SLR - April 2023 - McKayla Seymour, DPM
Title: Long-term Impact of Planovalgus Foot on Activities of Daily Living in Patients With Down SyndromeReference: Galán-Olleros, M., Ramírez-Barragán, A., Rodríguez-Zamorano, P., Egea-Gámez, R. M., Serrano, J. I., & Martínez-Caballero, I. (2023). Long-term Impact of Planovalgus Foot on Activities of Daily Living in Patients With Down Syndrome. Journal of Pediatric Orthopedics, 10.1097/BPO.0000000000002354. Advance online publication. https://doi.org/10.1097/BPO.0000000000002354
Level of Evidence: Level IV, Case series.
Scientific Literature Review
Reviewed By: McKayla Seymour, DPM
Residency Program: Eastern Virginia Medical School, Norfolk, VA
Podiatric Relevance: Down Syndrome (DS) affects multiple organs and body systems, including the musculoskeletal system. One musculoskeletal manifestation a podiatric physician may encounter in their practice would be planovalgus foot (PVF). Implications on activities of daily living (ADL) as well as need for surgical intervention remains in question. The aim of this study was to evaluate the effect of PVF on ADL and participation in sports among those with DS as well as the impact related to clinical exam and radiographic imaging.
Methods: This study examined a data base of 649 patients with DS. 598 patients were excluded based on age <20 years, geographic location, inability/unwillingness to participate, and no PVF on clinical exam. 51 patients with a total of 102 PVF were examined clinically, radiographically, functionally through the Foot and Ankle Outcome Score (FAOS), and pain using the Visual Analogue Scale (VAS). The level of participation in sports was assessed and categorized as active or sedentary. A correlation analysis was performed to determine the clinical and radiographic variables associated with functional outcomes. Linear regression models were utilized to quantify the impact of these clinical and radiographic variables on function.
Results: Of the 51 patients in this study, 52.94% were male and the mean age was 26.14 +/- 3.8863 years. 65% were grade 3 or 4 flat feet with most being flexible PVF. The lateral talo-first metatarsal angle demonstrated mild to moderate midfoot flattening in 92.16%. Talocalcaneal angle and talo-first metatarsal angle on anterior-posterior (AP) projection showed hindfoot valgus and forefoot abduction in only 32.25% of feet. 58.82% showed increased talar head uncoverage. First metatarsal varus was more common than first metatarsal valgus. FAOS was between 65% to 71%. Mean VAS score was 1.45. The correlation analysis did not identify any significant relationship between clinical and radiographic variables and the functional and pain scores. No relationship was found between the nature of sports played and the functional and pain scores. Linear regression showed that hindfoot valgus measured by AP talocalcaneal angle and lateral talocalcaneal angle, midfoot flattening measured by lateral talo-first metatarsal angle, abduction measured by AP talo-first metatarsal angle, and hallux valgus deformity were major contributors to functional scales. Other demographics and variables had less of an effect.
Conclusions: As patients with DS continue to live longer and are more mobile, it is important to be educated on proper treatment as they come into clinic. This study demonstrated an acceptable FAOS score and low VAS score in young adults with DS and PVF, meaning that non-operative management may be justified. This study concluded that DS patients with midfoot flattening, hindfoot valgus, abducted feet, and asymmetry of hallux valgus were associated with lower functional scores and higher pain scores. It is important to note this study was retrospective in nature with possible selection bias. Plain radiographs were interrupted by 2 individuals with interobserver reliability. PVF in DS patients should be treated on an individual basis.