Foot Deformities

BackgroundThis study aimed to determine the risk factors of hallux valgus angle among preprofessional adolescent dancesport athletes.MethodsA total of 275 athletes, (73 males and 202 females) aged between the ages of 11 and 18 years, participated in this study. A cross-sectional questionnaire was used to survey their demographic characteristics (sex and age), training information (starting age, weekly training time, and athletic career [number of years of training at this specific dancesport school]), and measured their height and weight. The hallux valgus angle was measured based on foot photographs. The chi-square test was used to compare the difference with prevalence of hallux valgus between male and female athletes. A normal distribution test was performed, and based on the test results, unpaired t-test and multiple logistic regression were conducted to identify training factors for the hallux valgus in this cohort.ResultsChi-square test showed higher prevalence of hallux valgus in female elite adolescent dancesport athletes than males. The t-test results did not show any significant differences between the hallux valgus group and non-hallux valgus groups with start age, athletic career, and weekly training time. Multiple logistic regression analysis with hallux valgus as the dependent variable revealed that the female sex was a strong predictor of a higher prevalence of hallux valgus (odds ratio [OR]: 3.954, 95% confidence interval 95% CI: 2.193-7.131, and p ConclusionsOur findings revealed that the prevalence of hallux valgus in adolescent dancesport athletes was higher in females than in males. Longer weekly training time was also a risk factor for hallux valgus. Training factors should be considered in preventive programs for elite adolescent dancesport athletes, and special attention should be paid to female athletes.

BackgroundPainful degenerative joint disease (DJD) of the first metatarsophalangeal joint (MTP I), or hallux rigidus, mainly occurs in later stages of life. For end-stage hallux rigidus, MTP I arthrodesis is considered the gold standard. As young and active patients are affected considerably less frequently, it currently remains unclear, whether they benefit to the same extent. We hypothesized that MTP I arthrodesis in younger patients would lead to an inferior outcome with decreased rates of overall with lower rates of patient postoperative pain and function compared to an older cohort.MethodsAll patients aged 60 years. Minimum follow-up was 10 years. Outcome measures were Tegner activity score (TAS), a "Virtual Tegner activity score" (VTAS), the visual analog scale (VAS), and the Foot Function index (FFI).ResultsSixty-one MTP I fusions (n = 28 young, n = 33 old) in 46 patients were included in our study at an average of 14 years after surgery. Younger patients experienced significantly more pain relief as reflected by changes in VAS and FFI Pain subscale scores. No difference in functional outcomes was found with change in the FFI function subscale or in the ability to have desired functional outcomes using the ratio of TAS to VTAS. Revision rate did not differ between the two groups apart from hardware removal, which was significantly more likely in the younger group.ConclusionIn patients below the age of 50 years with end-stage DJD of the first metatarsal joint, MTP I arthrodesis not only yielded highly satisfactory postoperative results at least equal outcome compared to an older cohort of patients aged >60 years at an average 14 years' follow-up. Based on these findings, we consider first metatarsal joint fusion even for young patients is a valid option to treat end-stage hallux rigidus.Level of evidenceLevel III, a case-control study.

ObjectivesWe developed the deep neural network (DNN) model to automatically measure hallux valgus angle (HVA) and intermetatarsal angle (IMA) on foot radiographs. The objective is to assess the accuracy of the model by comparing to the manual measurement of foot and ankle surgeons.Materials and methodsA DNN was developed to predict the bone axes of the first proximal phalanx and all metatarsals from the first to the fifth in foot radiographs. The dataset used for model development consisted of 1798 radiographs collected from a population-based cohort and patients at our foot and ankle clinic. The retrospective validation cohort comprised of 92 radiographs obtained from 92 consecutive patients visiting our foot and ankle clinic. The mean absolute error (MAE) between automatic measurements by the model and the median of manual measurements by three foot and ankle surgeons was compared to 3° using one-tailed t-test and was also compared to the inter-rater difference in manual measurements among the three surgeons using two-tailed paired t-test.ResultsThe MAE for HVA was 1.3° (upper limit of 95% CI 1.6°), and this was significantly smaller than the inter-rater difference of 2.0 ± 0.2° among the surgeons, demonstrating the superior accuracy of the model. In contrast, the MAE for IMA was 0.8° (upper limit of 95% CI 1.0°) that showed no significant difference from the inter-rater difference of 1.0 ± 0.1° among the surgeons.ConclusionOur model demonstrated the ability to measure the HVA and IMA with an accuracy comparable to that of specialists.

Children born with severe congenital conditions in low-income countries rank among the most disadvantaged among the global ultra-poor. We study the impact of clubfoot and its treatment across multiple dimensions of human flourishing on data collected from 564 children in Ethiopia. Working with Hope Walks, an organization that funds clubfoot interventions in numerous countries, we use a quasi difference-in-differences approach that generates counterfactual outcomes from the nearest-age siblings of children born with clubfoot, nested within a family-level fixed effect. We find that clubfoot status (early treatment) results in an impairment (restoration) of -1.44 σ$\sigma $ (0.91 σ$\sigma $ ) in physical mobility, -1.17 σ$\sigma $ (0.79 σ$\sigma $ ) in mental health, -1.07 σ$\sigma $ (0.64 σ$\sigma $ ) in social inclusion, -0.48 σ$\sigma $ (0.98 σ$\sigma $ ) in an education index, -0.76 σ$\sigma $ (0.42 σ$\sigma $ ) in religious faith, and -1.32 σ$\sigma $ (0.94 σ$\sigma $ ) in an aggregate index of human flourishing (all p<0.05$p< 0.05$ ). We attribute the large, broad, and significant impacts from clubfoot treatment to (i) a highly effective medical intervention that is (ii) carried out in an impoverished setting with scarce existing support for children born with disabilities, which (iii) broadly generates spillover effects across key development outcomes.