Correlation between clinical and radiographic parameters of the feet in children with flatfoot

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Background. Flatfoot in children is one of the most common reasons for visiting an orthopedic specialist. The main criteria in determining various types of flatfoot are clinical (severity of arch flattening, hindfoot valgus, and degree of the foot dorsiflexion) and radiographic (angular values calculated from lateral and anteroposterior radiographs). The primary assessment of the degree of flatfoot is based on the clinical criteria. Detection of changes in the foot shape is the reason for the radiographic assessment.

Aim. This study aimed to determine and analyze the relationship between clinical and radiological parameters of the feet in children with flatfoot.

Materials and methods. The study group included patients with flatfoot observed in the outpatient clinic of H. Turner National Medical Research Center within the period from 2018 to 2020. The study population consisted of 30 children (53 feet) with flexible flatfoot and 65 children (111 feet) with flatfoot and short Achilles tendon. The patients were 10 (8.3; 12) years old. Clinical parameters (valgus value, longitudinal arch angle, and degree of foot dorsiflexion) and radiographic data (Kite’s angle, Meary’s angle, calcaneal pitch, talotibial angle, longitudinal arch angle, talonavicular coverage angle, and forefoot adduction angle) were analyzed. Statistical differences were determined between groups of patients with flexible flatfoot and patients flatfoot and short Achilles tendon, and correlations between the studied parameters were identified.

Results. Strong correlations were revealed in the following pairs of criteria: lateral Kite’s angle and lateral Meary’s angle; talotibial angle and lateral Meary’s angle; radiographic longitudinal arch angle and lateral Meary’s angle; talotibial angle and lateral Kite’s angle; foot dorsiflexion and foot dorsiflexion with great toe extension; and radiographic longitudinal arch angle and calcaneal pitch. Only moderate and weak correlations were found between clinical and radiographic parameters of the feet.

Conclusion. The relationship between clinical and radiographic parameters of the feet in patients with flatfoot is characterized by a moderate and weak correlation. Results suggest that the assessment of the clinical parameters of the feet in this population does not provide complete information about the degree of flatfoot.

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About the authors

Andrey V. Sapogovskiy

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
ORCID iD: 0000-0002-5762-4477
SPIN-code: 2068-2102

Russian Federation, Saint Petersburg

MD, PhD, senior researcher in the Department of Foot and Ankle Surgery

Aleksey E. Boyko

Gatchina Clinical Interdistrict Hospital

ORCID iD: 0000-0002-0615-9907

Russian Federation, Leningrad region, Gatchina

MD, trauma surgeon in the Department of Emergency Orthopedics


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Supplementary files

Supplementary Files Action
Figure: 1. Measurement technique during clinical examination: a - the valgus of the hindfoot; b - clinical angle of the longitudinal arch; c - isolated dorsiflexion of the foot; d - dorsiflexion of the foot with stabilization of the subtalar joint

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Figure: 2. Scheme for plotting angles on the X-ray of the foot in lateral (a) and anteroposterior (b) projections (see the text for explanations)

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Figure: 3. Graphical representation of strong connections of clinical and radiological parameters of the feet in children with flat feet according to the following pairs of criteria: a, b - lateral angle Kite - talo-tibial angle / lateral angle Meary; c, d - talus-tibial angle / angle of the longitudinal arch X-ray - talus-tibial angle; e - the angle of inclination of the calcaneus - the angle of the longitudinal arch of the radiographic; f - dorsal flexion of the foot - dorsal flexion of the foot with extension of the first toe

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Figure: 4. Correlation Pleiades P.V. Terentyev. Different lines mark significant correlations [correlation is significant at the level of 0.01 (two-sided)]

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Copyright (c) 2021 Sapogovskiy A.V., Boyko A.E.

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