Subtalar Joint Morphology and the Determinants of Flexible Flatfeet in Children
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Alpesh Kothari, MD, MSc, Oxford, United Kingdom
Julie Stebbins, PhD, Oxford, United Kingdom
Amy B. Zavatsky, PhD, Oxford, United Kingdom
Tim Theologis, Oxford/ Oxfordshire, United Kingdom
Presented at AAOS Annual Meeting; March 2015
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If we could identify these children, and if we could use an orthosis to adduct the head of the talus by reducing STJ pronation, then it is possible that they might develop a more supportive anterior facet and a less flat foot as an adult. This study could possibly be used to help justify orthotic intervention in pediatric flatfoot, especially if there is a family history of adult flatfoot in the child's parent or parents.
Jeff -
I'm trying to imagine how Wolff's Law might apply here.
- If left to nature will the bone morphology adapt?
- Does the use of orthosis enhance a better architecture of the bone over time?
- or could the use of orthosis prevent the development of beneficial bone adaptation?
My personal feeling is that I would be delighted if such studies could help nail the paediatric treat -or-not-to- treat dilemma for once and for all -
Hi there
If you google "foot binding", you can find a counterexample how external force changes the morphology of the foot. -
Here are some pictures of a foot skeleton I have that doesn't have an anterior facet. It is an extremely flat foot that demonstrates no calcaneal inclination angle. The calcaneus has a large spur that extends over the dorsal aspect of the cuboid, presumably to create stability. The trochlea of the talus is adducted and the neck and head are abducted. In spite of the abducted position of the head and neck, the head of the talus does not articulate with the calcaneus (see view of plantar surface). This is a good example of what can happen when there is no anterior calcaneal facet.
JeffAttached Files:
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Here is a good article that demonstrates the benefit of radiographic evaluation of the pediatric foot so that structural conditions can be readily identified and more appropriately treated.
http://www.ajronline.org/doi/pdf/10.2214/AJR.07.7143 -
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I agree with your "chicken and egg", BTW. -
One can tell a lot about structure and function from osseous members. Anthropologists look at bones and draw conclusions about how extinct creatures functioned. To answer your question, I will post some photos to help explain how I drew my conclusions.
Here are photos of two foot skeletons. When you place the joint surfaces together the foot in question has no lateral longitudinal arch as compared to a more normal foot, which clearly demonstrates a lateral arch in the sagittal plane. Also, the foot in question demonstrates a large beak that overrides the cuboid. This blocks dorsiflexion of the cuboid. If I try to create a lateral arch, there is a gap at the dorsal aspect of the CC joint. This would not occur during weightbearing activity.
In addition, as I mentioned in one of my previous posts on this thread, there is significant evidence in the structure of the talus to suggest that this was an extemely pronated and flat foot.
JeffAttached Files:
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All we see here is human variation in the shape of dry bones which have been wired together by people who had no idea of their relationships with one another in-vivo. Viva variation, though. -
I'm just expressing my observations and opinion. You have every right to disagree if you like.
Jeff -
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Great article but I'd like to read the whole thing. Not published yet?
Question for the "Wolff's law" theorists...If stress could cause such severe bone remodeling that the calcaneus distorts to a position where the anterior facet does not articulate with the talus, how come only SOME kids develop flatfoot.
So, if the effect of Wolff's law is equal in everyone, that is, the same law applies to every child, wouldn't we see a trend of flatfeet occurring in overactive toddlers/children? The late walkers would have higher arches? Generally, all kids are"flat footed" as toddlers.
Does anyone know of any reference of Wolff's law affecting normal bone growth? I've never heard of it described as a factor in bone maturity. Not sure it applies here... -
As an aside, an interesting finding in Jeff's picture of the foot bones without the anterior facet, is the amount of calcaneus that goes over the top of the cuboid. That overhang, as opposed to a flat surface could increase the stiffness of the midtarsal joint.
Eric -
Eric -
I don't have any real knowledge on cell differentiation but I figured that as the calcaneus develops, those calcaneal tissues are programmed to grow into the calcaneus, and any real anomalies are the product of genetic differences, DNA programming.
The idea that anatomical bone shape could be determined or changed by pressure or stimulus is new to me. If you have any reference or source for more info on this, I'm interested. -
http://www.boneandjoint.org.uk/high...ield_highwire_article_pdf/0/834.full-text.pdf -
Simon Spooner, thank you for the article!
They state that 7 of the ankle joints studied had normal shape at birth and remodeled by the age of five. (From what I read there weren't newborn x-rays available for the others.) -
Another example is serial casting for club foot. The adult x-rays of people casted have more normal looking joint facets than those that were not treated.
There was an old paper by Salter (of the pediatric growth plate injury classification system) where he drilled holes in rabbits knees. There were 3 recovery regimens: in a cast, walking around a cage, continuous passive motion machine. The cartilage was examined after a period of time. The quality of the cartilage was much better with continuous passive motion, ok with walking around the cage and worst when in a cast. So the mechanical input had an effect on the wound healing. There is no reason to think that the mechanism is different in development. It's been a few years since I read about wound healing. It is a fascinating subject.
Eric -
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Ball and socket ankle- pictures attached- this guy was a competitive triathlete. It's probably best to think of bone morphology in terms of phenotype (geometric shape) = genotype + environment + (genotype x environment).
Attached Files:
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Association Between Subtalar Articular Surface
Typing and Flat Foot Deformity: Which Type is More
Likely to Cause Flat Foot Deformity
Lei Zhang et al
Research Square
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Biomechanics of transverse axis of medial longitudinal arch of children's foot based on 3D scanning
Qinglin Liu et al
Front Pediatr. 2023 Jul 10
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