Calcaneal lengthening osteotomy for treatment of idiopathic flexible flat foot in children
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20164165Keywords:
Flexible, Flat foot, Calcaneal, Lengthening, OsteotomyAbstract
Background: The modified Evans osteotomy technique of calcaneal osteotomy was reported to be effective in correction of flexible flat foot in restoring foot alignment.
Methods: The modified Evans technique of calcaneal lengthening osteotomy was used in treatment of 18 feet of 12 patients. The mean follow-up period was 24 months (18-42). The etiology was idiopathic flexible flat foot deformity in all patients. Preoperative conservative therapy was tried in all patients. For clinical evaluation a modified point scoring system containing 32 points for patients' assessment with added 4 points for radiological evaluation the total of score became 36 points.
Results: According to the modified points scoring system the results were satisfactory in 16 feet (88.9%) and unsatisfactory in two feet (11.1%) at the final follow up All osteotomies were united within a mean time of 11 months (range 9-14 months). All 6 angles were measured at the end of the follow up and assessed as points added to the 32 points score. The score in 14 feet (77.7%) were (4) having the 6 angels within normal values. The values from 4 angles were within normal values and take score 3 in 3 feet (16.5%). In one foot (5.5%), 3 angles felt in normal range with score 2.
Conclusions: Calcaneal lengthening osteotomy for symptomatic flexible flat foot is effective in correction of the deformity and pain relief.
References
Farzin H, Reza M, Maryam M, Ladan A. Pediatric Flexible Flatfoot; Clinical Aspects and Algorithmic Approach. Iran J Pediatr. 2013;23(3):247–60.
Evans AM, Rome K, Peet L. The foot posture index, ankle lunge test, Beighton scale and the lower limb assessment score in healthy children: a reliability study. J Foot Ankle Res. 2012;5(1):1.
Lin CJ, Lai KA, Kuan TS, et al. Correlating factors and clinical significance of flexible flatfoot in preschool children. J Pediatr Orthop. 2001;21(3):378–82.
Lee JH, Sung IY, Yoo JY. Clinical or radiologic measurements and 3-D gait analysis in children with pes planus. Pediatr Int. 2009;51(2):201–5.
Zorer G, Bagatur AE, Dogan A, Unlu T. Dennyson-Fulford subtalar extra-articular arthrodesis in the treatment of paralytic pes planovalgus and its value in the alignment of the foot. Acta Orthop Traumato Turc. 2003;37:162-9.
Evans D. Calcaneo-valgus deformity. J Bone Joint Surg [Br]. 1975;57:270-8.
Flexible flatfoot (pes planovalgus). In: Herring JA. Tachdjian’s pediatric orthopedics. Volume 2, 3rd edition. Philadelphia: WB Saunders; 2002: 908-917.
Vanderwilde R, Staheli LT, Chew DE, Malagon V. Measurements on radiographs of the foot in normal infants and children. J Bone Joint Surg [Am]. 1988;70:407-15.
Viegas GV. Reconstruction of the pediatric flexible planovalgus foot by using an Evans calcaneal osteotomy and augmentative medial split tibialis anterior tendon transfer. J Foot Ankle Surg. 2003;42:199-207.
Mosca VS. Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot. J Bone Joint Surg [Am]. 1995;77:500-12.
Andreacchio A, Orellana CA, Miller F, Bowen TR. Lateral column lengthening as treatment for planovalgus foot deformity in ambulatory children with spastic cerebral palsy. J Pediatr Orthop. 2000;20:501-5.
Hadley N, Rahm M, Cain TE. Dennyson-Fulford subtalar arthrodesis. J Pediatr Orthop. 1994;14:363-8.
Mosca VS. Flexible flatfoot and tarsal coalition. In: Richards BS, editor. Orthopedic knowledge update: pediatrics. Illinois: American Academy of Orthopedic Surgeons; 1996.
Davitt JS, Mac-Williams BA, Armstrong PF. Plantar pressure and radiographic changes after distal calcaneal lengthening in children and adolescents. J Pediatr Orthop. 2001;21:70-5.
Ragab AA, Stewart SL, Cooperman DR. Implications of subtalar joint anatomic variation in calcaneal lengthening osteotomy. J Pediatr Orthop. 2003;23:79-83.
Phillips GE. A review of elongation of os calcis for flat feet. J Bone Joint Surg Br. 1983;65:15-8.
Yoo WJ, Chung CY, Choi IH, Cho TJ, Kim DH. Calcaneal lengthening for the planovalgus foot deformity in children with cerebral palsy. J Pediatr Orthop. 2005;25:781-5.