Hi, my name is Caleb Eel. I'm a third-year medical student at the University of Iowa, and I'm going to be discussing flat-foot deformity correction using a longitudinal arch support ankle-foot orthosis, a weight-bearing CT prospective case-controlled study. These are the disclosures for the members of our group. So for the background, PCFD is a complex 3D deformity of the foot. PCFD has three defining characteristics, collapse of longitudinal arch, abduction of the foot, and valgus deformity of the hind foot. Some flat-foot cases do not progress and therefore don't require surgery, but others often do, and surgery is used to treat progressive and more severe cases. The question is, can we conservatively treat these patients without surgery? A longitudinal arch support is often used for this purpose. We looked at the inflatable ankle-foot orthosis, aka IAFO, which inflates an air bladder underneath the longitudinal arch. This is commonly used as a conservative treatment. The question is, does it actually work? To answer that question, we looked at, we used a weight-bearing CT technology to assess 3D measurements and flat-foot deformity components. The measurements were used to quantitatively assess correction via the brace. The objective of our study is to assess the amount of 3D correction of flat-foot deformity with the use of the IAFO, and our hypothesis was that the IAFO would significantly correct the flat-foot deformity components of the coronal, sagittal, and axial planes. For our methods, we did a prospective comparative control study. We used 12 patients at 17 flat feet. These patients were symptomatic. For our numbers, we had nine controls, 17 feet, and they were matched for age, sex, and BMI. All patients and controls underwent weight-bearing CT imaging with and without the IAFO. We focused on six multi-planar measurements that were done by two independent employee readers. They're listed here below. I don't have time to explain all of them, but you can look those up on your own time. So, for our methods, we decided to compare, within each individual group, the control brace versus non-braced and the flat-foot brace versus flat-foot non-braced, and then we wanted to compare the change in both of those groups to see if it was significant as well. For our statistical analysis, we used continuous variables that were assessed by Shapiro-Wilk. Variables were compared using a paired T-test or paired Wilcoxon, and we considered less than 0.05 significant. For the intra-group comparison, we had an increase in the middle cuneiform to floor distance, an increase in the porphyrin angle arch, and no significant difference in the talus first metatarsal angle. All the other measurements that we took were insignificant. For the intra-group comparison, we had an increase in the middle cuneiform, an increase in the forefoot arch angle, and a decrease in the talus first metatarsal angle, and so this showed that the longitudinal arch collapse improved with the brace. For our intra-group comparison, there was no significant improvement in the FAO, hind foot moment arm, or TCA as mentioned before. For our intra-group comparison, we found that the medial cuneiform to floor distance had a significant increase, and the talus first metatarsal angle had a significant decrease from our control compared to our flat foot, so it helped flat foot patients more, two times more, and then 10 times more in each individual case. So for our conclusion, our primary hypothesis was confirmed. The use of the IAFO significantly improved some of the medial longitudinal arch height measurements for both flat foot patients and control patients. Improvements were overall more pronounced in our flat foot patients than in the control patients, so the use of the IAFO did not improve the overall 3D deformity for the FAO, the hind foot falgus, or midfoot abduction. The results of our study should be considered when prescribing these IAFO braces for flat foot patients. Thank you for your attention. I appreciate your time.

Caleb Eel

medical student

University of Iowa

longitudinal arch support ankle-foot orthosis

flat-foot deformity