Background: Flexible flatfoot is a physiological variation of normality that does not need correction unless it
becomes symptomatic1. The objective of this study was to assess the value of Lateral Calcaneal lengthening
osteotomy in Symptomatic flexible Flat foot in children and adolescents to improve structural alignment while
maintaining hind foot motion, which may further protect the function of adjacent motion segments. We
performed this procedure on 36 feet of 22 patients where Achilles tendon lengthening is also done.
Postoperative follow-up showed significant improvement in both clinical and radiological parameters and ankle
foot score. Methods: In a prospective study conducted in abo aresh, Cairo University or orthopedic department
in zagzaig University Hospital, 36 feet of 22 patients were operated for symptomatic flexible Flat foot from
January 2010 and February 2014. All the cases were treated as per protocol. There were 12 female (54.5℅)
and 10 males (45.5℅). Mean operation age was 10 years 4 months, range from 7 years 6 months to 17 years 2
months. There were 14 bilateral cases (63.6℅) and 8 unilateral cases (36.4℅). The average follow up duration
was 18.7 months (SD 80.5) (ranging from 6 to 37 months). Inclusion criteria included painful, passively
correctable pes planovalgus (No symptomatic arthritis in the subtalar, calcaneocuboid and talonavicular joints.).
Exclusion criteria included fixed pesplanovalgus, osteoporosis of the calcaneum, advanced degenerative
arthritis of the subtalar, talonavicular or calcaneocuboid joints, Paralytic condition affecting foot and ankle
Severe bone metabolism disorder (e.g., poorly controlled insulin-dependent diabetes mellitus with neuropathy),
severe trophic skin disorders and Standard contraindications to any surgery such as poor circulation,
unhealthy or compromised patient and concurrent infection. The diagnosis of functional flexible flatfoot was
established by clinical and radiographic examination. Clinical diagnosis was based on increased valgus position
at rest and during tiptoe standing test as well as restriction of dorsiflexion of the ankle joint in neutral
varus/valgus position. All patients are assessed clinical and American Academy of Orthopedic Surgeons
(AOFAS) foot and ankle core score. - All patients underwent American Orthopedic Foot and Ankle Society
(AOFAS) hindfoot/ankle scoring preoperatively, 3 months after the second foot surgery, and at the time of
maximal follow-up. Results: Out of 36 feet of 22 patients who were operated for symptomatic flexible Flat foot
showed significant correction (P <0.001) in all parameters clinically postoperatively. The pain which was the
main indication for the surgery was eliminated in all patients. In the follow-up period, there were no difficulties in
wearing shoes. Postoperative 20 patients showed excellent results (18–16 points), and 13 patient show good
result (15–13 points) And 3 patient show fair results (12–10 points) and no patient show poor result (< 10
points). The average AOFAS preoperative score was 68.7±5.7 (Range: 58 to 78). A 3-month postoperative
AOFAS score was determined for all 36 patients after the second foot surgery. The average score was
86.5±3.4 (Range, 82 to 92). 1 patient showed Incision dehiscence which improved on daily dressing. 1 patient
show Mild sural neuritis improved dramatically by physiotherapy and local steroid injection. 1 patient Subluxed
talonavicular joint on postoperative which corrected by k-wire pass across medial cuneiform, navicular, talus,
on final follow up the graft incorporated well with well covered talonavicular. 2 patients, a graft minimally
dislocated after surgery, but then healed uneventfully. In both cases, there is bony prominence. 1 of these 2
patients also exhibited some loss of forefoot adduction correction. At follow-up, moderate pain was present at
the lateral ankle and subtalar joint, and the result was rated as fair. Conclusion: Lateral calcaneal lengthening
osteotomy with tendon achilis lengthening is relatively simple, effective procedure in treating flexible flatfoot in
pediatric age. The objective of the technique was achieved. Good alignment and improvement in sagittal and
hind foot motion was observed. Such an improvement in AOFAS score has been previously reported.
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