Calcaneal lengthening vs extra-articular subtalar arthrodesis for flexible pes planovalgus

NewsBot · Sep 26, 2009

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A comparison of two different techniques in the surgical treatment of flexible pes planovalgus: calcaneal lengthening and extra-articular subtalar arthrodesis.
Dogan A, Zorer G, Mumcuoglu EI, Akman EY.
J Pediatr Orthop B. 2009 Jul;18(4):167-75.

The objective of this study was to compare the results of calcaneal lengthening and Dennyson-Fulford extra-articular subtalar arthrodesis operations performed in patients with flexible pes planovalgus owing to various etiologies and to compare their effectiveness in realigning the foot. Two patient groups were retrospectively formed out of the patients in whom calcaneal lengthening (25 feet of 13 patients) and subtalar extra-articular arthrodesis (27 feet of 15 patients) operations were performed. The modified Evans technique for the calcaneal lengthening operation and the Dennyson-Fulford technique for the subtalar extra-articular arthrodesis operation were applied. Any special criterion to choose the indication was not considered. The main indication for the surgery was pain during daily routine activities in both groups. The patients were evaluated preoperatively and during the last visit, both clinically and radiographically. The groups were homogenous for sex and mean age for the process, but in the subtalar extra-articular arthrodesis group, the deformity was more severe in some parameters, mean follow-up period was significantly longer and neurologic etiologies were more dominant. Anteroposterior talocalcaneal and talonavicular angles were worse in the subtalar extra-articular arthrodesis group preoperatively (P<0.05). Both groups showed significant correction (P<0.05) in all parameters postoperatively. In the last visit, lateral talocalcaneal, anteroposterior, and lateral talonavicular angles were worse in the calcaneal lengthening group (P<0.05) and calcaneal pitch angle was worse in the subtalar extra-articular arthrodesis group (P<0.05). Both groups showed significant clinical correction (P<0.05) in all parameters postoperatively, but there was no significant difference between the groups during the last visit in terms of total clinical scores (P>0.05). Pain, the parameter that was the main indication for surgery, was eliminated in all patients except for one in the calcaneal lengthening group. The evaluation of the effectiveness of the surgical technique on the results made by performing repeated measures from general linear models showed significantly better correction in anteroposterior and lateral talocalcaneal angles, anteroposterior and lateral talonavicular angles, and medial longitudinal arc angle in the subtalar extra-articular arthrodesis group (P<0.05). In conclusion, in this study group, the subtalar extra-articular arthrodesis technique was superior in talocalcaneonavicular joint complex reduction and medial longitudinal arc reconstruction in the surgical treatment of flexible pes planovalgus, and calcaneal lengthening provided better correction of calcaneal equinus. Therefore, it is better to use the calcaneal lengthening technique in mild or moderate deformities because of its physiological advantages, and subtalar extra-articular arthrodesis technique in severe and/or rigid deformities because of its superior potential to correct the deformity and stabilize the foot in the corrected position.
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NewsBot · Oct 19, 2009

The stop screw technique—A simple and reliable method in treating flexible flatfoot in children
Joerg Jerosch, Jochem Schunck and Hazem Abdel-Aziz
Foot and Ankle Surgery; Volume 15, Issue 4, December 2009, Pages 174-178

Purpose
The purpose of this study was to evaluate the stop screw method inserted with a minimal invasive technique in the treatment of flexible flatfoot in children.

Materials and methods
We evaluated the results in a series of 21 flat feet in the age group ranging from 8 to 14 years between 1999 and 2007. The correction was evaluated clinically by assessment of heel valgus angle, range of motion of the ankle joint, and the photopodographic grading. The radiological assessment was performed by measuring the talonavicular angulation (Meary's line).

Results
At time of follow-up there was significant improvement in the heel valgus angle during rest and during tiptoe standing, significant improvement in the dorsiflexion from neutral position, and in podographic grading. Radiologically talonavicular angulation improved significantly from 162 ± 8.9° preoperatively to 174 ± 5.8° postoperatively.

Conclusion
We can conclude that subtalar arthroereisis is relatively simple, effective, and minimally invasive procedure in treating flexible flatfoot in pediatric age
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NewsBot · Apr 13, 2010

A Retrospective Analysis of Anterior Calcaneal Osteotomy with Allogenic Bone Graft.
Shine J, Child BJ, Hix J, Maskill M, Bowers C, Catanzariti AR, Mendicino RW, Saltrick K.
J Foot Ankle Surg. 2010 Apr 10. [Epub ahead of print]

Anterior calcaneal osteotomy (ACO) with extension bone graft is commonly employed in the treatment of symptomatic supple, hypermobile flatfoot in adolescent as well as adult (>/= 18 years of age) patients. Although autogenous bone graft has been considered the gold standard, allogenic bone is widely used for this procedure because it is readily available, requires no additional procedure for procurement and has incorporation rates similar to autogenous bone graft. There is increasing agreement among surgeons that the union rates with allograft bone are comparable with that observed with autograft bone when used in the ACO. We reviewed the medical records of 51 consecutive patients who had undergone 53 ACO with allogenic bone graft for the repair of flatfoot deformity in an effort to further evaluate outcomes associated with the use of allogenic bone graft. All of the patients had at least 12 months of follow-up. The mean time to graft incorporation was 9.10 +/- 1.54 weeks for adolescents and 9.81 +/- 2.13 weeks for adults (P = .0149), The incidence of graft incorporation (bone union) was 100% and 90% (P = .1391) in the adolescent and adult groups, respectively. Complications included lateral column pain, sinus tarsitis, nonunion, calcaneocuboid capsulitis, complex regional pain syndrome, incisional dehiscence, and sural neuritis; and all of the complications occurred in the adult group. The results support the understanding that ACO with allogenic bone graft is a reasonable alternative to autograft bone graft in the treatment of flexible flatfoot in adolescent and adult patients.
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NewsBot · May 20, 2011

Calcaneo-stop procedure for paediatric flexible flatfoot.
Kellermann P, Roth S, Gion K, Boda K, Tóth K.
Arch Orthop Trauma Surg. 2011 May 19. [Epub ahead of print]

BACKGROUND:
Flexible flatfoot is a frequent deformity found in children. The aim of this study is to evaluate the pedographic outcome of the percutaneous arthroereisis with the use of a screw through the sinus tarsi into the talus.

MATERIALS AND METHODS:
43 calcaneo-stop procedures of 25 patients (18 bilateral, seven unilateral) were evaluated. Mean age at surgery was 10 years (7-14, SD 2.2) (SD: standard deviation), mean follow-up time was 9.7 months (3-19, SD 5.5). Patient satisfaction rate was recorded, the Meary's talus-first metatarsal angle was measured with lateral radiograms, and a dynamic pedographic assessment was also performed.

RESULTS:
Patient satisfaction rate was excellent for 33 feet of 19 children, good for eight feet of five children, and poor for either feet of one child. We did not observe any complications during or following the surgery.The mean rest heel valgus decreased from 13.4° (10°-17°, SD 1.5) to 2.8° (0°-6°, SD 1.7) post op. The Meary's angle improved from 160.2° (148°-177°, SD 6.8) to 175.9° (167°-179°, SD 3.5). By pedographic analysis, the area and the pressure-time integral (load amount, PTI) values increased on the lateral regions of the sole (except for the lesser toes) and decreased on the medial areas (except for the hallux). The relative contact time in the lateral midfoot increased from 63.8% (39.6-78.4%, SD 10.6) to 75.1% (50-86.1%, SD 9.4), and that in the lateral forefoot region from 81.2% (60.4-89.2%, SD 6.6) to 86.8% (78.1-97.1%, SD 4.8).

CONCLUSION:
The calcaneo-stop procedure is a simple and reliable method for the correction of severe flexible paediatric flatfoot. Our prospective, short-term results following the anterograde screw implantation into the talus correlate well with the results of similar or different arthroereisis methods. Further investigations are required to evaluate the long-term outcome of the screw calcaneo-stop method, including the conditions following implant removal.
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NewsBot · Nov 14, 2012

Comparison of the calcaneo-cuboid-cuneiform osteotomies and the calcaneal lengthening osteotomy in the surgical treatment of symptomatic flexible flatfoot.
Moraleda L, Salcedo M, Bastrom TP, Wenger DR, Albiñana J, Mubarak SJ.
J Pediatr Orthop. 2012 Dec;32(8):821-9.

BACKGROUND:
: Surgery is indicated in symptomatic flatfoot when conservative treatment fails to relieve the symptoms. Osteotomies appear to be the best choice for these painful feet. The purpose of this study was to compare the clinical and radiographic outcome of the calcaneo-cuboid-cuneiform osteotomies (triple C) and the calcaneal-lengthening osteotomy in the treatment of children with symptomatic flexible flatfoot.

METHODS:
: The surgeries were performed by senior surgeons who preferred either triple C or calcaneal lengthening. The results were graded by an orthopaedic surgeon uninvolved with the cases. The clinical and radiographic outcome was evaluated in 30 feet (21 patients) with a triple C osteotomy and 33 feet (21 patients) with a calcaneal-lengthening osteotomy. We used the American College of Foot and Ankle Surgeons (ACFAS) score (flatfoot module) for clinical assessment, which contains a subjective and objective test. We measured and compared 12 parameters on the anteroposterior and lateral weight-bearing radiographs. The effect of additional procedures (Kidner procedure, medial reefing of the talonavicular capsule, tendo-Achilles lengthening, peroneous brevis lengthening and, in the calcaneal-lengthening group, a medial cuneiform osteotomy) on the clinical and radiographic result was also evaluated.

RESULTS:
: Average age at the time of surgery was similar (triple C: 11.2±3 y, calcaneal lengthening: 11.6±2.5 y, P=0.51). Average follow-up was 2.7±2.2 years in the triple C group and 5.3±4 years in the calcaneal-lengthening group. There were no significant differences in the clinical outcome measured by the ACFAS subjective test in the calcaneal-lengthening group (P=0.003). There were no significant differences in the ACFAS score, both the subjective test (triple C: 43.3±6.1, calcaneal lengthening: 44.7±7.6, P=0.52) and the ACFAS objective test (triple C: 28.6±2, calcaneal lengthening: 25.9±7, P=0.13). We found significant differences in 2 of the 12 radiographic measurements: anteroposterior talo-first metatarsal angle (triple C: 15.5±11.1, calcaneal lengthening: 7.4±7.3, P=0.001) and talonavicular coverage (triple C: 28±14.7, calcaneal lengthening: 13.7±12.4, P<0.001). None of the additional procedures improved the clinical outcome. There were 3 (10%) complications in the triple C group and 6 (18%) complications in the calcaneal-lengthening group. Also, calcaneocuboid subluxation was present in 17 (51.5%) feet of the calcaneal-lengthening group.

CONCLUSIONS:
: Both techniques obtain good clinical and radiographic results in the treatment of symptomatic idiopathic flexible flatfoot in a pediatric population. The calcaneal-lengthening osteotomy achieves better improvement of the relationship of the navicular to the head of the talus but it is associated with more frequent and more severe complications. Additional soft-tissue procedures have not proven to improve clinical or radiographic results.
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NewsBot · Dec 29, 2015

Calcaneo-stop Procedure for Management of Pediatric Symptomatic Flexible Flatfoot
Kang Lee, and Young Joon Nam
J Korean Foot Ankle Soc. 2015 Dec;19(4):176-180

Purpose
The aim of the current study is to report on the clinical and radiographic results after calcaneo-stop procedure in Korean children with symptomatic flexible flatfoot.

Materials and Methods
Twenty-two children suffering pain along the medial aspect of midfoot with flexible flatfoot whose symptoms did not improve with conservative measures and therefore underwent calcaneo-stop procedure were identified retrospectively. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and visual analogue scale (VAS) were evaluated. Radiographically, standing anteroposterior and lateral radiographs of the foot and Saltzman's alignment views were taken and talonavicular coverage angle, lateral talo-first metatarsal angle, and hindfoot alignment angles were measured and analyzed.

Results
Clinically, AOFAS ankle-hindfoot scale improved from 70.3?5.6 to 97.3?2.5 and VAS improved from 6.4?1.6 to 0.2?0.4. Radiographically, talonavicular coverage angle improved from 28.3??12.3? to 10.9??8.1?, lateral talo-first metatarsal angle improved from -19.3??9.0? to -2.4??8.1?, and hindfoot alignment angle improved from valgus 11.9??10.0? to 3.5??4.3? at minimum 2-year follow-up. No complications occurred postoperatively.

Conclusion
Calcaneo-stop procedure is a simple and very effective procedure for management of pediatric symptomatic flexible flatfoot that does not respond to conservative treatment.
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NewsBot · Jul 13, 2016

Calcaneal Z Lengthening Osteotomy Combined With Subtalar Arthroereisis for Severe Adolescent Flexible Flatfoot Reconstruction
Yang Xu, MD et al
Foot & Ankle International July 9, 2016

Background: The timing and strategy for operative treatment of flatfoot are still controversial. The purpose of this study was to evaluate clinical outcomes and radiographic changes following calcaneal Z osteotomy combined with subtalar arthroereisis for severe adolescent flexible flatfoot.
Methods: Data were analyzed for 16 patients (20 feet) who had flatfoot without tibialis posterior tendon dysfunction and were treated by calcaneal Z osteotomy combined with arthroereisis between October 2011 and February 2015. The mean age of patients at the time of surgery was 12.8 ? 1.4 years (range, 10-14 years). Preoperative and postoperative measurements included changes in hindfoot valgus angles; changes in talonavicular uncoverage angles on anteroposterior (AP) radiographic view; and changes in talo–first metatarsal angles, talar pitch angles, and calcaneal pitch angles on lateral radiographic view. The American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AH) was used to assess foot function. The mean follow-up was 18.9 ? 6.9 months (range, 13-33 months).
Results: The hindfoot valgus angle improved from 14.9 ? 4.2 degrees to 2.3 ? 1.7 degrees. On the AP view, the preoperative and postoperative talonavicular uncoverage angles were 30.5 ? 9.4 degrees and 9.8 ? 4.8 degrees, respectively. On lateral radiographs, the preoperative talo–first metatarsal angle, talar pitch angle, and calcaneal pitch angle were −22.1 ? 7.9 degrees, 36.1 ? 4.4 degrees, and 14.4 ? 4.0 degrees, respectively. Postoperative lateral radiographs demonstrated talo–first metatarsal angle, talar pitch angle, and calcaneal pitch angle of −6.2 ? 4.7 degrees, 27.3 ? 4.9 degrees, and 19.0 ? 4.3 degrees, respectively. The AOFAS-AH score improved from 66.8 ? 24.1 preoperatively to 96.5 ? 3.4 postoperatively.
Conclusions: For adolescents with flatfoot, calcaneal Z osteotomy combined with subtalar arthroereisis provided satisfactory results.
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NewsBot · Nov 17, 2016

Surgical treatment results for flexible flatfoot in adolescents.
Yontar NS
Acta Orthop Traumatol Turc. 2016 Nov 11

OBJECTIVE:
Idiopathic flexible pes planus (IFPP) is a common foot problem in adolescents and young adults. Hypothesis for the present study was that combination of procedures for IFPP can achieve results in adolescents and young adults that are as good as those seen in adult-acquired pes planovalgus (AAPP) treatment in adults.
METHODS:
A total of 21 feet of 18 patients (10 boys, 8 girls) with mean age of 15.6 years underwent surgical reconstruction for flatfoot deformity. Symptomatic patients who had been unresponsive to conservative treatment were included in study group. Mean follow-up time was 39.2 months. American Orthopedic Foot and Ankle Society (AOFAS) scores were calculated for all patients, and based on final results, all families were asked whether or not they would elect to have the surgery again in same circumstances.
RESULTS:
All procedures were performed by the same surgeon: lateral column calcaneal lengthening osteotomy on 21 feet; percutaneous lengthening or gastrocnemius recession for Achilles tendon on 21 feet; medializing calcaneal osteotomy on 15 feet; flexor digitorum longus tendon transfer on 15 feet; medial cuneiform opening wedge osteotomy on 5 feet, spring ligament plication on 3 feet, and accessory navicular bone excision on 2 feet. Preoperative mean AOFAS score increased significantly from 56.76 to 95.29. All parents stated that they were satisfied with surgery results and would choose to have the same surgery performed again.
CONCLUSION:
Soft tissue and bony procedures used for reconstruction of AAPP can be used safely for IFPP in adolescents and young adults.
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NewsBot · Sep 21, 2017

Long-Term Outcomes of the Calcaneo-Stop Procedure in the Treatment of Flexible Flatfoot in Children: A Retrospective Study.
Costa FP et al
Acta Med Port. 2017 Aug 31;30(7-8):541-545. doi: 10.20344/amp.8137

INTRODUCTION:
Flexible flatfoot is common amongst children, although treatment is rarely indicated. The calcaneo-stop procedure has been reported to be effective in short-term studies. We aim to evaluate the long-term outcomes of the calcaneo-stop procedure in the treatment of flexible flatfoot in children.
MATERIAL AND METHODS:
Twenty-six calcaneo-stop procedures performed between 1995 and 2006 on 13 patients were evaluated clinically and using photopodoscopy, and the FAOS questionnaire was applied for both feet.
RESULTS:
Of the 26 feet evaluated, 22 presented with heel valgus, 13 had forefoot supination and 11 had abnormal footprints. Median FAOS questionnaire score was 97.22 for 'Pain', 92.86 for 'Other symptoms', 98.53 for 'Function in daily living', 100 for 'Function in sports and recreation' and 93.75 for 'Foot and ankle-related quality of life'.
DISCUSSION:
The calcaneo-stop procedure is the least invasive and most simple surgical treatment for symptomatic flexible flatfoot in children. Short-term studies report excellent clinical and radiographic results. The authors report alterations in clinical parameters in a large proportion of patients. These findings can be due to biomechanical alterations in the years following removal of the screw. Patient foot and ankle-related satisfaction data is promising, although hard to evaluate given the absence of preoperative data.
CONCLUSION:
Larger, prospective, controlled studies are required to better evaluate the long-term success of this procedure.
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NewsBot · Sep 11, 2018

Evaluation of Results of Calcaneo-Stop Procedure in Treatment of
Pediatric Flexible Flatfoot
ALY M. FAYED, M.Sc.; AHMED M. SAMY, M.D.; MUHAMMAD A. QUOLQUELA, M.D. and
MAHMOUD A. EL-ROSASY, M.D.
Med. J. Cairo Univ., Vol.86,No. 1, March: 333-339, 2018

Background: Flexible flatfoot is a common finding in
pediatrics. It is usually amenable to conservative treatment
but in less frequent occasions, some cases are not optimally
responsive to conservative measures. Calcaneo-stop procedure
is minimally invasive and safe resort for this cases after failure
of conservative measures.
Objective: Evaluate the results of treatment of pediatric
flexible flatfoot by Calcaneo-stop procedure only after exhaustion
of six months of supervised conservative management.
Study Design and Setting: A prospective randomized
clinical trial in a tertiary care center.
Patients and Methods: 20 cases of pediatric flexible
flatfoot (ten patients) were operated on after failure of six
months of conservative treatment. All patients were evaluated
pre-operative and post-operative via Kite's angle, Meary's
angle and according to American college of Foot and Ankle
Society score (ACFAS). A p-value of less than 0.001 was
considered statistically significant.
Results: There was statistically significant improvement
in Meary's, Kite's angle. While ACFAS score measurement
was better than preoperative score in all cases but not statistically
significant.
Conclusion: Calcaneo-stop is safe, minimally invasive
and effective in treatment of pediatric flexible flatfoot also
it doesn't burn bridges for other adjuvant procedures later on.
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NewsBot · Oct 2, 2018

Outcomes of the calcaneo-stop procedure
for the treatment of juvenile flatfoot in young athletes.
Pavone V, Vescio A, Di Silvestri CA, Andreacchio
A, Sessa G, Testa G.
J Child Orthop 2018;12:DOI 10.1302/1863-2548.12.180032

Purpose Flexible flatfoot (FFF) is a widespread condition in
juvenile patients. If symptomatic, FFF can require surgical
treatment. The calcaneo-stop procedure has shown excellent
clinical and radiographic outcomes and low rates of complications.
The aim of the present study was to assess the sport
practice of young athletes affected by FFF having undergone
the calcaneo-stop procedure.
Methods Between 2008 and 2016, 68 sport practitioners
were bilaterally treated by the calcaneo-stop procedure, for a
total of 136 FFF cases. Clinical evaluation, including the American
Orthopedic Foot and Ankle Score (AOFAS), the Yoo et al
score and The Foot & Ankle Disability Index (FADI) and FADI
Sport scores were assessed. Radiographic evaluation was
based on measurement of talar declination, Costa-Bertani’s
angle and calcaneal pitch.
Results Mean follow-up was 57.6 months (SD 16.8). The AOFAS
score mean increased from 79.3 (SD 5.7) to 97.3 (SD 4.5)
three years after surgery. The Yoo score improved from 3.1
(SD 1.0) preoperatively to 11.7 (SD 0.6) three years after surgery.
The FADI Sport subscale mean improved from 74.1 (SD
10.4) preoperatively to 95.9 (SD 4.9) three years after surgery.
Costa-Bertani’s angle decreased from 156.1° (SD 4.2°) to
135.8° (SD 7.3°) at three years postoperatively; mean talar
declination angle decreased from 44.2° (SD 6.3°) to 30.6°
(SD 3.2°) at three years postoperatively and mean calcaneal
pitch increased from 12.6° (SD 2.3°) to 16.3° (SD 1.3°) at
three years postoperatively.
Conclusion Adolescent patients who underwent the calcaneo-stop
procedure reported satisfactory outcomes in terms
of clinical and radiological evaluations. Moreover, our results
showed an improvement of sport activity levels, with patients
recovering sports activity within three months of surgery and
without limitation in the execution of preferred activities.
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NewsBot · Jan 19, 2019

Effects of body weight on the clinical and radiological outcomes of children with flexible flatfeet managed with the ‘calcaneo-stop’ procedure
Pavone, Vito et al
Journal of Pediatric Orthopaedics B: January 16, 2019 - Volume Publish Ahead of Print - Issue - p

This study aimed to evaluate the clinical and radiological outcomes of normal, overweight, and obese children with symptomatic flexible flatfeet managed with the ‘calcaneo-stop’ procedure (CSP), and to determine whether any correlation exists between patient weight and outcome. One hundred and seventy-four symptomatic flexible flatfeet were managed with CSP during the study period. The patients were divided into three groups according to their BMI and weight Z-scores: normal, overweight, and obese. Their clinical and radiographic outcomes were assessed preoperatively, and at 1 and 5 years after the index procedure. Although the radiographic criteria were comparable between the three groups, the clinical outcome was worse in obese children than in normal and overweight patients (P<0.05). BMI and the Z-score affected the outcomes of obese patients treated with CSP for symptomatic flexible flatfeet. Although the radiographic outcome was similar irrespective of BMI and Z-scores, obese patients had significantly lower clinical scores than the other patients.
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NewsBot · Mar 28, 2019

Effects of body weight on the clinical and radiological outcomes of children with flexible flatfeet managed with the ‘calcaneo-stop’ procedure
Pavone, Vito ET AL
Journal of Pediatric Orthopaedics B: May 2019 - Volume 28 - Issue 3 - p 228–234

This study aimed to evaluate the clinical and radiological outcomes of normal, overweight, and obese children with symptomatic flexible flatfeet managed with the ‘calcaneo-stop’ procedure (CSP), and to determine whether any correlation exists between patient weight and outcome. One hundred and seventy-four symptomatic flexible flatfeet were managed with CSP during the study period. The patients were divided into three groups according to their BMI and weight Z-scores: normal, overweight, and obese. Their clinical and radiographic outcomes were assessed preoperatively, and at 1 and 5 years after the index procedure. Although the radiographic criteria were comparable between the three groups, the clinical outcome was worse in obese children than in normal and overweight patients (P<0.05). BMI and the Z-score affected the outcomes of obese patients treated with CSP for symptomatic flexible flatfeet. Although the radiographic outcome was similar irrespective of BMI and Z-scores, obese patients had significantly lower clinical scores than the other patients.
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NewsBot · Dec 5, 2020

Prospective Comparison of Subtalar Arthroereisis With Calcaneal Lengthening in the Management of Planovalgus Feet of Ambulatory Children With Spastic Cerebral Palsy?
Amr H Ahmed et al
Foot Ankle Spec. 2020 Dec 3

Background: Pes planovalgus (PPV) deformity is common among cerebral palsy (CP) patients. There is no true consensus about the best way of treating this common deformity, especially when surgical interference is required. Treatment options range from orthotics to complex surgical procedures. The purpose of this prospective study was to evaluate and compare the effectiveness of 2 different procedures in the correction of symptomatic flexible PPV in ambulatory CP patients.

Methods: A total of 57 feet in 35 patients were divided into 2 groups: group 1, subtalar arthroereisis group, using the calcaneostop technique; group 2, lateral column lengthening group, using Evans osteotomy. Patients were assessed clinically by the clinical score proposed by Yoo et al and radiologically by measuring 7 weight-bearing angles, both preoperatively and 12 months postoperatively. Patients' (or parents') satisfaction and their tolerance to braces or shoes were assessed 12 months after surgery as secondary outcome parameters.

Results: There was a statistically significant improvement in both primary and secondary outcome parameters after both procedures in comparison to the preoperative parameters. No statistically significant differences were observed between the 2 groups regarding the outcomes of both procedures except for the greater power of arthroereisis in the correction of hindfoot valgus, which was statistically significant both clinically and radiographically.

Conclusion: Both procedures are valid options for the surgical management of PPV in ambulatory children with spastic CP. The less-invasive nature and lower potential morbidity suggest that judicious use of arthroereisis is appropriate for some patients, especially in the context of single-event multilevel surgery.
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NewsBot · Oct 8, 2021

Functional and radiographic comparison of subtalar arthroereisis and lateral calcaneal lengthening in the surgical treatment of flexible flatfoot in children
Mohammad Ali Tahririan, Sina Ramtin & Pegah Taheri
International Orthopaedics volume 45, pages2291–2298 (2021)

Purpose
One of the most widespread diseases of children’s orthopaedic problems is flatfoot. If conservative therapy failed, surgical treatment would be indicated. Lateral calcaneal lengthening (LCL) and subtalar arthroereisis (SA) are two types of operations used to correct symptomatic flexible flatfoot (FFF). The purpose of this study is to compare the functional and radiographic features of these two surgical procedures.

Patients and methods
In this prospective randomized clinical trial study, we recruited 66 patients between 2018 and 2019. For clinical assessment, American Orthopedics Foot and Ankle Society (AOFAS), visual analog scale (VAS), subtalar motion, presence of medial longitudinal arch, and family satisfaction were measured. Evaluation of radiographic angles was based on AP (AP Tal-1Met) and Lat (Lat Tal-1Met) view of Talus-1st metatarsal angle (Meary’s angle) and calcaneal pitch.

Result
There was no significant difference between the two types of surgery regarding Lat Tal-1Met and AP Tal-1Met. The significantly larger angle in the LCL group was calcaneal pitch (P value < 0.001). AOFAS significantly increased from 68.71 ± 5.70 to 87.87 ± 7.14 (P value < 0.001) and from 67.28 ± 6.01 to 86.14 ± 7.56 (P value < 0.001) in LCL and SA respectively. Family satisfaction was significantly higher in the SA (8.14 ± 0.97) comparing to LCL (7.29 ± 0.86) at the latest follow-up (P value < 0.001).

Conclusion
While both groups have substantial improvement in clinical and radiographic aspects, the SA technique is less-invasive, rapid symptom relief, and has early weight-bearing capacity.
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NewsBot · Apr 5, 2022

Long-term clinical and radiological outcomes following surgical treatment for symptomatic pediatric flexible flat feet: a systematic review
Maria Anna Smolle et al
Acta Orthop. 2022 Mar 18

Background and purpose: Albeit pediatric flexible flat foot (FFF) is a common condition, only a minority of patients become symptomatic. Long-term outcomes of surgically treated pediatric patients with symptomatic FFF are largely unknown. In this systematic review, studies providing outcomes at a mean follow-up of at least 4 years after the procedure in these patients were analyzed.

Material and methods: A PubMed search was undertaken involving original articles published up to July 2021 on outcome in children aged 6 to 14 with surgically treated FFF and mean (or minimum) follow-up of at least 4 years. Radiographic and clinical outcomes were analyzed.

Results: Of initially 541 entries, 10 could be included in the systematic review (all level IV), involving 846 pediatric patients with 1,536 symptomatic FFF. Pooled mean radiological (n = 8) and clinical follow-up (n = 10) was 5.3 (range 0.5-15) and 7.0 (range 4.1-15) years, respectively. Surgical procedures included arthroereisis (n = 8), lateral column lengthening (n = 1), and Horseman procedure (n = 1). Overall relative frequency of implant-associated complications and wound-healing problems was 3.2% and 1.3%, as well as 2.8% and 1.6% following subtalar arthroereisis only. From preoperative to latest radiological assessment following subtalar arthroereisis (including 3 studies with radiological follow-up < 48 months), pooled median decrease in talonavicular coverage angle (TNCA; -9.2°), anteroposterior talocalcaneal angle (A-TCA; -6.5°), lateral talocalcaneal angle (L-TCA; -3.5°), talar declination angle (TDA; -14°), Moreau Costa Bertani angle (MCB; -13°), and talo-firstmetatarsal angle (L-T1MA; -10°) was observed, as was an increase in calcaneal pitch (4.5°).

Interpretation: In symptomatic pediatric FFF patients, surgery is associated with a manageable complication profile, and results in satisfactory long-term clinical as well as radiological outcome. Yet scientific evidence is low, warranting larger scaled studies in the future.
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NewsBot · Jun 7, 2022

Grice extra-articular subtalar fusion for spastic pes planovalgus
Phatcharapa Osateerakun et al
Int Orthop. 2022 Jun 6

Introduction: A pes planovalgus deformity, an unstable foot deformity, affects the gait of children with cerebral palsy (CP). Treatments, including subtalar fusion, were proposed. The Grice procedure maintains foot stability, but bone graft non-union poses a challenge. This study aimed to identify the rate and factors related to post-operative bone graft non-union.

Methods: Thirty-one paediatric CP patients (age, 8.9 ± 1.8 years) who underwent the Grice procedure (53 feet) using ipsilateral tibial bone grafts were reviewed. Pre-operative gross motor function classification system (GMFCS) classes were class 1 in five, 2 in five, 3 in 14, and 4 in seven patients. Standing foot radiographs were assessed for signs of non-union, and parameters (talocalcaneal and talar declination angles and talar head uncovering index) measured pre-operatively, post-operatively, and at the most recent evaluation were compared. Factors associated with bone graft non-union were analysed by regression analysis. P < 0.05 was considered statistically significant. Degenerative changes in hindfoot joints were evaluated by Bargon's criteria.

Results: At the average follow-up evaluation at 5.4 ± 4.3 years, the GMFCS class was improved or was maintained in 29/31 patients. Post-operative radiographic measurements were restored and were maintained over the follow-up period (P < 0.001). A total of 14/53 feet (26%) had non-union. The pre-operative lateral talocalcaneal angle (OR 1.08, p = 0.04) and follow-up duration (OR 1.18, p = 0.03) were identified in univariate analysis as potential factors related to non-union but were not confirmed in a multivariate model. Hindfoot joints in most feet showed mild degenerative changes.

Conclusion: Grice subtalar fusion in patients with a higher pre-operative lateral talocalcaneal angle might lead to bone graft non-union.
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NewsBot · Aug 10, 2023

MODIFIED MUBARAK TECHNIQUE FOR FLEXIBLE FLATFOOT CORRECTION IN CHILDREN AND ADOLESCENTS
Bruno Air Machado DA Silva et al
Acta Ortop Bras. 2023 Jul 31;31(4):e265045

Objective: To describe the technique, analyze possible radiographic correction and evaluate the clinical result of medial and plantar calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy for flexible flatfoot correction.

Methods: 23 patients (30 feet) diagnosed with flexible flat foot treated with plantar and medial calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy were evaluated retrospectively. In the lateral radiographs calcaneal pitch and Meary's angle were the radiographic parameters evaluated; while the talonavicular coverage angle was evaluated in the anteroposterior radiographs. To assess the clinical outcome of the surgical procedure, the American Orthopedic Foot and Ankle Society Score (AOFAS) for the ankle and hindfoot was adopted.

Results: The mean values of the evaluated angles and AOFAS score for ankle and hindfoot significantly improved when comparing pre- and postoperative values.

Conclusion: Plantar and medial calcaneal displacement osteotomy associated with an opening wedge cuboid osteotomy is able to improve radiological and clinical parameters of child patients with flexible flatfoot.
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