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A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment.

Publication ,  Journal Article
Lalevée, M; Barbachan Mansur, NS; Lee, HY; Ehret, A; Tazegul, T; de Carvalho, KAM; Bluman, E; de Cesar Netto, C
Published in: Arch Orthop Trauma Surg
March 2023

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.

Duke Scholars

Published In

Arch Orthop Trauma Surg

DOI

EISSN

1434-3916

Publication Date

March 2023

Volume

143

Issue

3

Start / End Page

1331 / 1339

Location

Germany

Related Subject Headings

  • Sclerosis
  • Retrospective Studies
  • Posterior Tibial Tendon Dysfunction
  • Orthopedics
  • Humans
  • Foot Deformities, Acquired
  • Foot Deformities
  • Flatfoot
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Lalevée, M., Barbachan Mansur, N. S., Lee, H. Y., Ehret, A., Tazegul, T., de Carvalho, K. A. M., … de Cesar Netto, C. (2023). A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment. Arch Orthop Trauma Surg, 143(3), 1331–1339. https://doi.org/10.1007/s00402-021-04279-z
Lalevée, Matthieu, Nacime Salomao Barbachan Mansur, Hee Young Lee, Amanda Ehret, Tutku Tazegul, Kepler Alencar Mendes de Carvalho, Eric Bluman, and Cesar de Cesar Netto. “A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment.Arch Orthop Trauma Surg 143, no. 3 (March 2023): 1331–39. https://doi.org/10.1007/s00402-021-04279-z.
Lalevée M, Barbachan Mansur NS, Lee HY, Ehret A, Tazegul T, de Carvalho KAM, et al. A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment. Arch Orthop Trauma Surg. 2023 Mar;143(3):1331–9.
Lalevée, Matthieu, et al. “A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment.Arch Orthop Trauma Surg, vol. 143, no. 3, Mar. 2023, pp. 1331–39. Pubmed, doi:10.1007/s00402-021-04279-z.
Lalevée M, Barbachan Mansur NS, Lee HY, Ehret A, Tazegul T, de Carvalho KAM, Bluman E, de Cesar Netto C. A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment. Arch Orthop Trauma Surg. 2023 Mar;143(3):1331–1339.
Journal cover image

Published In

Arch Orthop Trauma Surg

DOI

EISSN

1434-3916

Publication Date

March 2023

Volume

143

Issue

3

Start / End Page

1331 / 1339

Location

Germany

Related Subject Headings

  • Sclerosis
  • Retrospective Studies
  • Posterior Tibial Tendon Dysfunction
  • Orthopedics
  • Humans
  • Foot Deformities, Acquired
  • Foot Deformities
  • Flatfoot
  • 3202 Clinical sciences
  • 1103 Clinical Sciences