To assess the effect of internal foot progression angle (inturning) on knee dynamics in children with treated clubfeet.
This is explained by internal foot deformation as shown above.
Moreover, the magnitude of internal foot rotation was associated with the presence and severity of medial meniscal lesions, independent of the peak knee adductor moment during late stance.
In limbs with abnormally high preoperative transverse plane values, multilevel soft tissue surgery resulted in reduced pelvic retraction and reduced internal foot progression.
In limbs with abnormally high preoperative internal foot progression the mean improvement was 11°, which is quite satisfactory from a clinical point of view.
Statistically significant improvements in pelvic retraction occurred in both age groups, whereas internal foot progression was significantly improved only in children under 12.1 years of age.
However, our results demonstrated an association between internal foot rotation and the presence and severity of medial meniscal tears, independent of the peak external knee adduction moment.
The presence of a medial compartment meniscal tear was associated with a 6.2° (95% confidence interval [CI] 0.5 to 11.8; P = 0.03) increase in internal foot rotation, and each grade increase in meniscal tear severity was associated with a 3.5° (95% CI 0.35 to 6.6; P = 0.03) increase in internal foot rotation (Table 3).
This suggests that, also for the plantar flexion range, internal foot deformation plays an important role in causing changes in foot plate angle to be an inadequate estimator of angular changes at the talocrural joint.
Barnett described the presentation of this deformity as a bimalleolar axis of less than 80º, internal foot progression angle, curved lateral border of the foot, shallow sinus tarsi, equinus, and rotation of the medial column of the forefoot [ 1].
