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  1. Khan SJ, Khan SS, Usman J
    Foot (Edinb), 2019 Jun;39:122-128.
    PMID: 30580888 DOI: 10.1016/j.foot.2018.06.002
    BACKGROUND: Toe-in and toe-out foot positions have not yet been tested for dynamic balance and risk of fall. The aim of this study was to investigate the effects of these two modifications on static and dynamic postural stability and risk of fall through instrumental (Biodex Balance System®) and functional (timed up and go-TUG test) tools.

    METHODOLOGY: Twenty healthy adults (8 males, 12 females, age: 29±4.10years, BMI: 21.56±2.36kg/m2) participated in this study. Static and dynamic (levels 8 and 2) balance with single stance and double stance and dynamic (level 8 and levels 6-2) for risk of fall with double stance were tested with the Biodex Balance System with three self-selected feet positions: straight (13.8°), toe-out (35.6°) and toe-in (-11.9°) for each test condition. Additionally, TUG test was performed with toe-out and toe-in gait.

    RESULTS: The results of repeated measures ANOVA showed significant differences (p<0.05) between straight and modified toe angles in balance at dynamic level 2 with both double and single stance conditions. Significant differences (p<0.001) were also found in TUG scores for the test conditions.

    CONCLUSION: Toe-in and toe-out gait modifications have significant effects on balance at higher levels of platform tilt and functional balance. Further investigations with knee osteoarthritis patients and electromyography may provide insight in balancing strategies adopted by the body in toe-out and toe-in gait.

  2. Sulaiman AR, Munajat I, Mohd EF
    Foot (Edinb), 2018 Sep;36:6-9.
    PMID: 30041040 DOI: 10.1016/j.foot.2018.01.001
    Limb lengthening of fibular hemimelia is associated with progressive ankle valgus deformity. We reported a successful tibial lengthening in fibular hemimelia without recurrence of ankle valgus in 2 cases. The procedure involved 2 stages. First stage was a resection of the fibular remnant followed by a bending osteotomy through the distal tibial physis before the age of 2 years old. The second stage was a tibia lengthening up to 25% of its original segmental length performed at the age of 5 years old. There was neither progressive ankle valgus nor distal tibial growth arrest observed at 4 years follow-up.
  3. Munajat I, Yoysefi M, Nik Mahdi NM
    Foot (Edinb), 2017 Aug;32:30-34.
    PMID: 28672132 DOI: 10.1016/j.foot.2017.05.003
    BACKGROUND: Arterial deficiency in congenital clubfoot or congenital talipes equinovarus (CTEV) was postulated as either the primary cause of deformity or secondary manifestation of other bony and soft tissue abnormalities. The objectives of the study were to find any association between arterial deficiency with severity of CTEV and its treatment.

    METHOD: This prospective study conducted on 24 feet with CTEV (18 babies) with Pirani score ranging between 2 to 6. Eighteen normal babies (36 feet) were selected as control. We used Color Doppler Ultrasound to assess dorsalis pedis and posterior tibial arteries before initiating the treatment. Second ultrasound was performed in study group upon completion of Ponseti treatment.

    RESULTS: The patients were from one week to 15 weeks of life. Dorsalis pedis arterial flows were absent in 7 clubfeet (29.1%) while the remaining 17 clubfeet (70.8%) had normal flow. There was a significant association between Pirani severity score and vascular status in congenital clubfoot. There was a higher proportion of clubfeet having abnormal vascularity when the Pirani severity score was 5 and more. In study group, posterior tibial arteries were detectable and patent in all feet. All normal feet in control group had normal arterial flow. There was a significant difference in vascular flow before and after the Ponseti treatment (p 0.031).

    CONCLUSION: The study concludes that there is an association between Pirani severity score and arterial deficiency in CTEV. Ponseti treatment is safe in CTEV with arterial deficiency and able to reconstitute the arterial flow in majority of cases.

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