Journal article
A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment
Archives of orthopaedic and trauma surgery, Vol.143(3), pp.1331-1339
03/2023
DOI: 10.1007/s00402-021-04279-z
PMID: 34859296
Abstract
Introduction Bluman et al., flatfoot classification is based on posterior tibial tendon (PTT) dysfunction leading to a chronological appearance of several foot deformities. An expert consensus recently proposed a new classification named Progressive Collapsing Foot Deformity (PCFD) in which the focus was shifted to five different independent foot and ankle deformities and their flexibility or rigidity. The aim of this study was to compare Bluman and PCFD classifications. We hypothesize that both classifications will be reliable and that the PCFD classification will allow a larger distribution of the different types of foot deformity. Materials and methods We performed a retrospective IRB-approved study including 92 flatfeet. Three foot and ankle surgeons reviewed patient files and radiographs to classify each foot using both classifications. Bluman classification was performed one time as initially described and a second time after removing the Angle of Gissane sclerosis sign. Interobserver reliabilities were determined with Fleiss' kappa values. Results Interobserver reliabilities of Bluman and PCFD classifications were, respectively, substantial 0.67 and moderate 0.55. PCFD Class C and D reliabilities were, respectively, slight 0.07 and fair 0.28. The 276 readings were spread into 10 substages in Bluman and 65 subclasses in PCFD. The progressivity of the Bluman classification prevented the combination of flexible hindfoot valgus (II Bluman, 1A PCFD), midfoot abduction (IIB, 1B) and medial column instability (IIC, 1C) which was frequent in our study (112/276 readings, 40.6%). By removing the Angle of Gissane sclerosis sign from the Bluman classification, the prevalence of stage III decreased from 44.2 to 10.1%. Conclusions Bluman and PCFD classifications were reliable. The PCFD classification showed a larger distribution of different types of flatfeet but Classes C and D need better definition. The progressivity of Bluman classification causes inconsistencies and Gissane angle sclerosis sign is inappropriately used and might lead to incorrect surgical indications.
Details
- Title: Subtitle
- A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment
- Creators
- Matthieu Lalevee - Roy J. and Lucille A. Carver College of MedicineNacime Salomao Barbachan Mansur - Univ Iowa, Carver Coll Med, Dept Orthoped & Rehabil, 200 Hawkins Dr,John PappaJohn Pavill JPP, Iowa City, IA 52242 USAHee Young Lee - Roy J. and Lucille A. Carver College of MedicineAmanda Ehret - Roy J. and Lucille A. Carver College of MedicineTutku Tazegul - Roy J. and Lucille A. Carver College of MedicineKepler Alencar Mendes de Carvalho - Roy J. and Lucille A. Carver College of MedicineEric Bluman - Orthopedic Surgery, Brigham Health, 75 Francis Street, Boston, MA, 02115, USA.Cesar de Cesar Netto - Univ Iowa, Carver Coll Med, Dept Orthoped & Rehabil, 200 Hawkins Dr,John PappaJohn Pavill JPP, Iowa City, IA 52242 USA
- Resource Type
- Journal article
- Publication Details
- Archives of orthopaedic and trauma surgery, Vol.143(3), pp.1331-1339
- Publisher
- Springer Nature
- DOI
- 10.1007/s00402-021-04279-z
- PMID
- 34859296
- ISSN
- 0936-8051
- eISSN
- 1434-3916
- Number of pages
- 9
- Grant note
- GCS-G4 (Lille, France) French Society for Orthopedic Surgery and Traumatology (SOFCOT, France)
- Language
- English
- Electronic publication date
- 12/03/2021
- Date published
- 03/2023
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984303964402771
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