SLR - August 2023 - Karlos Peña, DPM
Title: Biomechanical Effects of Surgical Reconstruction for Flexible Progressive Collapsing Foot Deformity: A Systematic ReviewReference: Estes W, Syal A, Latt LD. Biomechanical Effects of Surgical Reconstruction for Flexible Progressive Collapsing Foot Deformity: A Systematic Review. Foot Ankle Spec. 2022 Dec 13
Level of Evidence: Level III: System Review
Reviewed By: Karlos Peña, DPM
Residency Program: Hoboken University Medical Center, Hoboken, NJ
Podiatric Relevance: Symptomatic progressive collapsing foot deformity (PCFD) is a condition that is commonly addressed through reconstructive surgery performed by foot and ankle surgeons. Various studies have reported positive results in terms of symptom alleviation and improvements in physical examination findings after surgical treatment. However, the impact of surgery on gait function remains uncertain, and it is unclear whether there are consistent improvements in this aspect following the surgical intervention.
Methods: A systematic review was performed according to the guidelines of the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) protocols. Only articles that were published within the last 20 years were considered. Articles were included involved patients with symptomatic flexible PCFD who underwent a reconstructive surgery, with primary outcomes that involved objective quantifiable measurements of kinematics, kinetics, or muscle activity, and underwent surgical intervention that included at least one of the following procedures: osteotomies, tendon transfer, and ligament repair or reconstruction.
Results: The reviewed literature implies that surgical intervention for flexible PCFD leads to objective improvements in gait. However, there are variations in the specific improvements reported among the studies. Parameters such as stride length, cadence, and walking speed generally increased following surgery, but there is discrepancy on whether they reach the level of healthy controls. Despite improvements in gait speed, studies found that surgical intervention does not fully restore single support time in the affected foot. Kinematic changes observed after surgery include a shift towards normal hindfoot dorsiflexion during early stance and late swing. Sagittal, coronal, and transverse motion also become comparable to those of healthy controls. Sagittal ankle range of motion was improved to the point comparable to the control group. These findings suggest that surgical intervention can have positive biomechanical effects on gait in patients with flexible PCFD.
Conclusions: Each study found that surgical intervention resulted in significant improvements in measurable outcomes. The specific findings included that stride length, cadence, and walking speed showed improvements after surgery. The kinetics of walking improved, with restoration of normal motion in the frontal and sagittal planes and improvements in dorsiflexion angle. The studies did not reach an agreement on whether stride length, cadence, or walking speed reached the same level as healthy controls. Limitations to the study included small sample size, short follow-up time, and lack of parameter repetition among the studies. Surgical intervention for flexible PCFD has clear positive effects on gait performance, as demonstrated by improvements in objective measures. However, more research is needed to establish the reliability and long-term durability of these improvements