Ebral palsy who were able to walk. We focused primarily on changes in radiographic parameters and how altered mobility of the subtalar joint by the two operative methods would modify pressure distribution over the plantar surface of the foot....

Yoon HK, et al. Clin Orthop Surg. 2010 Mar;2(1):13-21. http://dx.doi.org/10.4055/cios.2010.2.1.13

Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture. Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups. There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients’ BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile. Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.

Park H, et al. Yonsei Med J. 2017 Jul;58(4):829-836. https://doi.org/10.3349/ymj.2017.58.4.829

Background: The surgical treatment of calcaneal deformity in patients with myelomeningocele has not been uniformly successful in correcting the deformity and preventing recurrence. The purpose of the present study was to examine the results of posterior transfer of the anterior tibial tendon with concurrent procedures in an attempt to balance the muscular forces on the foot and ankle and to obtain a plantigrade foot. We investigated whether surgery improved pressure distribution over the plantar surface of the foot and whether concurrent abnormal movements observed at the knee, hip, and pelvis influenced the surgical outcome. Methods: Thirty-one feet in eighteen patients who were able to walk were included in the study. The mean age at the time of surgery was seven years and four months, and the mean duration of follow-up was forty-seven months. Eight patients were classified as having an L5-level myelomeningocele, and ten patients were classified as having a sacral level myelomeningocele. A tibialis anterior tendon transfer was performed in all patients, and accompanying osseous deformities were also corrected in twelve feet. Measurements on plain radiographs, the results of gait analyses, and dynamic foot pressures that were determined before surgery and at the time of the final follow-up were compared. Results: No recurrence or worsening of the deformity was observed in any of the patients, and no other types of foot deformity developed after surgery. Postoperative kinematic studies showed a significant (p < 0.0001) increase in peak plantar flexion and a significant decrease in peak dorsiflexion force of the ankle in the stance phase of gait. Peak pressures under the forefoot and midfoot were increased after surgery, and the relative amount of weight-bearing on the heel as compared with the forefoot was shifted toward more equal weight-bearing. However, less improvement in foot-pressure distribution was observed in patients with increased pelvic rotation before surgery. Those patients also had decreased knee extension in stance phase and increased hip abduction and pelvic obliquity both before and after surgery in comparison with patients who had normal pelvic rotation. Conclusions: Appropriately combined corrective surgical procedures for the treatment of calcaneal deformity in patients with myelomeningocele can effectively reduce the pressure placed on the calcaneus, increase pressures in the forefoot and midfoot, and prevent recurrence of the calcaneal deformity. However, in the presence of excessive pelvic movement in the coronal and transverse planes and decreased knee extension in stance phase, adequate improvement in pressure distribution over the plantar surface of the foot is not likely to occur after this type of foot surgery. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.