SLR - June 2010 - Shanta L. Griffin

Plantar Pressures in Patients with and without Lateral Foot Pain after Lateral Column Lengthening

Reference: 
Ellis, S.J., Yu, J.C., Johnson, A.H., Elliot, A., O’Malley, M. and Deland, J. (2010).  Plantar Pressures in Patients with and without Lateral Foot Pain after Lateral Column Lengthening.  The Journal of Bone and Joint Surgery (American), 92, 81-91.

Scientific Literature Review

Reviewed by:  Shanta L. Griffin
Residency Program:  Central Alabama Veterans Health Care System

Podiatric Relevance: 
This study provides evidence confirming that patients who have undergone lateral column lengthening, and who experience lateral plantar pain, have increased lateral midfoot plantar pressure values that cannot be accounted for by radiographic and demographic factors alone.

Methods: 
This is a prognostic, case control study design.  A computerized database search was conducted to identify patients who had undergone lateral column lengthening as a part of flatfoot reconstructive surgery.  Ten individuals who had lateral column lengthening and who were experiencing pain or discomfort in the plantar-lateral aspect of the foot for a minimum of two years postoperatively were selected.  All surgical procedures occurred between October 2001 and August 2005.  Asymptomatic controls that had undergone similar lengthening procedures were matched for age, sex, accessory reconstructive procedures and time since surgery.  In order to ensure that increased plantar pressures were not due to increased body weight, all plantar pressures were normalized to body weight. 

Results: 
There were no differences between the pain and non-pain groups with regard to length of the graft.  The median weight in the pain group was 94.8 kg and 81.7 kg for the non-pain group.  The radiographic parameters before and after surgery were similar for the two groups.  The SF-36 Physical Function Subscale, SF-36 Physical Health Summary, and FAOS average scores were significantly lower in the pain group.  The average mean lateral midfoot pressure was significantly higher in the group with pain for both the non-normalized and normalized data.  All remaining values were similar between the two groups.

Conclusions: 
Based on the findings of this study, increased lateral column pressure cannot be solely explained by radiographic or demographic factors.  Therefore, surgeons must be careful to minimize increased pressure on the lateral plantar border of the foot when performing lateral column lengthening procedures.  In addition, maintaining near normal subtalar joint eversion is of high importance because it may serve as a guide as to the amount of lateral column lengthening that can be achieved perioperatively and to decrease the amount of lateral plantar discomfort post-operatively.

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