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What is the general opinion on surgery in young adolescents with rigid flat foot and shortened achilles? Having seen three different children in this past year ranging from 13 to 16 all of which have had surgery with varying degrees of success I thought it would be interesting to hear of new techniques or other case outcomes.

 

Hi Chellep:

Not such a simple question.
Most of the procedures depend on not only the symptoms but what is the deformity and the general health of the patient. For instance, is there a marked genu valgum present? CP? Coalitions?

As you are aware, you cannot do much with a rigid pes valgus with an equinus other than fuse whatever joints are luxated and perform an achilles or gastroc-soleus procedure. Posterior ankle releases are sometimes needed.
A lengthening of the lateral column as part of a triple might be needed as well.
A true rigid deformity disallows any tendon type procedures such as a modified Young's suspension.

Aside from how the fusions are performed and various fixating techniques (hardware), I'm not aware of much "new" in this area other than Illizarov.

Illizarov techniques might be a utilized but I have not been trained in this area. Perhaps someone who performs these can enlighten us.

Steve

 

And, when you attempt this surgery, you have a patient for life. Or until they sue you.
Cheers

 

Thanks Steve heres a few more questions if you dont mind? If we are talking of tarsal coalitions, what are the general outcomes of the removal of the coalition and a calcaneal osteotomy? with associated proceedures on the medial gastroc?
regards
chellep

 

Hi
Your question covers a lot of ground....I'll abridge this.

As far as Tarsal Coalitions....

as you know there are quite a few different types and areas they occur.
Partial, complete, fibrous..... the most common areas are Middle Facet STJ and calcaneal- navicular.
I just this week saw a 12 y/o F with cuboid-navicular (I'll try and post her xray or MRI)

The C-N bar is historically the most successfully resected with the best symptomatic relief.
The Middle Facet STJ coalition tends to respond better the younger the patient (boys under 15) and the less secondary joint remodeling. Compared to the C-N bar, this is a different animal mainly due to joint involvement. If there are arthritic changes in the STJ (especially a deviated sustentaculum tali on a harris-beath projection) the prognosis is less favorable.

And Fred is correct; when you perform surgery on Peds they are your patient forever and the degree of success or failure increase. That's not really a bad thing. When you can help a child it's just a bit more rewarding ....... I think, anyway.

Steve