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Silva BAMDA, Silva NADA, Vasconcelos JB. MODIFIED MUBARAK TECHNIQUE FOR FLEXIBLE FLATFOOT CORRECTION IN CHILDREN AND ADOLESCENTS. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e265045. [PMID: 37547233 PMCID: PMC10399999 DOI: 10.1590/1413-785220233104e265045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/19/2022] [Indexed: 08/08/2023]
Abstract
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. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
- Bruno Air Machado DA Silva
- Hospital de Urgencias de Aparecida de Goiania, Goiania, GO, Brazil
- Instituto Ortopedico de Goiania, Goiania, GO, Brazil
| | - Nilzio Antônio DA Silva
- Universidade Federal de Goiania, Escola de Medicina, Departamento de Reumatologia, Goiania, GO, Brazil
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MacInnes P, Lewis TL, Griffin C, Martinuzzi M, Shepherd KL, Kokkinakis M. Surgical management of pes planus in children with cerebral palsy: A systematic review. J Child Orthop 2022; 16:333-346. [PMID: 36238147 PMCID: PMC9550996 DOI: 10.1177/18632521221112496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Pes planus (or flatfoot) is the most common deformity in children with cerebral palsy. There are several surgical interventions used to treat it: single calcaneal osteotomies, extra-articular arthrodesis, double calcaneal osteotomy, calcaneo-cuboid-cuneiform osteotomy, intra-articular arthrodesis, and arthroereisis. There is currently no evidence on optimal treatment for flatfoot in children with cerebral palsy. Our purpose is to systematically review studies reporting complications, recurrence rates, and radiological outcomes of the surgical management of flatfoot in children with cerebral palsy. METHODS Five databases were searched to identify studies published from inception until July 2021, with keywords relating to flatfoot, cerebral palsy, and surgical interventions. We included prospective, retrospective, and comparative study designs in the English language. Data was extracted and tabulated in duplicate into Excel, and analysis was conducted using Python SciPy. RESULTS In total, 1220 studies were identified of which 44 met the inclusion criteria, comprising 2234 feet in 1364 patients with a mean age of 10.3 years and mean follow-up of 55.9 months. Radiographic outcomes showed improvement with all procedures; complications and recurrence rates were too poorly reported to compare. Only 6 (14%) studies were assessed as a low risk of bias. There was substantial heterogeneity of outcome measures. CONCLUSION There is a lack of high-quality, comparative studies assessing the radiological outcomes, complications, and recurrence rates of surgical alternatives to treat flatfoot in children with cerebral palsy. There is currently no clear evidence on optimal surgical treatment. LEVEL OF EVIDENCE IIa based on Oxford Centre for Evidence-based Medicine.
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Affiliation(s)
- Poppy MacInnes
- GKT School of Medical Education, King’s
College London, London, UK,Poppy MacInnes, GKT School of Medical
Education, King’s College London, Strand, London WC2R 2LS, UK.
| | - Thomas L Lewis
- Evelina Children’s Hospital, St Thomas’
Hospital, London, UK
| | - Cora Griffin
- GKT School of Medical Education, King’s
College London, London, UK
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Rethlefsen SA, Hanson AM, Wren TAL, Kay RM. Calcaneal Sliding Osteotomy Versus Calcaneal Lengthening Osteotomy for Valgus Foot Deformity Correction in Children With Cerebral Palsy. J Pediatr Orthop 2021; 41:e433-e438. [PMID: 33734201 DOI: 10.1097/bpo.0000000000001790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medial calcaneal sliding (CS) osteotomy and lateral column lengthening (LCL) are often performed to relieve pain and improve transverse plane alignment and gait stability for children with cerebral palsy (CP) and valgus foot deformities. The purpose of this study was to examine the effectiveness of these procedures in this population. METHODS Retrospective medical record review (including 3D gait analysis data) of patients with CP who underwent LCL (26 subjects, 46 limbs) or CS (46 subjects, 73 limbs). Data extraction included complications (modified Clavien-Dindo system), change in standing foot position (modified Yoo system), and change in gait kinematics and kinetics preoperatively to postoperatively. Groups were compared using paired t tests, Fisher exact test, and survivorship analysis using Cox proportional hazard models. RESULTS Subjects were 57% male, average age at surgery 11.1 (SD 2.5) years. Average length of follow-up was 3.2 (SD 2.8) years, and was longer in the LCL group (P=0.0004). Complications were minor with similar rates between groups (P=0.14). Prolonged pain and plantar hypersensitivity occurred only in the CS group. Successful maintenance of deformity correction was achieved in 52/73 limbs (71%) in the CS group and 16/44 limbs (36%) in the LCL group (P<0.001). Recurrent pes valgus and need for repeat foot surgery were more common after LCL (P=0.003 and 0.001, respectively). Recurrent pes valgus never occurred when talonavicular fusion was done concomitantly with CS. After accounting for the between group difference in length of follow-up, there was no difference in the rates of recurrent valgus or repeat foot surgery between LCL and CS. None of the variables predicted development of pes varus (P>0.20). Ankle kinematics and kinetics during gait were unchanged in both groups. CONCLUSIONS CS and LCL have similar effectiveness in providing long-lasting correction of valgus foot deformities. Concomitant talonavicular fusion is key to success of CS for lower functioning patients with severe deformities, and obligate brace wearers. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | - Alison M Hanson
- Children's Orthopaedic Center, Children's Hospital Los Angeles
| | - Tishya A L Wren
- Children's Orthopaedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert M Kay
- Children's Orthopaedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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Kim NT, Lee YT, Park MS, Lee KM, Kwon OS, Sung KH. Changes in the bony alignment of the foot after tendo-Achilles lengthening in patients with planovalgus deformity. J Orthop Surg Res 2021; 16:118. [PMID: 33557891 PMCID: PMC7869243 DOI: 10.1186/s13018-021-02272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study was performed to investigate the change in the bony alignment of the foot after tendo-Achilles lengthening (TAL) and the factors that affect these changes in patients with planovalgus foot deformity. Methods Consecutive 97 patients (150 feet; mean age 10 years; range 5.1–35.7) with Achilles tendon contracture (ATC) and planovalgus foot deformity who underwent TAL were included. All patients underwent preoperative and postoperative weight-bearing anteroposterior (AP) or lateral (LAT) foot radiographics. Changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, LAT talo-1st metatarsal angle, and calcaneal pitch angle and the factors affecting such changes after TAL were analyzed using lineal mixed model. Results There were no significant change in AP talo-1st metatarsal angle and AP talo-2nd metatarsal angle after TAL in patients with cerebral palsy (CP) (p = 0.236 and 0.212). However, LAT talo-1st metatarsal angle and calcaneal pitch angle were significantly improved after TAL (13.0°, p < 0.001 and 4.5°, p < 0.001). Age was significantly associated with the change in LAT talo-1st metatarsal angle after TAL (p = 0.028). The changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, and calcaneal pitch angle after TAL were not significantly associated with the diagnosis (p = 0.879, 0.903, and 0.056). However, patients with CP showed more improvement in LAT talo-1st metatarsal angle (− 5.0°, p = 0.034) than those with idiopathic cause. Conclusion This study showed that TAL can improve the bony alignment of the foot in patients with planovalgus and ATC. We recommend that physicians should consider this study’s findings when planning operative treatment for such patients.
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Affiliation(s)
- Nak Tscheol Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea
| | - Young Tae Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Oh Sang Kwon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea
| | - Ki Hyuk Sung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, 13620, Republic of Korea. .,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Agashe MV, Sagade BS, Bansal AV. Functional and Radiological Outcomes Following Calcaneo-Cuboid-Cuneiform Osteotomy for the Treatment of Planovalgus Feet: A Short-Term Analysis. Indian J Orthop 2020; 55:119-127. [PMID: 34122764 PMCID: PMC8149568 DOI: 10.1007/s43465-020-00195-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/07/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Flexible flatfoot refers to the loss of the medial longitudinal arch of the foot on weight bearing and is associated with excessive heel eversion or forefoot abduction. Unless symptomatic, flexible flatfeet are best managed non-operatively. The calcaneo-cuboid-cuneiform osteotomy is a procedure that restores the anatomical shape of the foot without arthrodesis of the joints. Our study aims to evaluate the functional and radiological outcomes of patients treated with calcaneo-cuboid-cuneiform osteotomy in patients with planovalgus feet. METHODOLOGY A retrospective review of records and radiographs of patients with symptomatic flexible planovalgus feet, who were operated with the calcaneo-cuboid-cuneiform osteotomy by a single senior surgeon in a time period between April 2016 and July 2017 was done. The clinical and radiological outcomes were evaluated in 12 feet in 8 children. RESULTS A total of 12 feet in 8 children were operated (6 males and 2 females). Average age of patients was 11 ± 1.27 years; average follow up was 14.7 months ± 2.7 months. Two patients had planovalgus feet secondary to spastic diplegia and 6 had idiopathic planovalgus feet. There was a statistically significant improvement in the pain score as well as the radiographic parameters in all the operated patients. CONCLUSION The calcaneo-cuboid-cuneiform osteotomy has potential to give good results for symptomatic planovalgus feet with minimal complications.
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Affiliation(s)
- Mandar V. Agashe
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 India
| | - Bhushan S. Sagade
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 India
| | - Ankita V. Bansal
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 India
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Kim JR, Kim KB, Chong SW, Ham DH, Wang SI. Treatment Outcomes at Skeletal Maturity after Calcaneo-Cuboid-Cuneiform Osteotomy for Symptomatic Flatfoot Deformity in Children. Clin Orthop Surg 2020; 12:252-257. [PMID: 32489549 PMCID: PMC7237249 DOI: 10.4055/cios19062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to evaluate clinical and radiological outcomes at skeletal maturity after a calcaneo-cuboid-cuneiform osteotomy (triple C osteotomy) for symptomatic flatfoot deformity compared with healthy young adult controls. Methods Nineteen patients (30 feet) who undergone a triple C osteotomy for idiopathic symptomatic flatfeet from July 2006 to April 2013 were compared with 19 controls (38 feet). Radiographic measurements at preoperative examination, 1-year postoperative follow-up, and follow-up at skeletal maturity were evaluated. Functional outcomes were assessed by using the validated visual analog scale foot and ankle (VAS-FA) and the modified American Orthopaedic Foot and Ankle Surgery (AOFAS) score. Results In the triple C osteotomy group, 11 of 12 radiographic measurements were significantly improved at 1 year postoperatively and the last follow-up (p < 0.001). There was no recurrence at skeletal maturity (p > 0.05). There were no significant differences in nine of 12 radiographic measurements between the triple C osteotomy group at maturity and the control group (p > 0.05). Average VAS-FA and AOFAS scores were significantly improved at the time of skeletal maturity (p < 0.001). Conclusions Surgical correction of symptomatic flatfoot deformity in childhood resulted in favorable outcomes after the triple C osteotomy. Deformity correction was also maintained during follow-up at skeletal maturity.
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Affiliation(s)
- Jung Ryul Kim
- Department of Orthopaedic Surgery, Jeonbuk National University Medical School, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Ki Bum Kim
- Department of Orthopaedic Surgery, Jeonbuk National University Medical School, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Seong Woo Chong
- Department of Orthopaedic Surgery, Jeonbuk National University Medical School, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Dong Hun Ham
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Sung Il Wang
- Department of Orthopaedic Surgery, Jeonbuk National University Medical School, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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7
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Phillips RD. Using the Biomechanical Examination to Guide Therapy. Clin Podiatr Med Surg 2020; 37:1-22. [PMID: 31735261 DOI: 10.1016/j.cpm.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In trying to explain the myriad of foot deformities and symptoms that have slow onset and/or are considered to be overuse syndromes, clinicians have been trying to develop quantitative examinations to describe the cause of the patient's problems and to better individualize treatment modalities. This type of examination is called a biomechanical examination. This article discusses some of the more common portions of a biomechanical examination of the foot and lower extremity. It will also point out some ways that the information from a biomechanical examination can be applied in clinically treating patients.
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Affiliation(s)
- Robert D Phillips
- Orlando VA Medical Center, Orlando, FL, USA; Podiatric Medicine and Surgery Residency; Podiatric Medicine, University of Central Florida College of Medicine, Orlando, FL, USA.
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8
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El-Hilaly R, El-Sherbini MH, Abd-Ella MM, Omran AA. Radiological outcome of calcaneo-cuboid-cuneiform osteotomies for planovalgus feet in cerebral palsy children: Relationship with pedobarography. Foot Ankle Surg 2019; 25:462-468. [PMID: 30321957 DOI: 10.1016/j.fas.2018.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/09/2018] [Accepted: 02/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Calcaneo-cuboid-cuneiform (triple C) osteotomies correct all levels of deformity of flexible planovalgus feet (PVF) in patients with cerebral palsy (CP). The objective was assessing short term results and the hypothesis was that static pedobarography correlates with radiological parameters as outcome measures. METHODS A prospective case series of consecutive skeletally immature ambulatory spastic CP patients above the age of 4 years who underwent triple C for PVF. Assessment was done using static pedobarography and standing dorsoplantar (DP) and lateral radiographs. The calcaneal pitch, lateral talocalcaneal, lateral and DP talo-first metatarsal, and DP talonavicular coverage angles were measured. RESULTS Eighteen feet (12 patients) were analyzed. Postoperative changes in lateral and DP talo-first metatarsal, and DP talonavicular coverage angles were statistically significant (P-value=0 with paired T-test). Post operative foot pressure changes were significant and highest in mid-foot. Both outcomes were related together with a p-value of 1 using McNemar test. CONCLUSIONS The triple C and associated soft tissue procedures reliably corrected PVF deformities. Static pedobarography can be used for postoperative assessment of adequate correction.
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Affiliation(s)
- Rana El-Hilaly
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Mostafa H El-Sherbini
- Department of Orthopaedic Surgery, National Institute of Neuromotor System (NINMS), GOTHI, Imbaba, Giza, Great Cairo, Egypt
| | - Mohamed M Abd-Ella
- Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Ahmed A Omran
- Department of Orthopaedic Surgery, National Institute of Neuromotor System (NINMS), GOTHI, Imbaba, Giza, Great Cairo, Egypt.
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Amene J, Krzak JJ, Kruger KM, Killen L, Graf A, Altiok H, Smith PA, Harris GF. Kinematic foot types in youth with pes planovalgus secondary to cerebral palsy. Gait Posture 2019; 68:430-436. [PMID: 30594871 DOI: 10.1016/j.gaitpost.2018.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/24/2018] [Accepted: 12/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kinematic variability of the foot and ankle segments exists during ambulation among individuals with pes planovalgus (PPV) secondary to cerebral palsy (CP). Clinicians have previously recognized such variability through classification schemes to identify subgroups of individuals, but have been unable to identify kinematic foot types. RESEARCH QUESTION The purpose of this work was to identify kinematic foot types among children with PPV secondary to CP using 3-dimensional multi-segment foot and ankle kinematics during gait as inputs for principal component analysis (PCA) and K-means cluster analysis. METHODS In a single assessment session, multi-segment foot and ankle kinematics using the Milwaukee Foot Model (MFM) were collected in 31 children/adolescents with pes planovalgus (49 feet) and 16 typically developing (TD) children/adolescents (31 feet). PCA was used as a data reduction technique on 34 kinematic variables. K-means cluster analysis was performed on the identified principal components (PCs) and one-way analyses of variance (ANOVA) was done to determine the effect of subgroup membership on PC scores. RESULTS The PCA reduced the kinematic variables to seven PCs which accounted for 91% of the total variance. Six distinct kinematic foot types were identified by the cluster analysis. The foot types showed unique kinematic characteristics in both the hindfoot and forefoot. SIGNIFICANCE This study provides further evidence of kinematic variability in the foot and ankle during ambulation associated with pes planovalgus secondary to CP. The specific contributions of the hindfoot and forefoot would not have been detected using a single segment foot model. The identification of kinematic foot types with unique foot and ankle characteristics has the potential to improve treatment since patients within a foot type are likely to benefit from similar intervention(s).
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Affiliation(s)
- Juliet Amene
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD, United States; Orthopaedic & Rehabilitation Engineering Center (OREC), Marquette University/Medical College of Wisconsin, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States
| | - Joseph J Krzak
- Orthopaedic & Rehabilitation Engineering Center (OREC), Marquette University/Medical College of Wisconsin, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States; Midwestern University, Physical Therapy Program, College of Health Sciences, 555 31st Street, Downers Grove, IL, United States; Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Ave., Chicago, IL, United States.
| | - Karen M Kruger
- Orthopaedic & Rehabilitation Engineering Center (OREC), Marquette University/Medical College of Wisconsin, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States; Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Ave., Chicago, IL, United States
| | - Logan Killen
- RUSH University Medical Center, Department of Behavioral Sciences, Biological Rhythms Research Laboratory, 1645 W Jackson Blvd, Chicago, IL, United States
| | - Adam Graf
- Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Ave., Chicago, IL, United States
| | - Haluk Altiok
- Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Ave., Chicago, IL, United States; RUSH University Medical Center, Department of Orthopaedic Surgery, College of Medicine, 1611 West Harrison Street, Chicago, IL, United States
| | - Peter A Smith
- Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Ave., Chicago, IL, United States; RUSH University Medical Center, Department of Orthopaedic Surgery, College of Medicine, 1611 West Harrison Street, Chicago, IL, United States
| | - Gerald F Harris
- Orthopaedic & Rehabilitation Engineering Center (OREC), Marquette University/Medical College of Wisconsin, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States; Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Ave., Chicago, IL, United States
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Suh DH, Park JH, Lee SH, Kim HJ, Park YH, Jang WY, Baek JH, Sung HJ, Choi GW. Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review. INTERNATIONAL ORTHOPAEDICS 2019; 43:1179-1192. [PMID: 30701302 DOI: 10.1007/s00264-019-04303-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and arthroereisis (AR) for treating symptomatic flatfoot in children. METHODS We conducted a comprehensive search on MEDLINE, EMBASE, and Cochrane Library databases. Literature search, data extraction, and quality assessment were conducted by two independent reviewers. The outcomes analyzed included radiographic parameters, clinical scores, satisfaction, complications, and re-operations. RESULTS Twenty-one and 13 studies were included in the LCL and AR groups, respectively. The change in anteroposterior talo-first metatarsal angle was greater in the LCL (9.5° to 21.7°) than in the AR group (10.6° to 12.8°). The change in calcaneal pitch was greater in the LCL (2.1° to 26.53°) than in the AR group (- 1.3° to 3.23°). Improvements in the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were greater in the LCL (27.7 to 39.1) than in the AR group (17 to 22). The percentage of satisfaction was similar between the LCL (68% to 89%) and AR (78.5% to 96.4%) groups. The complication rate was higher in the LCL (0% to 86.9%) than in the AR group (3.5% to 45%). The most common complications were calcaneocuboid subluxation and persistent pain in the LCL and AR groups, respectively. The re-operation rate was similar between the LCL (0% to 27.3%) and AR (0% to 36.4%) groups. CONCLUSIONS The LCL group has achieved more radiographic corrections and more improvements in the AOFAS score than the AR group. Complications were more common in the LCL group than in the AR group, and the re-operation rates were similar between the two groups.
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Affiliation(s)
- Dong Hun Suh
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Jung Ho Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Soon Hyuck Lee
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Woo Young Jang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung Heum Baek
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Hyun Jae Sung
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do, 15355, South Korea.
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Kim JR, Park CI, Moon YJ, Wang SI, Kwon KS. Concomitant calcaneo-cuboid-cuneiform osteotomies and the modified Kidner procedure for severe flatfoot associated with symptomatic accessory navicular in children and adolescents. J Orthop Surg Res 2014; 9:131. [PMID: 25480361 PMCID: PMC4267443 DOI: 10.1186/s13018-014-0131-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 11/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accessory navicular can become symptomatic in childhood, and in some cases, the condition is associated with progressive flattening of the longitudinal arch. Moreover, some severe, rigid flatfoot deformities are associated with an accessory navicular. We investigated the results of concomitant calcaneo-cuboid-cuneiform osteotomies (triple C) and the modified Kidner procedure for severe flatfoot associated with a symptomatic accessory navicular in children and adolescents. METHODS Twenty-one feet of 13 patients (nine boys, four girls; mean age 12.7 years) with severe flatfoot associated with a symptomatic accessory navicular who were treated with concomitant triple C and the modified Kidner procedure were evaluated based on clinical and radiographic examinations preoperatively and at a mean follow-up of 22.4 months (range, 12-36 months). We measured 12 variables on the anteroposterior (AP) and lateral weight-bearing radiographs, and we used the American College of Foot and Ankle Surgeons (ACFAS) score for clinical assessment. RESULTS We found significant improvements (p < 0.001) in eight of the 12 radiographic measurements: the AP talo-first metatarsal (MTT) angle, AP talo-navicular coverage angle, AP talo-calcaneal angle, lateral talo-first MTT angle, calcaneal pitch, lateral talo-calcaneal angle, lateral talo-horizontal angle, and naviculo-cuboid overlap. Average ACFAS scores were significantly improved at the time of the last follow-up (p < 0.001). The only complication was overcorrection of the hindfoot in one patient. CONCLUSIONS Concomitant triple C and the modified Kidner procedure result in favorable radiographic and clinical outcomes in the treatment of severe flatfoot associated with a symptomatic accessory navicular in children and adolescents.
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Affiliation(s)
- Jung Ryul Kim
- Department of Orthopaedics Surgery, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea.
| | - Chan Il Park
- Department of Orthopaedics Surgery, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea.
| | - Young Jae Moon
- Department of Orthopaedics Surgery, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea.
| | - Sung Il Wang
- Department of Orthopaedics Surgery, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea.
| | - Keun Sang Kwon
- Department of Preventive Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea.
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Abstract
Pes planovalgus deformity is common in children with cerebral palsy. In planovalgus foot, the talus subluxates medially, the calcaneus is in valgus, and the forefoot is in supination and external rotation related to the midfoot. In young children, mild planovalgus feet can be managed with orthotics. Surgery is indicated if the deformity is not reducible or if the patient cannot tolerate orthotics during functional activities. The surgery can be calcaneal lengthening or subtalar fusion to restore a stable plantigrade foot and achieve hindfoot correction. Medial column fusion is important to reconstruct the medial arch in severe planovalgus feet.
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