FLATFOOT

A BLOODLESS METHOD FOR ITS CORRECTION

ANTONIO LEPORE° MD ALFREDO COLUCCI*, MD

FRANCESCO PETTRONE*   ANTONIO VOZZA*

MAURIZIO INDOLFI^ IVO RENDINA^

° Bureau of Pediatrics "Hospital S.Giuseppe and Melorio"

Via Melorio, 81055 - S.Maria Capua Vetere (CE) Italy

*Center "Gymnasium", Via Appia 8, Casagiove (CE) Italy

^ National Advice  of the Researches Institute of Research for the Electromagnetism and the Electronics Components (CNR-IRECE)

Via Diocleziano 328, 80124 – Napoli Italy

Key words: Flatfoot-Valgusfoot-Electrostimulations-StepWave

SUMMARY

The main objective of this article is to describe a new method for the correction of flatfoot and valgusfoot.

It a method of a bloodless and non-invasive nature based on the use of electrostimulations.

The new approach has proved to be useful in treating alterations of all levels.

It has produced fast and irreversible results in more than 90% of the patients treated.

The following pages elaborate the technique, the process carried out, and the apparatus employed, as well as the results obtained in 12 years of experimentation.

INTRODUCTION

Flatfoot ( Ff), and valgusfoot (Vf), are evident in a large number of children, and it exists either in the single or in combined forms .

It concerns a pathology present in about 50% of pre-school children and in 43.1% of children between the ages of 5 and 10.

It diminishes to 24.6% in the 10 to 20 age group, and continues its descent, 12.7%, in adults.

All evidence points to the fact that, in addition to being a common pathology, through the course of a patient’s life, it can result in many and varied problems such as tiredness, pain in the lower joints, and even a pathology often confused with lombosciatalogy, a pathology actually caused by other factors.

Flatfoot is by definition a condition in which the plantar vault is considerably reduced in height or has disappeared altogether, and is almost always accompanied by a valgus heel ².

In order to verify the existence of flatfoot, it is necessary to wait for the moment in which the foot takes on a more stable form especially as weight bearer, that is to say, the age between 4 and 6, a period characterized by the development of the connective tissues such as capsules and ligaments.

At this stage of development, these structures are in the process of losing cells and elastin while, at the same time, they are being enriched by fibers and connective tissues.

It is the moment in which the muscles acquire the capacity to contrast gravity².

The bloodless and non-invasive corrections, better known as orthesis, still in use today, do not seem to bring about an actual correction of the foot’s alterations since they function exclusively as supports and as such, do not possess a corrective quality².

We hold that the surgical methods still considered to be today the only means of achieving a real correction are applicable to malformations that cannot be treated in any other way.

The rather poor results achieved by the above-stated bloodless methods have led us to explore innovative approaches that center particularly around the plantar arch .

This paper’s aim is to communicate the achievements of a twelve-year research project carried out by our group.

We aim specifically to bring to the attention of the scientific community the positive results achieved through this new methodology based on the use of electrostimulations.

In twelve years of experimentation, this innovative technique, absolutely bloodless and non-invasive, has produced rapid and irreversible results in the greater majority of the cases treated.

Our work can certainly be defined as experimental, since the only other existing group on an international level to have dealt with the same idea stopped all work at one point⁽⁷⁾.

Unable to find any other work of the sort published, we proceeded in the experimentation by applying our own methodological criteria.

Hence, the selection of the age group, the years between 5 and 11, the diagnosis, generally carried out in a preceding moment by an orthopedist and subsequently confirmed by us, and the frequent use of orthesis.

It is important to note that many of the patients that had worn the so-called orthesis not only had not benefited from such a method of treatment but had even encountered greater difficulty in correcting the defect with our method.

METHODOLOGY

The idea at the base of the methodology stems from the fact that flatfoot originates essentially in an unnatural "relaxation"of the plantar arch.

In such cases, the arch’s tendon structure is not fully supported by the toned muscle strips. (It is obviously the opposite of how every muscle-tendon tract of our organism should be performing).

Furthermore, it is interesting to note how the majority of patients who suffer from flatfoot also possess a "relaxed" bearing in their entire person.

A plausible conclusion could be that such a bearing is associated with an erroneous "body image" that the patient "receives" regarding his/her entire organism, including the foot.

The treatment consists of stimulating a well-defined anatomic area situated at approximately the center of the arch’s vault known as "Spitzy’s sub-astragalic point" .

This point, very active proprioceptively and esteroceptively, transmits to the thalamus the information regarding the correct spatial position of the talus and the heel.

This position, in addition to being conditioned in a mechanical way, is further confirmed by the muscle response to the stimulus in a proriocetive and esteroceptive way.

Spitzy was so convinced, and rightly so, that the stimulus connected to the point discovered by him would have resulted in the formation of the arch’s vault, that he accentuated it, perhaps with too much determination, by means of a nail applied directly on a plantar arch deviced for the purpose.

The objective is the activation of a "reflected arch" which, after a certain period of time, will produce an automatic movement that induces a stabilization and toning of the relaxed muscles.

In addition, it leads to a corrected body image in regard to the altered zone.

The method is based on the use of electrostimulations in the form of stepwaves in a regime of impulses.

The electric impulses employed reach a maximum peak of a few dozen milliamperes, a duration of several hundred milliseconds, and repetitive frequencies of about 1Hz.

The electrodes are placed on the inner part of the leg, allowing for the maximum use of the front tibial muscle and Spitzy’s point (fig. 1).

In collaboration with the Italian National Research Council (Consiglio Nazionale delle Ricerche), we have been able to perfect a mechanism which produces a stepwave that allows us first to depolarize the muscle so that it can be stimulated.

Then we proceed to establish the variation of the form of the wave and of the parameters that characterize it, as well as the regulation of the optimum values of the current employed.

DIAGNOSIS AND THERAPY

In a new-born baby, flatfoot is a physiological phenomenon and remains such at least until the baby begins to walk and "build the supports".

The diagnosis of a "real" flatfoot can be carried out only from the moment the child begins to walk.

This is the reason why, in our opinion, any eventual treatment should be started after age five.

The first phase of the therapy involves the execution of a plantscopy which allows us to diagnose the level of flatfoot or valgusfoot.

For the reasons already stated, it should not be carried out before the age of 3-5.

The second phase consists of the treatment itself which requires no less than ten applications interposed by a second plantgraph check-up half-way through the therapy.

Finally, there follows a third plantscopy in order to decide whether to interrupt the therapy if successfully terminated, or vice versa, proceed with other applications.

The third and final phase consists of a follow up procedure involving a first plantscopic check-up within two months followed by subsequent ckeck-ups every six months which aim to ascertain whether brief applications are necessitated having a restimulation effect.

The follow-up phase must be continued for at least two years.

RESULTS

The method has proved to be efficacious in a total of 97% of the patients who have undergone the therapy for flatfoot or valgusfoot.

As the plantscopy in Figures 2,3,4,5, point out, it is possible to obtain a disappearance of the exceeding weight, verifiable even visually, and the foot regains a perfectly normal form in the cases of complete healing.

206 children having flatfoot and 182 having valgusfoot were treated by our group from January 1995 through September 1997.

Upon a close examination of the table below, it is possible to note that the best results are obtained in the pathologies of the first level, with a 92% healing for flatfoot and 94% for valgusfoot.

In flatfoot of the second level, the percentage of healing is 63% while 37% of the patients heal partially.

In the third level, these percentages are inverted: 33% heal completely while 67% heal only partially.

In the valgusfoot of the second level, we verified that 92% of the patients healed completely and only 8% did so partially, while in the third level, the percentage for both cases is 50%.

As can be seen, the percentage of unresolved cases in the flatfoot of the first level consists of 8%, while in the valgusfoot of the same level, it is a question of 6%, an altogether negligible percentage.

The follow-up check-ups which we have been having for about two years, (even if we continue to see the patients we have treated even after longer periods of time), have demonstrated that the results obtained by us rarely have a tendecy to regress.

In the few cases where it happens, it is sufficient to reapply a few electrostimulations in order to stabilize the situation definitively.

The statistics provided in this paper concern patients between the age of 5 and 11.

CONCLUSIONS

As is evident, the results obtained with our method are certainly positive, since the overall result, including healing and modifications, amounts to 97%.

Such results are totally comparable on an equal basis to those obtained by surgical treatments, and specifically those obtained by Valenti in a one of his surveys.

In this case record, of the 362 patients operated with the arthritis technique of the sub-talaric canal, 358 patients, or 99% healed and 4, or 1%, remained unresolved.

It is necessary to take into account the fact that our method is absolutely bloodless and non-invasive, and, furthermore, does not procure the patient any danger since the machine functions detached from the patient at all times.

At the present moment, there exist two studies in the preparation stage, one involving a collaborating effort of seven centers, five of which are university pediatric centers and two are orthopedic-pediatric hospital centers.

The second will be carried out by a bioengineer center.ù

All contacts are to be addressed to the author

Antonio Lepore, M.D.

“S. Giuseppe e Melorio” Hospital

Via Melorio

81055-Santa Maria Capua Vetere (CE), Italy

Tel. +39(0823) 891210

Cell. 0335-6582160

Fax +39(0823) 819898