metricas
covid
Buscar en
Revista Española de Cirugía Ortopédica y Traumatología
Toda la web
Inicio Revista Española de Cirugía Ortopédica y Traumatología Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair
Journal Information

Statistics

Follow this link to access the full text of the article

Original Paper
Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair
Tratamiento quirúrgico del pie plano valgo adquirido del adulto en estadio IIB: papel de la reparación del «spring ligament»
E. García-Jaraboa,
Corresponding author
evagjarabo@hotmail.com

Corresponding author.
, L.M. Ramos-Ramosb, E.J. Sánchez-Morataa, Y. Hernanz-Gonzáleza, M.Á. Mellado-Romeroa, J. Vilá y Ricoa,c
a Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
b Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
c Departamento de Cirugía, Universidad Complutense de Madrid, Madrid, Spain
Read
1084
Times
was read the article
180
Total PDF
904
Total HTML
Share statistics
 array:24 [
  "pii" => "S1888441522003356"
  "issn" => "18884415"
  "doi" => "10.1016/j.recot.2022.11.003"
  "estado" => "S300"
  "fechaPublicacion" => "2023-01-01"
  "aid" => "1155"
  "copyright" => "SECOT"
  "copyrightAnyo" => "2022"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Esp Cir Ortop Traumatol. 2023;67:T62-T67"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1888441522002107"
    "issn" => "18884415"
    "doi" => "10.1016/j.recot.2022.07.021"
    "estado" => "S300"
    "fechaPublicacion" => "2023-01-01"
    "aid" => "1115"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2023;67:68-74"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "La radiograf&#237;a en bipedestaci&#243;n inmediata predice el colapso final de la v&#233;rtebra fracturada en pacientes a&#241;osos con fractura estallido toracolumbar"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "68"
          "paginaFinal" => "74"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Immediate standing X-ray predicts the final vertebral collapse in elderly patients with thoracolumbar burst fracture"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1086
              "Ancho" => 1675
              "Tamanyo" => 70295
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Recta de regresi&#243;n lineal de C2 en funci&#243;n de C1&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">C1&#58; cifosis regional medida en la radiograf&#237;a inmediata a levantar al paciente con la ortesis colocada&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">C2&#46; cifosis regional medida en la radiograf&#237;a realizada a los 3 meses de la lesi&#243;n&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Pazos Mohri, L&#46; Puente S&#225;nchez, M&#46;A&#46; Diez Ulloa"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Pazos Mohri"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Puente S&#225;nchez"
            ]
            2 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Diez Ulloa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441522002107?idApp=UINPBA00004N"
    "url" => "/18884415/0000006700000001/v3_202404150756/S1888441522002107/v3_202404150756/es/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1888441522002314"
    "issn" => "18884415"
    "doi" => "10.1016/j.recot.2022.08.008"
    "estado" => "S300"
    "fechaPublicacion" => "2023-01-01"
    "aid" => "1124"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2023;67:62-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
      "titulo" => "Tratamiento quir&#250;rgico del pie plano valgo adquirido del adulto en estadio IIB&#58; papel de la reparaci&#243;n del &#171;spring ligament&#187;"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "62"
          "paginaFinal" => "67"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Surgical treatment at adult acquired flatfoot stage IIB&#58; Spring ligament repair"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figura 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1873
              "Ancho" => 2340
              "Tamanyo" => 366254
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Radiograf&#237;as en carga&#46; a&#41; Dorsoplantar preoperatoria&#46; b&#41; Lateral preoperatoria&#46; c&#41; Dorsoplantar postoperatoria&#46; d&#41; Lateral postoperatoria&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Garc&#237;a-Jarabo, L&#46;M&#46; Ramos-Ramos, E&#46;J&#46; S&#225;nchez-Morata, Y&#46; Hernanz-Gonz&#225;lez, M&#46;&#193;&#46; Mellado-Romero, J&#46; Vil&#225; y Rico"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Garc&#237;a-Jarabo"
            ]
            1 => array:2 [
              "nombre" => "L&#46;M&#46;"
              "apellidos" => "Ramos-Ramos"
            ]
            2 => array:2 [
              "nombre" => "E&#46;J&#46;"
              "apellidos" => "S&#225;nchez-Morata"
            ]
            3 => array:2 [
              "nombre" => "Y&#46;"
              "apellidos" => "Hernanz-Gonz&#225;lez"
            ]
            4 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Mellado-Romero"
            ]
            5 => array:2 [
              "nombre" => "J&#46; Vil&#225; y"
              "apellidos" => "Rico"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441522002314?idApp=UINPBA00004N"
    "url" => "/18884415/0000006700000001/v3_202404150756/S1888441522002314/v3_202404150756/es/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:18 [
      "pii" => "S1888441522002314"
      "issn" => "18884415"
      "doi" => "10.1016/j.recot.2022.08.008"
      "estado" => "S300"
      "fechaPublicacion" => "2023-01-01"
      "aid" => "1124"
      "copyright" => "SECOT"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Esp Cir Ortop Traumatol. 2023;67:62-7"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Tratamiento quir&#250;rgico del pie plano valgo adquirido del adulto en estadio IIB&#58; papel de la reparaci&#243;n del &#171;spring ligament&#187;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "62"
            "paginaFinal" => "67"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Surgical treatment at adult acquired flatfoot stage IIB&#58; Spring ligament repair"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0015"
            "etiqueta" => "Figura 3"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr3.jpeg"
                "Alto" => 1873
                "Ancho" => 2340
                "Tamanyo" => 366254
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Radiograf&#237;as en carga&#46; a&#41; Dorsoplantar preoperatoria&#46; b&#41; Lateral preoperatoria&#46; c&#41; Dorsoplantar postoperatoria&#46; d&#41; Lateral postoperatoria&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "E&#46; Garc&#237;a-Jarabo, L&#46;M&#46; Ramos-Ramos, E&#46;J&#46; S&#225;nchez-Morata, Y&#46; Hernanz-Gonz&#225;lez, M&#46;&#193;&#46; Mellado-Romero, J&#46; Vil&#225; y Rico"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Garc&#237;a-Jarabo"
              ]
              1 => array:2 [
                "nombre" => "L&#46;M&#46;"
                "apellidos" => "Ramos-Ramos"
              ]
              2 => array:2 [
                "nombre" => "E&#46;J&#46;"
                "apellidos" => "S&#225;nchez-Morata"
              ]
              3 => array:2 [
                "nombre" => "Y&#46;"
                "apellidos" => "Hernanz-Gonz&#225;lez"
              ]
              4 => array:2 [
                "nombre" => "M&#46;&#193;&#46;"
                "apellidos" => "Mellado-Romero"
              ]
              5 => array:2 [
                "nombre" => "J&#46; Vil&#225; y"
                "apellidos" => "Rico"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441522002314?idApp=UINPBA00004N"
      "url" => "/18884415/0000006700000001/v3_202404150756/S1888441522002314/v3_202404150756/es/main.assets"
    ]
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Paper</span>"
    "titulo" => " Surgical treatment at adult acquired flatfoot stage IIB&#58; Spring ligament repair"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "T62"
        "paginaFinal" => "T67"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "E&#46; Garc&#237;a-Jarabo, L&#46;M&#46; Ramos-Ramos, E&#46;J&#46; S&#225;nchez-Morata, Y&#46; Hernanz-Gonz&#225;lez, M&#46;&#193;&#46; Mellado-Romero, J&#46; Vil&#225; y Rico"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "E&#46;"
            "apellidos" => "Garc&#237;a-Jarabo"
            "email" => array:1 [
              0 => "evagjarabo@hotmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "L&#46;M&#46;"
            "apellidos" => "Ramos-Ramos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "E&#46;J&#46;"
            "apellidos" => "S&#225;nchez-Morata"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Y&#46;"
            "apellidos" => "Hernanz-Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#46;&#193;&#46;"
            "apellidos" => "Mellado-Romero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Vil&#225; y Rico"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a&#44; Hospital Universitario 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a&#44; Hospital Universitario Rey Juan Carlos&#44; M&#243;stoles&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Departamento de Cirug&#237;a&#44; Universidad Complutense de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tratamiento quir&#250;rgico del pie plano valgo adquirido del adulto en estadio IIB&#58; papel de la reparaci&#243;n del &#171;spring ligament&#187;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1873
            "Ancho" => 2340
            "Tamanyo" => 366254
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Loading radiographs&#46; &#40;a&#41; Preoperative dorsoplantar&#46; &#40;b&#41; Preoperative lateral&#46; &#40;c&#41; Postoperative dorsoplantar&#46; &#40;d&#41; Postoperative lateral&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Adult acquired flatfoot &#40;AAF&#41; is a progressive painful deformity characterised by hindfoot valgus&#44; medial arch collapse&#44; associated with secondary supination and abduction of the forefoot&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In addition to the tibialis posterior that is the dynamic stabiliser of the medial longitudinal arch&#44; the foot deformity results from a failure of the static ligamentous stabilisers&#44; especially involving the spring ligament complex&#44; formed by two fascicles&#44; the superomedial calcaneonavicular ligament &#40;with direct attachment to the tibialis posterior and the superficial deltoid ligament&#41; and the inferior calcaneonavicular ligament&#44; the former being stronger and wider than the latter&#46; This ligamentous complex provides direct support to the medial&#47;plantar aspect of the talar head&#44; and its reconstruction may therefore be the basis for treatment in association with bone techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Among the multiple classifications of AAF&#44; the RAM<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> classification determines that it is not a linear process&#44; as it can affect different areas &#40;hindfoot&#44; ankle and midfoot&#41; in varying forms and degrees in each individual patient&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Subsequently&#44; Pasapula<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> introduced a new concept to the classification&#44; from a biomechanical point of view&#44; based on the medial column&#44; with the initial failure of the calcaneonavicular spring ligament being the determining factor in the development of this pathology&#44; adding a subclinical stage 0&#44; and the failure of the tarsometatarsal plantar ligament&#44; inducing dorsiflexion of the first metatarsal and favouring valgus deformity of the hindfoot&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Because it is this midfoot instability which leads to valgus deformity&#44; in 2020 Myerson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> proposed a new nomenclature for this pathology&#44; &#8220;progressive collapsing foot deformity&#8221;&#44; categorising the deformities into flexible &#40;stage 1&#41; or rigid &#40;stage 2&#41;&#44; and into five patterns of deformity based on location and clinical and radiological features&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of the study was to analyse the clinical and radiological results of spring ligament repair with augmentation and transfer of the flexor digitorum longus&#44; together with lateral column lengthening osteotomy and Cotton&#39;s osteotomy&#44; associated or not with medial sliding osteotomy of the calcaneus&#44; in patients diagnosed with acquired flatfoot deformity stage IIB according to the RAM classification&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The secondary objective was to evaluate the usefulness and integration of porous titanium wedges used in osteotomies&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient recruitment</span><p id="par0045" class="elsevierStylePara elsevierViewall">We conducted a retrospective study between 2017 and 2019&#44; with a mean follow-up of 21&#46;5 months &#40;18&#8211;38 months&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Twenty-three cases were studied in 20 patients with a mean age of 63 years &#40;46&#8211;73 years&#41;&#44; with the female sex predominating at 73&#46;9&#37; &#40;17 cases&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">With regards to inclusion criteria&#44; patients had been diagnosed with AAF deformity grade IIB according to the RAM classification&#44; had had no previous surgery and conservative osteoprosthetic treatment with medial support insoles and supinator gradient had failed&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study variables</span><p id="par0060" class="elsevierStylePara elsevierViewall">A clinical&#8211;radiological study was performed&#44; based on the American Orthopaedic Foot and Ankle Society Scale&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> and on pre- and post-surgical loading radiographs&#46; The radiological results were based on the variation of the talonavicular coverage angles &#40;TNC&#41;&#44; the talar first metatarsal angle in the dorsoplantar projection in loading &#40;TFMA&#41; and the Meary line in the lateral projection in loading &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">All patients underwent the same treatment sequence&#46; Firstly&#44; the achilles-calcaneal-plantar system was assessed to determine the need for surgical action at the level of the medial gastrocnemius muscle or Achilles tendon&#46; Subsequently&#44; Evans-type lateral column lengthening with porous titanium wedges up to 8<span class="elsevierStyleHsp" style=""></span>mm thick &#40;Wright Medical&#174;&#44; Memphis&#44; TN&#41;&#44; associated in 9 cases with MSCO&#44; fixed with two 6&#46;5<span class="elsevierStyleHsp" style=""></span>mm headless HCS cannulated screws &#40;DePuy Synthes Johnson &#38; Johnson&#174;&#44; New Brunswick&#44; NJ&#41;&#46; All patients underwent repair with spring ligament augmentation and transfer of the flexor digitorum longus to the navicular tubercle with 5&#46;5<span class="elsevierStyleHsp" style=""></span>mm Swivelock biodegradable screws &#40;Arthrex&#174;&#44; Naples&#44; FL&#41; and Cotton osteotomy with porous titanium wedges<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> about 6<span class="elsevierStyleHsp" style=""></span>mm thick &#40;Wright Medical&#174;&#44; Memphis&#44; TN&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">For the statistical study the SPSS 23&#46;0 programme was used &#40;IBM Corp&#46;&#174;&#44; Chicago&#44; IL&#44; U&#46;S&#46;A&#46;&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Functional clinical results were assessed according to the AOFAS scale&#44; with the preoperative result being 52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 and the postoperative result being 88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44; and with this difference being statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Regarding radiological findings&#44; the preoperative talonavicular coverage angle &#40;TNC&#41; was 21&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4 and 7&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4 postoperatively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; the TFMA was 18&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1 preoperatively and 3&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4 postoperatively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; and Meary&#39;s line went from 15&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4 preoperatively to 3&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2 postoperatively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">All the studied parameters show a statistically significant improvement &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">In reference to the degree of integration of the porous titanium wedges&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> the appearance of osteolysis and radiolucency was taken into account&#44; as well as mobilisation of the material in serial radiographs&#44; which were not observed in any of the cases studied&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">With regard to complications&#44; one case of progression of the deformity requiring double medial arthrodesis and one case of dehiscence of the surgical wound&#44; which was resolved with local dressings&#44; should be highlighted&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Based on the role of the calcaneonavicular spring ligament as a stabiliser of the medial spine&#44; and how its primary involvement favours the progressive development of the AAF&#44; it is to be expected that surgical action at this level&#44; associated with other surgical gestures&#44; will have good results in treating this pathology in still flexible stages&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Ligament repair must be accompanied by surgical intervention at bone level&#46; Traditionally&#44; medial calcaneal osteotomy &#40;Koutsogiannis technique<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a>&#41; has been used to restore the point of traction of the Achilles tendon&#44; helping to correct the valgus deformity of the hindfoot&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> However&#44; this technique does not complete the correction of forefoot abduction or the lack of coverage of the talar head at the talonavicular joint&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Therefore&#44; depending on the predominant type of deformity&#44; it is necessary to perform other surgical techniques&#44; such as lateral column lengthening osteotomy &#40;Evans technique<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a>&#41; to correct forefoot abduction&#44; present in stage IIB&#44; thus favouring navicular rather than talar head coverage&#44; reducing calcaneotalar divergence&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">12&#44;13</span></a> Other techniques necessary to correct residual forefoot supination deformity include plantar flexion osteotomy of the medial cuneiform &#40;Cotton technique<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a>&#41; or tarsometatarsal fusion &#40;Lapidus technique<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a>&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">At present&#44; there are various techniques for ligamentous intervention&#44; either direct suturing in the case of tears or anatomical reconstruction of the ligament&#44; creating an augmentation with a FiberTape&#174; type suture with a vertical tunnel at the level of the navicular&#44; anchoring it to another tunnel in the sustentaculum tali&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">16&#8211;18</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">With regard to osteotomies&#44; a possible associated complication is the non-union of the graft traditionally used&#46; According to the literature&#44; the percentage of non-union is around 1&#46;4&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> In the total sample studied&#44; no radiological signs indicating consolidation failure were detected&#44; and adequate osteotomy integration was observed in all cases&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In addition&#44; with the use of titanium wedges&#44; replacing the traditionally used plates&#44; we have observed a decrease in the rate of complications related to them&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The first limitation of our study is that it is a retrospective study&#46; In addition&#44; for the radiographic measurement of the angles studied&#44; there is great inter- and intra-observer variability&#44; after using measurement programmes available in our hospital&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Despite the limitations listed above&#44; the sample was homogeneous in terms of patient selection&#44; with an adequate number of patients for the study&#46; In addition&#44; all patients underwent the same protocolised treatment&#44; performed in all cases by the same surgical team&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">There are no comparative studies in the literature on the degree of integration between porous titanium wedges and previously used grafts&#44; nor studies on the function and degree of correction of the wedges&#44; so prospective studies are needed to determine the long-term clinical and functional repercussions of using porous titanium wedges in the treatment of AAF deformity in flexible stages&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0180" class="elsevierStylePara elsevierViewall">The repair of medial stabilisers associated with bone techniques offers excellent clinical and radiological results in the treatment of stage IIB AAF&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In addition&#44; porous titanium wedges are well integrated&#44; avoiding problems of peroneal impingement and the need for plate removal&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0190" class="elsevierStylePara elsevierViewall">This research did not receive any specific grants from public or commercial sector agencies or from any not-for-profit entities&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Level of evidence</span><p id="par0195" class="elsevierStylePara elsevierViewall">Level of evidence IV&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span><span id="sec2050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1110">Right to privacy and informed consent</span><p id="par1305" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from the patients and&#47;or subjects referred to in the article&#46; This document is held by the corresponding author&#46;</p></span><span id="sec2150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect2110">Ethics committee approval</span><p id="par2305" class="elsevierStylePara elsevierViewall">Approved by the Ethics Committee of Hospital Vozandes Quito&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:15 [
        0 => array:3 [
          "identificador" => "xres2130364"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background and aims"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1809223"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2130363"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Antecedentes y objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1809224"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patient recruitment"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Study variables"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Level of evidence"
        ]
        11 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of interests"
        ]
        12 => array:2 [
          "identificador" => "sec2050"
          "titulo" => "Right to privacy and informed consent"
        ]
        13 => array:2 [
          "identificador" => "sec2150"
          "titulo" => "Ethics committee approval"
        ]
        14 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-06-28"
    "fechaAceptado" => "2022-08-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1809223"
          "palabras" => array:2 [
            0 => "Adult acquired flatfoot deformity"
            1 => "Spring ligament"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1809224"
          "palabras" => array:2 [
            0 => "Pie plano adquirido adulto"
            1 => "Ligamento spring"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and aims</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The spring ligament has paramount role in supporting the arches and its fail causes the collapse of the medial longitudinal arc&#44; inducing adult acquired flatfoot deformity&#46; Our aim was to analyze the clinical and radiological outcomes of spring ligament repair and titanium wedges integration used in surgical osteotomies&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of 23 cases with middle ages of 63&#44; diagnosed with adult acquired flatfoot deformity stage IIB in RAM classification after ortho-prosthetic treatment failure&#44; assessing the functional outcomes using the American Orthopedic Foot and Ankle Society scale and the radiological outcomes studying angles variation &#40;talonavicular uncoverage&#44; talo-first metatarsal angle and Meary axis&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean preoperative American Orthopedic Foot and Ankle Society score of the sample was 52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 and the postoperative 88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The radiological outcomes showed a statistically significant improvement&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Spring ligament repair associated to bone reconstruction offers large functional and radiological outcomes to adult acquired flatfoot deformity stage IIB treatment&#46; Titanium wedges present an excellent bone integration&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and aims"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En el desarrollo del pie plano valgo adquirido del adulto ha cobrado gran importancia el fallo de la columna medial&#44; y no tanto la rotura del tibial posterior&#44; siendo principalmente la lesi&#243;n del ligamento en hamaca calcaneonavicular &#40;<span class="elsevierStyleItalic">spring ligament</span>&#41; el determinante del desarrollo de esta deformidad&#46; Nuestro objetivo es analizar los resultados cl&#237;nico-radiol&#243;gicos de la reparaci&#243;n del ligamento en hamaca&#44; y valorar la utilidad e integraci&#243;n de las cu&#241;as de titanio poroso en las osteotom&#237;as a las que se asocia la reparaci&#243;n ligamentosa&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio retrospectivo de 23 casos con una edad media de 63 a&#241;os&#44; diagnosticados de pie plano valgo adquirido del adulto estadio IIB de la clasificaci&#243;n RAM tras fallo de tratamiento ortoprot&#233;sico&#44; valorando los resultados cl&#237;nicos mediante la escala de la <span class="elsevierStyleItalic">American Orthopaedic Foot and Ankle Society</span> y los resultados radiol&#243;gicos pre y postoperatorios bas&#225;ndose en la variaci&#243;n de los &#225;ngulos estudiados &#40;cobertura talonavicular y &#225;ngulo talar-1&#46;<span class="elsevierStyleSup">er</span> metatarsiano en la proyecci&#243;n dorsoplantar y l&#237;nea de Meary en la proyecci&#243;n lateral&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La puntuaci&#243;n media en escala de la <span class="elsevierStyleItalic">American Orthopaedic Foot and Ankle Society</span> pas&#243; de 52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 preoperatorio a 88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6 &#40;p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En cuanto a los resultados radiol&#243;gicos se demostr&#243; una mejor&#237;a estad&#237;sticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; en la variaci&#243;n de los &#225;ngulos en el postoperatorio&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La reparaci&#243;n de los estabilizadores mediales&#44; asociada a t&#233;cnicas &#243;seas&#44; ofrece excelentes resultados cl&#237;nico-radiol&#243;gicos en el tratamiento del pie plano valgo adquirido del adulto estadio IIB&#46; Adem&#225;s&#44; las cu&#241;as de titanio poroso presentan una adecuada integraci&#243;n&#44; evitando los problemas de pinzamiento de los peroneos&#44; asociados al uso de placas y la necesidad posterior de retirada&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 848
            "Ancho" => 2340
            "Tamanyo" => 195188
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;a and b&#41; Dorsoplantar loading X-ray&#46; Talonavicular coverage angle &#40;blue&#41;&#46; Talar-1 metatarsal angle &#40;red&#41;&#46; &#40;c&#41; Lateral loading X-ray&#46; Meary&#39;s line &#40;black&#41;&#46; The colour of the figure can only be seen in the electronic version of the article&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2861
            "Ancho" => 2508
            "Tamanyo" => 750467
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Evans&#8217; osteotomy&#46; &#40;b&#41; Cotton&#39;s osteotomy&#46; &#40;c&#41; Degenerated posterior tibial tendon and ruptured spring ligament&#46; &#40;d&#41; Repair of the calcaneonavicular ligament&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1873
            "Ancho" => 2340
            "Tamanyo" => 366254
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Loading radiographs&#46; &#40;a&#41; Preoperative dorsoplantar&#46; &#40;b&#41; Preoperative lateral&#46; &#40;c&#41; Postoperative dorsoplantar&#46; &#40;d&#41; Postoperative lateral&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TNC angle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TFMA angle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Meary line&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Preoperative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postoperative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4&#176; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4&#176; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2&#176; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3511792.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Pre-and post-operative radiological outcomes&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The adult acquired flatfoot and spring ligament complex&#46; Pathology and implications for treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;T&#46; Deland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1083-7515(03)00086-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Clin"
                        "fecha" => "2001"
                        "volumen" => "6"
                        "paginaInicial" => "129"
                        "paginaFinal" => "135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11385920"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The RAM classification&#58; a novel&#44; systematic approach to the adult-acquired flatfoot"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;M&#46; Raikin"
                            1 => "B&#46;S&#46; Winters"
                            2 => "J&#46;N&#46; Daniel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fcl.2012.03.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Clin"
                        "fecha" => "2012"
                        "volumen" => "17"
                        "paginaInicial" => "169"
                        "paginaFinal" => "181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22541518"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adult acquired flat foot&#58; a new biomechanical classification for the deformity based on two point failure of the medial column"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Pasapula"
                            1 => "S&#46; Shariff"
                            2 => "S&#46; Cutts"
                            3 => "J&#46; West"
                            4 => "T&#46; Kobezda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Clin Res Foot Ankle"
                        "fecha" => "2018"
                        "volumen" => "6"
                        "paginaInicial" => "2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification and nomenclature&#58; progressive collapsing foot deformity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Myerson"
                            1 => "D&#46;B&#46; Thordarson"
                            2 => "J&#46;E&#46; Jonhson"
                            3 => "B&#46; Hintermann"
                            4 => "B&#46;J&#46; Sangeorzan"
                            5 => "J&#46;T&#46; Deland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1071100720950722"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "2020"
                        "volumen" => "41"
                        "paginaInicial" => "1271"
                        "paginaFinal" => "1276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32856474"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical rating systems for the ankle-hindfoot&#44; midfoot&#44; hallux&#44; and lesser toes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;B&#46; Kitaoka"
                            1 => "I&#46;J&#46; Alexander"
                            2 => "R&#46;S&#46; Adelaar"
                            3 => "J&#46;A&#46; Nunley"
                            4 => "M&#46;S&#46; Myerson"
                            5 => "M&#46; Sanders"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/107110079401500701"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "1994"
                        "volumen" => "15"
                        "paginaInicial" => "349"
                        "paginaFinal" => "353"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7951968"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcomes of corrective osteotomies using porous titanium wedges for flexible flatfoot deformity correction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Matthews"
                            1 => "E&#46;A&#46; Cook"
                            2 => "J&#46; Cook"
                            3 => "L&#46; Johnson"
                            4 => "T&#46; Karthas"
                            5 => "B&#46; Collier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.jfas.2018.03.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Foot Ankle Surg"
                        "fecha" => "2018"
                        "volumen" => "57"
                        "paginaInicial" => "924"
                        "paginaFinal" => "930"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29891128"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiographic outcomes following lateral column lengthening with a porous titanium wedge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;E&#46; Gross"
                            1 => "J&#46; Huh"
                            2 => "J&#46; Gray"
                            3 => "C&#46; Demetracopoulos"
                            4 => "J&#46;A&#46; Nunley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1071100715577788"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "2015"
                        "volumen" => "36"
                        "paginaInicial" => "953"
                        "paginaFinal" => "960"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25810461"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Deltoid-spring ligament reconstruction in adult acquired flatfoot deformity with medial peritalar instability"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;D&#46; Brodell Jr&#46;"
                            1 => "A&#46; MacDonald"
                            2 => "J&#46;A&#46; Perkins"
                            3 => "J&#46;T&#46; Deland"
                            4 => "I&#46; Oh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1071100719839176"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "2019"
                        "volumen" => "40"
                        "paginaInicial" => "753"
                        "paginaFinal" => "761"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30902021"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of mobile flat foot by displacement osteotomy of the calcaneus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Koutsogiannis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "1971"
                        "volumen" => "53"
                        "paginaInicial" => "96"
                        "paginaFinal" => "100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5578768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calcaneal osteotomy in the treatment of adult acquired flatfoot deformity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;R&#46; Guha"
                            1 => "A&#46;M&#46; Perera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fcl.2012.02.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Clin"
                        "fecha" => "2012"
                        "volumen" => "17"
                        "paginaInicial" => "247"
                        "paginaFinal" => "258"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22541523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calcaneo-valgus deformity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Evans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "1975"
                        "volumen" => "57"
                        "paginaInicial" => "270"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1171869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adult flatfoot"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Toullec"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.otsr.2014.07.030"
                      "Revista" => array:7 [
                        "tituloSerie" => "Orthop Traumatol Surg Res"
                        "fecha" => "2015"
                        "volumen" => "101"
                        "numero" => "Suppl&#46;"
                        "paginaInicial" => "S11"
                        "paginaFinal" => "S17"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25595429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The contribution of medializing calcaneal osteotomy on hindfoot alignment in the reconstruction of the stage II adult acquired flatfoot deformity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;Y&#46; Chan"
                            1 => "B&#46;R&#46; Williams"
                            2 => "P&#46; Nair"
                            3 => "E&#46; Young"
                            4 => "C&#46; Sofka"
                            5 => "J&#46;T&#46; Deland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1071100712460225"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "159"
                        "paginaFinal" => "166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23413053"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foot statics and surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46;J&#46; Cotton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1936"
                        "volumen" => "214"
                        "paginaInicial" => "353"
                        "paginaFinal" => "362"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The operative correction of metatarsus primus varus in hallux valgus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;W&#46; Lapidus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Surg Gynecol Obstet"
                        "fecha" => "1934"
                        "volumen" => "58"
                        "paginaInicial" => "183"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anatomic reconstruction technique for a plantar calcaneonavicular &#40;spring&#41; ligament tear"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Palmanovich"
                            1 => "S&#46; Shabat"
                            2 => "Y&#46;S&#46; Brin"
                            3 => "V&#46; Feldman"
                            4 => "B&#46; Kish"
                            5 => "M&#46; Nyska"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.jfas.2015.06.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Foot Ankle Surg"
                        "fecha" => "2015"
                        "volumen" => "54"
                        "paginaInicial" => "1124"
                        "paginaFinal" => "1126"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26253476"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Novel reconstruction technique for an isolated plantar calcaneonavicular &#40;SPRING&#41; ligament tear&#58; a 5 case series report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Palmanovich"
                            1 => "S&#46; Shabat"
                            2 => "Y&#46;S&#46; Brin"
                            3 => "S&#46; Massrawe"
                            4 => "I&#46; Hestroni"
                            5 => "M&#46; Nyska"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.foot.2016.10.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot &#40;Edinb&#41;"
                        "fecha" => "2017"
                        "volumen" => "30"
                        "paginaInicial" => "1"
                        "paginaFinal" => "4"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27915133"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Isolated spring ligament failure as a cause of adult-acquired flatfoot deformity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;D&#46; Orr"
                            1 => "J&#46;A&#46; Nunley 2nd"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1071100713483099"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "818"
                        "paginaFinal" => "823"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23564421"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of nonunion of the unfixated&#44; isolated evans calcaneal osteotomy&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;A&#46; Prissel"
                            1 => "T&#46;S&#46; Roukis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.jfas.2012.01.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Foot Ankle Surg"
                        "fecha" => "2012"
                        "volumen" => "51"
                        "paginaInicial" => "323"
                        "paginaFinal" => "325"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22300686"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/18884415/0000006700000001/v3_202404150756/S1888441522003356/v3_202404150756/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7694"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/18884415/0000006700000001/v3_202404150756/S1888441522003356/v3_202404150756/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441522003356?idApp=UINPBA00004N"
]
Article information
ISSN: 18884415
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 1 0 1
2024 October 43 4 47
2024 September 57 4 61
2024 August 56 10 66
2024 July 31 6 37
2024 June 20 5 25
2024 May 24 8 32
2024 April 27 4 31
2024 March 30 5 35
2024 February 46 5 51
2024 January 31 5 36
2023 December 32 9 41
2023 November 38 10 48
2023 October 59 7 66
2023 September 55 1 56
2023 August 49 4 53
2023 July 54 4 58
2023 June 53 8 61
2023 May 78 15 93
2023 April 35 10 45
2023 March 7 10 17
2023 February 34 7 41
2023 January 44 19 63
2022 December 0 15 15
2022 November 0 5 5
Show all

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos