Tarsal coalition is an abnormal union of tarsal bones leading to rigid hindfoot valgus and altered biomechanics. Most symptomatic cases involve the talocalcaneal joint. Standard surgical options include resection or arthrodesis, both with limitations. We present a novel deltoid-preserving, mini-open approach designed to restore hindfoot motion while maintaining stability. A 22-year-old woman presented with severe unilateral hindfoot pain, instability, and valgus deformity. Imaging confirmed a type 3 shingled talocalcaneal coalition involving the sustentaculum tali. Nonoperative options failed, and the patient opted for surgery. A lateral mini-open approach through the sinus tarsi was used to osteotomise the coalition while preserving the superficial deltoid. A small medial approach was used to visualise the sustentaculum tali and protect the medial neurovascular structures. The sustentaculum tali fragment was secured to the calcaneum with a partially threaded screw. Postoperative rehabilitation emphasised subtalar mobility and tibialis posterior strengthening. At 17 weeks, the patient achieved pain-free gait, restoration of the medial arch, symmetrical subtalar motion, and a Manchester-Oxford Foot Questionnaire (MOXFQ) score of 0/64. Conventional talocalcaneal coalition resections often sacrifice the deltoid ligament and may fail to restore subtalar biomechanics. Arthrodesis relieves pain but increases adjacent joint degeneration risk. Our technique preserves key ligamentous stabilisers, maintains anatomical landmarks, and restores subtalar motion. Literature suggests that long-term issues after standard resections include persistent flatfoot and abnormal mechanics, highlighting the potential benefit of this approach. This novel deltoid-preserving, mini-open procedure may provide adult patients with an alternative to arthrodesis or traditional resection, offering pain relief, preservation of hindfoot motion, and improved biomechanics.

This study investigated the biomechanical effects of asymmetric backpack shoulder strap configurations on individuals with unilateral flatfoot (UF) using finite element analysis (FEA). A male subject with UF was recruited, and different shoulder strap settings were simulated to assess their impact on plantar fascia and Achilles tendon stress and strain, as well as on changes in foot arch morphology. The results showed that using equal-length straps on both shoulders resulted in lower stress and strain levels in the plantar fascia and Achilles tendon during walking. However, when the strap length on the flatfoot side was increased, the longitudinal and transverse arch deformation of the affected foot also increased, while deformation in the normal foot's longitudinal arch was reduced. These findings suggest that lengthening the strap on the flatfoot side may help improve arch morphology on that side, but at the cost of increased soft tissue loading and potential restriction of normal foot development.

Even though the link between foot posture and lower-extremity injuries remains controversial, there has been little research focus on bilateral foot symmetry. This study evaluated the correlation between bilateral symmetry in foot posture and lower extremity musculoskeletal injuries among workers in physically intensive occupations. A total of 248 participants with physically demanding roles were enrolled. Historical data on lower-limb musculoskeletal injuries were obtained through a review of medical records, supplemented by results from on-site consultations. The foot arch index (AI) was quantitatively measured using a 3D laser foot scanner, and foot posture was evaluated using the foot posture index-6 (FPI-6). The participants were categorized into subgroups based on bilateral symmetry assessments of their feet. Logistic regression analyses were performed for statistical comparisons after adjusting for potential confounding factors. The results indicate that abnormalities in foot posture and arch, assessed using the FPI-6 and AI, were identified in 42.3 ​% and 47.2 ​% of participants, respectively, with 20.9 ​% and 16.5 ​% demonstrating bilateral asymmetry in these parameters. When comparing bilateral and unilateral foot protonation with bilaterally normal feet, the risk adjustments revealed differences of 2.274 (95 ​% CI: 1.094-4.729, P ​= ​0.028) and 2.751 (95 ​% CI: 1.222-6.191, P ​= ​0.015), respectively. Furthermore, the risk adjustment for age, BMI, smoking status, physical training years, training time, training frequency, warm-up before training, relaxation after training, MIS prevention, and treatment learning for unilateral flatfoot relative to bilateral normal feet was 3.197 (95 ​% CI:1.235-8.279, P ​= ​0.017). This study demonstrates that workers in physically demanding occupations who exhibit unilateral foot protonation or unilateral flatfoot are at an increased risk of lower-extremity musculoskeletal injuries.

Patellofemoral pain syndrome (PFPS) is one of the most frequent musculoskeletal disorders. Flatfoot and weakness of the hip and core muscles have been introduced as distal and proximal factors associated with this syndrome, respectively. The aim of this study is to investigate the effectiveness of a combination of a proximal strengthening exercise (PSE) program and a foot orthosis (PSEFO) on pain and function in women with PFPS and a pronated foot (PF). In this randomized clinical trial (RCT), 117 female patients aged 18-40 years will be recruited through online announcements on cyberspace as well as those installed in rehabilitation and healthcare centers and gyms. Considering the inclusion criteria, the participants will be randomized into three groups of 39 (group I: practicing PSEs and wearing PSEFO; group II: practicing only PSEs; and group III: control group [CG]). Randomization will be conducted using the sequentially numbered, opaque, sealed envelope (SNOSE) technique. The intervention groups (groups I and II) will perform PSEs at gyms for 2 months at the rate of three sessions per week (each session lasting 45-60 min) under the guidance of a trainer. In addition to the PSE, group I participants will receive prefabricated polyurethane FOs with an 8° varus wedge. They will be asked to wear the orthosis for 2 h a day and then slowly increase their wearing time to a full day. The CG participants will follow their routine lives during this study. Pain, as the primary outcome, will be measured by the visual analog scale before and after the 8-week intervention program. Additionally, quality of life, disability, Q angle, performance, and dynamic balance will be evaluated as secondary outcomes using the 36-item Short Form Health Survey, the Kujala score, a goniometer, the step-down test, the unilateral squat test, the anteromedial lunge test, the bilateral squat test, and the Y-balance test, respectively. In this RCT, the effectiveness of PSEs focusing on the hip and core muscles, with and without FOs, on pain and performance among women with PFPS and PF will be investigated and compared. The present study was approved by the Research Ethics Committee of Guilan University of Medical Sciences, Rasht, Iran (code: IR.GUILAN.REC.1402.021) and registered on the Iranian Registry of Clinical Trials (IRCT, code: IRCT20230604058380N1) at 28 July 2023.

Background Flexible flatfoot deformity may be painful, and it is often difficult to pinpoint one painful area. Considerable variability of symptoms and areas of pain are noted in this condition. This study aimed to identify a reproducible area of pain and tenderness in these types of feet, implying a painful flatfoot. Methodology This study included 35 patients, comprising 23 males and 12 females, with 66 painful flexible flatfoot deformities representing the study group. The average age was 7.8 years (range = 2-15). In total, 31 patients had bilateral pain, and four patients had unilateral pain. The control group included 20 age-matched patients with normal painless feet. Results In 28 patients, pain was non-localized in the lower extremity. Overall, seven patients had non-localized pain in the foot and could not identify a point of maximal tenderness. A new trigger point for pain was identified in all patients, 1.5-2 cm below and 1.5-2 cm posterior to the tip of the lateral malleolus, well behind the peroneal tendons. No pain was reported by the control group. Conclusions A new constant trigger point for pain was identified in all patients with painful flatfoot deformity. It is hypothesized to be due to the overloading of the posterolateral corner of the talocalcaneal joint or impingement on the calcaneofibular ligament secondary to the heel valgus. We believe that the presence of this trigger point will help clinicians confirm flatfoot deformity as the source of pain, adding another tool in the evaluation and diagnosis of this condition.