70% of the whole collective triple arthrodesis with fusion of the talonavicular, calcaneocuboid and subtalar joints or Evans osteotomy was usually performed. Radiographs were taken at least 6 months post-surgery, and bony consolidation of the subtalar, talonavicular (TN), and calcaneocuboidal (CC) joints and the metatarsal I (MT I) osteotomy were assessed. If there was no evidence of fusion at this time, it was considered non-union. Results: In total, 117 arthrodesis procedures with K-wires were performed. Overall, 110 of the arthrodesis (94%) healed, and only 7 joints (6%) showed non-union (subtalar 0%, TN 7.7%, CC 6.5% and MT I 6.7%). All non-unions occurred in subjects with clubfoot deformities. No significant risk factors were observed. Conclusion: This study replicated the good consolidation rates reported in the literature with screws, plates, intramedullary nails or staples in arthrodesis of the adolescent foot in neurologically healthy subjects and confirmed the efficacy of K-wires. The main advantages of transcutaneous K-wire treatment are easy metal removal, lower osteosynthesis material costs and less concomitant damage. Further studies, especially randomised controlled trials, are needed to further investigate this topic. Full article

Background: Pes cavus is a multiplanar foot deformity with an abnormal plantar pressure distribution and an overhigh medial longitudinal arch (MLA). Its causes are complex. In the past, people have usually focused on clinical surgery for pes cavus. However, this is not necessarily the best choice for some patients with non-ongoing or mild symptoms. In the 21st century, studies have just begun to focus on assistive devices intervention for pes cavus, which has been proven to be an effective non-surgical treatment. However, the effectiveness of assistive devices for patients with arched feet of any etiology has not been evaluated and evidence-based guidelines for clinical treatment options are lacking. Methods: A systematic review and network meta-analysis were performed, employing a comprehensive search across the databases of Web of Science, PubMed, as well as Scopus. The selected studies adhered to specific eligibility criteria, which included: (1) involving patients with pes cavus; (2) interventions with assistive devices; and (3) outcome measures of plantar pressure distribution and anatomical characteristics (MLA). Meanwhile, the standard mean difference was selected as the effect size. Results: A total of three studies were selected, and the authors achieved an agreement on the risk of bias with a kappa value equal to 0.74. According to the results of network meta-analysis, customized foot orthotics compared to other devices (lace-up ankle-support brace, semirigid brace) demonstrated the highest likelihood of being the most effective in optimizing plantar-pressure distribution among pes cavus patients. On the other hand, wearing hard custom foot orthotics compared to other devices (soft custom foot orthotics, off-the-shelf orthotics) showed the greatest potential in improving the medial longitudinal arch (MLA) of pes cavus patients. Discussion: Although becoming better than wearing regular footwear, wearing lace-up ankle-support braces or semirigid braces might not be optimal choices for treatments of pes cavus with the potential mechanism that the internal force created by the fixation of the proximal joint might be much less than the ground reaction force loaded on the distal segments that touch the ground. It could be concluded that foot orthotics show great potential in treating pes cavus under non-surgical conditions. This systematic review could provide valuable evidence for future research and clinical practice. Other: The PROSPERO Registration Number is CRD42022349687. Full article

Introduction: Charcot–Marie–Tooth (CMT) is a group of inherited peripheral neuropathies characterized by wide genotypic and phenotypic variability. The onset is typically in childhood, and the most frequent clinical manifestations are predominantly distal muscle weakness, hypoesthesia, foot deformity (pes cavus) and areflexia. In the long term, complications such as muscle-tendon retractions, extremity deformities, muscle atrophy and pain may occur. Among CMT1, demyelinating and autosomal dominant forms, CMT1G is determined by mutations in the PMP2 myelin protein. Results: Starting from the index case, we performed a clinical, electrophysiological, neuroradiological and genetic evaluation of all family members for three generations; we identified p.Ile50del in PMP2 in all the nine affected members. They presented a typical clinical phenotype, with childhood-onset variable severity between generations and a chronic demyelinating sensory-motor polyneuropathy on the electrophysiologic examination; the progression was slow to very slow and predominant in the lower limbs. Our study reports a relatively large sample of patients, members of the same family, with CMT1G by PMP2, which is a rare form of demyelinating CMT, highlighting the genetic variability of the CMT family instead of the overlapping clinical phenotypes within demyelinating forms. To date, only supportive and preventive measures for the most severe complications are available; therefore, we believe that early diagnosis (clinical, electrophysiological and genetic) allows access to specialist follow-up and therapies, thereby improving the quality of life of patients. Full article

Background: Dynamic balance plays a key role in high-impact sports, such as CrossFit, where athletes are required to maintain balance in various weightlifting exercises. The loss of balance in these sport-specific movements may not only affect athlete performance, but also increase the risk of injuries. Objectives: The aim of the study is to achieve greater insight into the balance and athlete position during the CrossFit training by means of inertial sensors, with a particular focus on the role of different custom foot orthoses (CFOs) in order to detect correlations with the role of the cavus foot. Methods: A total of 42 CrossFit^® athletes, aged 25 to 42 years, were enrolled in this study. One-way ANOVA tests with post-hoc analysis of variance were used to compare foot posture groups and effects of different types of customized foot orthoses. Results: When comparing the effects of CFOs with the respective balance basal level during the pistol squat exercise, we observed a significant (p = 0.0001) decrease in the sway area, antero-posterior displacement (APD) and medio-lateral displacement (MLD) compared to the basal using both types of CFOs. Conclusion: No significant positive effects of CFOs were observed in some static tests. On the contrary, positive effects of CFOs and, in particular, postural insoles, are relevant to dynamic balance. Full article