1
|
Pourghazi F, Nabian MH, Bakht SS, Laripour R, Zoshk MY. Changes in gait pattern and quality of life of adolescents with flexible flat foot after Calcaneal Lengthening Osteotomy. Foot (Edinb) 2023; 57:101962. [PMID: 37865070 DOI: 10.1016/j.foot.2023.101962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/08/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Calcaneal Lengthening Osteotomy is a surgical technique to correct flexible flat foot deformities in patients who did not show any change in their symptoms after conservative treatment. In this study, the effects of CLO on the kinematic and kinetic changes of gait was analyzed and the clinical and quality of life improvements in children treated by CLO for moderate to severe symptomatic flexible flat foot deformities were assessed. METHODS Participants were seven adolescents (13 feet) with symptomatic FFF who underwent during 2019-2022 and seven (10 feet) healthy children as control group. Three items were evaluated in each foot before and after surgery including: 1. Clinical examination 2.quality of life (using Pediatric Quality of Life Inventory version 4 questionnaire) 3. Gait analysis (Vicon motion systems, Oxford metrics Inc., UK). Also, the kinetic and kinematic analysis between patients and healthy groups were compared. RESULTS Kinematic results of control was significantly better than FFF group. Ankle range of motion(32.94 ± 13.39 compared to 32.94 ± 13.39,P-Value:0.01),foot progression angle (-9.26 ± 7.67 compared to -16.07 ± 9.00,P-Value:0.01),and internal rotation of ankle was higher in control group compared to FFF. FFF patients demonstrated improvement in kinematic results after CLO surgery. Foot progression angle was improved after surgery (-11.31 ± 6.07 compared to -16.19 ± 7.06, P-value:0.00), maximum plantar flexion decreased after CLO surgery due to achil tendon procedure during CLO surgery. Kinetic results of FFF patients showed significant increase in ankle Power in coronal and transverse plane, Also knee and hip power showed similar results.Quality of life parameters showed significant improve in all parameters (Physical,Social, emotional and school function), Also ADKE and ADKF improved after surgery. CONCLUSION CLO surgery significantly improved patients' quality of life of patients with symptomatic FFF. Also, kinetic results showed improvement in some parameters of gait results after CLO surgery. Thus, our study suggested CLO surgery as an excellent surgical option for symptomatic FFF.
Collapse
Affiliation(s)
- Farzad Pourghazi
- Surgery and Trauma Research Center, AJA University of Medical Science, Iran
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-disciplinary Applied Research, Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Laripour
- Surgery and Trauma Research Center, AJA University of Medical Science, Iran
| | | |
Collapse
|
2
|
Tippabhatla A, Torres-Izquierdo B, William M, Pereira D, Meyer Z, Hosseinzadeh P. Is There a Benefit to Rigid Fixation in Calcaneal Lengthening Osteotomy in Painful Pediatric Idiopathic Flatfoot Deformity? Comparing Results of Kirschner Wire Versus Plate Fixation. J Pediatr Orthop 2023; 43:e823-e827. [PMID: 37694614 DOI: 10.1097/bpo.0000000000002514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Flexible flatfoot (FF) is a common pediatric condition that is mostly asymptomatic, and surgical intervention is only considered when painful FF is refractory to conservative treatment. Calcaneal lengthening osteotomy (CLO) is one of the most commonly used procedures to address painful FF. Traditionally, Kirschner wires (K-wires) were used for fixation, but there has been a recent increase in the use of plates. We compared the clinical and radiographic outcomes of these 2 fixation methods. METHODS This single-center retrospective study included children aged 8 to 18 years with symptomatic FF that received CLO using K-wire or plate fixation. Primary outcomes include weight-bearing radiographic measurements and complications after surgery. Secondary outcomes included patient-reported outcomes. Statistical significance was held at 0.05. RESULTS Among 102 feet (65 patients), 42 feet (41.2%) underwent K-wire and 60 feet (58.8%) underwent plate fixation. No differences in casting duration ( P =0.525) and time-to-radiographic healing ( P =0.17) were noted. Total complications were higher in the plate cohort (12 vs. 2, P =0.04) due to a higher rate of reoperations (16.7%) for hardware-related pain [10 vs. 0; odds ratio 17.74, 95% CI (1.01, 310.54), P <0.05], and infection rates were similar. Both interventions significantly improved ( P ≤ 0.001) aneteroposterior (AP) Talo-first metatarsal and calcaneal pitch angles. Irrespective of intervention, CLO significantly improved pain at 6 months and mobility scores at 12 months. Neither modality demonstrated superior pain or mobility scores at final follow-up. CONCLUSION Both K-wire and plate fixations lead to similar radiographic and functional outcomes after CLO in painful, pediatric flatfeet. Compared with K-wire fixation, plates cause a 17.7-fold increased risk of reoperations for painful hardware, with 16.7% of plated cases requiring reoperation. Noting this, along with the higher costs associated with using plates, our study advocates for K-wire fixation for children undergoing CLO. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Abhishek Tippabhatla
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, MO
| | | | | | | | | | | |
Collapse
|
3
|
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.
Collapse
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
| | | |
Collapse
|
4
|
Hosny GA, Hussein MA, Zaghloul KM, El-Mowafi H, Khalifa AA. Lateral column lengthening (LCL) using a rectangular shape graft for managing symptomatic flexible flatfoot showed acceptable early functional and radiological outcomes. Foot (Edinb) 2023; 55:101986. [PMID: 36863248 DOI: 10.1016/j.foot.2023.101986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/01/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE We aimed to report the results of performing lateral column lengthening (LCL) using a rectangular-shaped graft to correct the flat foot deformity. METHODS A total of 28 feet of 19 patients (10 males, 9 females) having an average age of 10 ± 3.2 years who were unresponsive to conservative management underwent flat foot deformity correction through LCL procedure supplemented with rectangular-shaped graft harvested from the fibula. Functional assessment was performed according to the American Orthopedic Foot and Ankle Society (AOFAS) scale. The radiographic assessment consisted of four parameters, Meary's angle in both anteroposterior (AP) and lateral (Lat.) views, calcaneal inclination angle (CIA), and calcaneocuboid angle (CCA). RESULTS After an average of 30.2 ± 8.1 months, the AOFAS improved significantly from 46.7 ± 10.2 preoperatively to 86.7 ± 9.5 at the last follow up (P < 0.05). All the osteotomies showed healing at an average of 10.3 ± 2.7 weeks. All the radiological parameters showed significant improvement at the last follow up compared to the preoperative measurements, CIA from 6.3 ± 2.8-19.3 ± 3.5, Lat. Meary's angle from 19.3 ± 4.9-5.8 ± 2.5, AP Meary's Angle from 19.3 ± 5.8-6.1 ± 3.1, and CCA from 23.9 ± 8.2-6.8 ± 4.5, (P < 0.05). No pain at the site of the fibular osteotomy was reported in any of the patients. CONCLUSION Lateral column lengthening using a rectangular graft effectively restores bony alignment with good radiological and clinical results, high patient satisfaction, and acceptable complications.
Collapse
Affiliation(s)
| | | | | | | | - Ahmed A Khalifa
- Orthopaedic Department, Qena faculty of medicine and University Hospital, South Valley University, Qena, Egypt.
| |
Collapse
|
5
|
Le Gall C, Lakhal W, Mayrargue E, Fraisse B, Marleix S, Lucas G, Losson A, Fréger N, Violas P. Functional and radiological outcome of subtalar arthroereisis for flexible pes planovalgus in children: A retrospective analysis. Orthop Traumatol Surg Res 2022:103488. [PMID: 36435370 DOI: 10.1016/j.otsr.2022.103488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pediatric idiopathic pes planovalgus can correct itself with growth. Otherwise, in the event of functional impairment and after failed conservative treatment, surgery can be considered. Based on a multicenter retrospective study, we report the functional and radiographic results obtained after subtalar arthroereisis. HYPOTHESIS We hypothesized that this surgery improves functional and radiological parameters in childhood. MATERIAL AND METHOD Forty-eight medical records of children (78 feet) operated on between 2010 and 2019 were studied. Functional (FAOS score) and radiographic (Djian angle, calcaneal slope, lateral talocalcaneal divergence and calcaneus/M5 alignment, talonavicular coverage measurement, AP talocalcaneal divergence) results were studied. The analysis of these different criteria was carried out between the preoperative period and the last follow-up. RESULTS The functional outcome was satisfactory with an average FAOS questionnaire score of 95.5 out of 100 total points. All the radiographic parameters studied were significantly improved (p<0.001). The average age at the time of surgery was 11.3 years (range: 7 to 16) with a mean follow-up of 35 months (range: 18 months to 84). Spontaneous screw expulsion and subtalar pain were the main complications found. DISCUSSION The results obtained are consistent with those in the literature. The age at the time of the surgery is an essential factor to consider with the goal of optimal correction. CONCLUSION This technique is reliable and effective in the short term. It can be offered as first-line therapy in the management of symptomatic pes planovalgus in children. The follow-up is short, which necessitates longer term studies of this population. The ideal age for surgery remains to be determined. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Caroline Le Gall
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France
| | - Walid Lakhal
- Service de chirurgie pédiatrique, CHRU Tours - Clocheville, 49, boulevard Beranger, 37000 Tours, France
| | - Emmanuelle Mayrargue
- Service de chirurgie pédiatrique, CHU Nantes, 1, Place Alexis-Ricordeau, 44093 Nantes, France
| | - Bernard Fraisse
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France
| | - Sylvette Marleix
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France
| | - Gregory Lucas
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France
| | - Alexandre Losson
- Service de chirurgie orthopédique et traumatologique, CHU Poitiers, 2 rue de la Miletrie, 86021 Poitiers, France
| | - Nicolas Fréger
- Service de chirurgie orthopédique et traumatologique, CHU Poitiers, 2 rue de la Miletrie, 86021 Poitiers, France
| | - Philippe Violas
- Service de chirurgie pédiatrique, CHU Rennes, boulevard de Bulgarie, 35203 Rennes, France.
| |
Collapse
|
6
|
Kang MS, Bae K, Kim HY, Park SS. Clinico-radiological factors predicting the failure risk of conservative management in moderate to severe pediatric idiopathic flexible flatfoot. J Pediatr Orthop B 2022; 31:e213-e218. [PMID: 34860780 DOI: 10.1097/bpb.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the clinico-radiological factors of related future surgical treatment in patients with pediatric flexible flatfoot (FFF) who first visited the orthopedic clinic before the age of 10 years. Sixty-five patients diagnosed with moderate/severe idiopathic FFF deformity between the ages of 2-10 years were included. We developed prognostic models for the risk of the surgery during the follow-up period. Twenty (30.8%) patients required surgical treatment, and all of them underwent calcaneal lengthening osteotomy. Among them, 7 (10.8%) patients required concomitant Achilles-lengthening surgery. Unilateral involvement, older age, smaller calcaneal pitch angle, and higher talo-first metatarsal malalignment were considered high-risk factors for pediatric FFF surgery. Prognostic models identified three prognostic risk groups based on those factors, and survival curves revealed significant differences among the groups. Our prognostic models help predict the failure risk of conservative management of pediatric idiopathic FFF. Level of Evidence: Level III, prognostic study.
Collapse
Affiliation(s)
- Michael Seungcheol Kang
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine
| | - Kunhyung Bae
- Department of Orthopedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ho Yeon Kim
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine
| | - Soo-Sung Park
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine
| |
Collapse
|
7
|
Stevens P, Lancaster A, Khwaja A. Talar-tarsal Stabilisation: Goals and Initial Outcomes. Strategies Trauma Limb Reconstr 2022; 16:168-171. [PMID: 35111256 PMCID: PMC8778731 DOI: 10.5005/jp-journals-10080-1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Peter Stevens
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
- Peter Stevens, Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States, of America Phone: +801 330-3656, e-mail:
| | - Alex Lancaster
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America
| | - Ansab Khwaja
- Department of Orthopedics, University of Arizona, Phoenix, Arizona, United States of America
| |
Collapse
|
8
|
Bloom T, Sabharwal S. Surgical Management of Foot and Ankle Deformities in Cerebral Palsy. Clin Podiatr Med Surg 2022; 39:37-55. [PMID: 34809794 DOI: 10.1016/j.cpm.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Children with cerebral palsy (CP) are at a high risk of developing foot and ankle deformities that can impact function, brace/shoe fit, and seating. The 3 commonly observed foot and ankle segmental malalignment patterns include equinus, planovalgus, and equinovarus. Assessment of foot deformities is multifaceted, requiring the collection and integration of data from a combination of sources that include the clinical history, standardized physical examination, observational and quantitative gait analysis, GMFCS classification, and radiographic findings. Surgical procedures are determined by identifying all segmental malalignments and assessing the contribution of dynamic or flexible soft-tissue imbalance, fixed soft-tissue imbalance, and skeletal deformities.
Collapse
Affiliation(s)
- Tamir Bloom
- The Pediatric Orthopedic Center, 218 Ridgedale Avenue, Cedar Knolls, NJ 07927, USA.
| | - Sanjeev Sabharwal
- UCSF Pediatric Orthopaedic Fellowship, University of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158, USA; Limb Lengthening and Reconstruction Center, UCSF Benioff Children's Hospital, 744 52nd Street, Oakland, CA 94609, USA
| |
Collapse
|
9
|
Bouchard M, Ross TD. Bony Procedures for Correction of the Flexible Pediatric Flatfoot Deformity. Foot Ankle Clin 2021; 26:915-939. [PMID: 34752244 DOI: 10.1016/j.fcl.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The pediatric flexible flatfoot is a common foot shape that is most often asymptomatic and may be a physiologic variant of normal. Surgery is only indicated when nonoperative interventions have failed to resolve symptoms. The goal of surgery is to alleviate symptoms by improving hindfoot alignment and restoring the medial arch while preserving joint mobility. This article focuses on the common bony techniques for surgical correction of the pediatric flexible flatfoot that has failed nonoperative management, including calcaneal, midfoot, and supramalleolar osteotomies and distal tibial hemiepiphyseodesis.
Collapse
Affiliation(s)
- Maryse Bouchard
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada; Division of Orthopaedic Surgery, The University of Toronto, Toronto, Canada.
| | - Tayler Declan Ross
- Division of Orthopaedic Surgery, The University of Toronto, 500 University Avenue #602, Toronto, Ontario M5G 1V7, Canada
| |
Collapse
|
10
|
Lai CC, Wang TM, Chang CH, Pao JL, Fang HW, Chang CC, Lin SM, Lan TY. Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents. BMC Musculoskelet Disord 2021; 22:977. [PMID: 34814872 PMCID: PMC8609868 DOI: 10.1186/s12891-021-04855-9] [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: 08/13/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. Methods We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites. Results The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001). Conclusions Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.
Collapse
Affiliation(s)
- Chien-Cheng Lai
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Chien Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Shang-Ming Lin
- Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Tsung-Yu Lan
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan. .,Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan.
| |
Collapse
|
11
|
Osman AE, El-Gafary KA, Khalifa AA, El-Adly W, Fadle AA, Abubeih H. Medial displacement calcaneal osteotomy versus lateral column lengthening to treat stage II tibialis posterior tendon dysfunction, a prospective randomized controlled study. Foot (Edinb) 2021; 47:101798. [PMID: 33957531 DOI: 10.1016/j.foot.2021.101798] [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: 05/14/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Adult-acquired flatfoot deformity (AAFD) requires optimum planning that often requires several procedures for deformity correction. The objective of this study was to detect the difference between MDCO versus LCL in the management of AAFD with stage II tibialis posterior tendon dysfunction regarding functional, radiographic outcomes, efficacy in correction maintenance, and the incidence of complications. PATIENT AND METHODS 42 Patients (21 males and 21 females) with a mean age of 49.6 years (range 43-55), 22 patients had MDCO while 20 had LCL. Strayer procedure, spring ligament plication, and FDL transfer were done in all patients. Pre- and Postoperative (at 3 and 12 months) clinical assessment was done using AOFAS and FFI questionnaire. Six radiographic parameters were analyzed, Talo-navicular coverage and Talo-calcaneal angle in the AP view, Talo- first metatarsus angle, Talo-calcaneal angle and calcaneal inclination angle in lateral view and tibio-calcaneal angle in the axial view, complications were reported. RESULTS At 12 months, significant improvement in AOFAS and FFI scores from preoperative values with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups were maintained at 12 months. However, the calcaneal pitch angle and the TNCA were better in the LCL at 12 months than MDCO, 17̊±2.8 versus 13.95̊±2.2 (p=0.001) and 13.70̊±2.2 versus 19.05̊±3.2 (p<0.001) respectively. 11 patients (26.2%) had metal removal, seven (16.6%) in the MDCO, and four (9.6%) in the LCL. Three (7.1%) in the LCL group had subtalar arthritis, only one required subtalar fusion. CONCLUSION LCL produced a greater change in the realignment of AAFD, maintained more of their initial correction, and were associated with a lower incidence of additional surgery than MDCO, however, a higher incidence of degenerative change in the hindfoot was observed with LCL.
Collapse
Affiliation(s)
- Ahmed E Osman
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | | | - Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | - Wael El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Amr A Fadle
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Hossam Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt.
| |
Collapse
|
12
|
Hyer LC, Carpenter AM, Swetenburg JR, Westberry DE. Calcaneocuboid distraction arthrodesis for children with symptomatic pes planovalgus: does fixation improve outcomes? J Pediatr Orthop B 2021; 30:273-281. [PMID: 32826728 DOI: 10.1097/bpb.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lateral column lengthening is a common surgical procedure for addressing symptomatic pes planovalgus foot deformity. For more severe cases, the use of a calcaneocuboid distraction arthrodesis (CCDA) can allow for more powerful correction. Previous reports have cited an increased risk of graft collapse with loss of correction when this procedure is performed without supplemental hardware fixation. The purpose of this study was to assess the outcomes of CCDA in children with and without supplemental locking fixation. A retrospective review from 2008 to 2016 of CCDA procedures with and without supplemental fixation was performed. The primary endpoint was graft collapse. Secondary objectives included evaluation of radiographic loss of correction, hardware failure, pain at 1-year follow-up, reoperations, and changes in the foot loading pattern foot per pedobarography. Twenty-nine feet in 24 patients were eligible for review. Supplemental locked fixation was used in 18 feet [hardware (HW)], with the remaining 11 feet managed without fixation [no hardware (NoHW)]. The overall failure rate on the basis of graft collapse and loss of correction was 55% (56% for the HW group, 55% for the NoHW group). Eleven patients (61%) in the HW group experienced hardware failure, with six (33%) of these requiring hardware removal. Fifty-six percent of the HW group and 45% of the NoHW group reported continued pain at 1-year follow-up. One patient from each group underwent revision arthrodesis. Supplemental locked fixation did not provide additional benefit in preventing graft collapse and loss of correction in this cohort. Alternative strategies should be considered to improve the outcomes for this procedure.
Collapse
Affiliation(s)
- Lauren C Hyer
- Pediatric Orthopedic Surgery, Shriners Hospitals for Children
| | | | | | - David E Westberry
- Pediatric Orthopedic Surgery, Shriners Hospitals for Children, Greenville, South Carolina, USA
| |
Collapse
|
13
|
Tahririan MA, Ramtin S, Taheri P. Functional and radiographic comparison of subtalar arthroereisis and lateral calcaneal lengthening in the surgical treatment of flexible flatfoot in children. INTERNATIONAL ORTHOPAEDICS 2021; 45:2291-2298. [PMID: 33796883 DOI: 10.1007/s00264-020-04899-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
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. TRIAL REGISTRATION IRCT20180823040853N1.
Collapse
Affiliation(s)
- Mohammad Ali Tahririan
- Department of Orthopedics, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sina Ramtin
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pegah Taheri
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
14
|
Do We Really Need to Worry About Calcaneocuboid Subluxation During Lateral Column Lengthening for Planovalgus Foot Deformity? J Pediatr Orthop 2021; 41:e246-e251. [PMID: 33417392 DOI: 10.1097/bpo.0000000000001752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although lengthening of the lateral column through an osteotomy of the anterior calcaneus is an integral component of flatfoot reconstruction in younger patients with flexible planovalgus deformities, the procedure has been implicated in iatrogenic calcaneocuboid (CC) subluxation and subsequent degenerative changes at the CC articulation. The purpose of this study is to characterize alterations at the CC joint after lateral column lengthening (LCL) and determine if Steinmann pin stabilization of the CC joint before distraction maintains a normal relationship. METHODS Seven matched pairs of fresh-frozen cadaveric feet underwent preprocedure plain radiography and cross-sectional computed tomography (CT) imaging. LCL by osteotomy through the anterior calcaneus was then performed. One foot of each matched pair had a single smooth Steinmann pin placed centrally across the CC joint before osteotomy distraction. Distraction across each osteotomy was then performed and maintained with a 12-mm porous titanium wedge. Repeat imaging was obtained and compared with preprocedure studies to quantify sagittal and rotational differences at the CC articulation. RESULTS Following LCL, plain radiography demonstrated statistically significant increases in the percentage of the calcaneal articular surface dorsal to the superior aspect of the cuboid in both the pinned (8.2% vs. 17.6%, P=0.02) and unpinned (12.5% vs. 16.3%, P=0.04) specimens. No difference in the percentage of subluxation was found between the 2 groups after LCL. CT imaging demonstrated statistically significant increases in rotation between the calcaneus and cuboid after LCL in both the pinned (7.6±5.6 degrees, P=0.01) and unpinned (17±12.3 degrees, P=0.01) specimens. The degree of rotation was greater in unpinned specimens after LCL (P=0.043). CONCLUSIONS Both sagittal and rotatory subluxation seem to occur at the CC joint after LCL regardless of pin stabilization. As a single pin would be expected to limit pure translation while having little effect on rotation, it is possible that the rotational changes identified on 3-dimensional imaging are interpreted as dorsal translation when viewed 2 dimensionally using plain radiography. Consideration should therefore be given to CC stabilization with 2 pins during LCL to prevent this rotatory subluxation. LEVEL OF EVIDENCE Level V-cadaver study.
Collapse
|
15
|
de Bot RTAL, Stevens J, Hermus JPS, Staal HM, van Rhijn LW, Witlox AM. Clinical and Radiological Outcomes of Subtalar Kalix II Arthroereisis for a Symptomatic Pediatric Flexible Flatfoot. Foot Ankle Spec 2021; 14:9-18. [PMID: 31875408 DOI: 10.1177/1938640019892062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The purpose of this study is to evaluate functional and radiological outcomes of subtalar arthroereisis in the treatment of symptomatic pediatric flexible flatfeet. Methods. A total of 16 patients (26 feet) were treated with a Kalix II as subtalar motion blocker between 2009 and 2014. Calcaneal pitch (CP) and Meary's angle (MA) were measured on radiographs preoperatively, directly postoperatively, and at follow-up 47 ± 17 (range 19-79) months. Patient satisfaction surveys were used to assess functional outcome and patient satisfaction. Results. Surgery was performed mostly for pain, walking problems, or a combination of both at a mean age of 12.5 ± 1.5 (range 10-15) years. Symptoms were relieved in 62.5% of patients in the postoperative phase and increased to 68.75% at follow-up. A statistically significant increase in CP of 2.8° and decrease in MA of 14.0° was observed directly postoperatively, which persisted during the follow-up period irrespective of Kalix removal. Revision surgery was necessary in 6 cases (23%) because of arthroereisis migration. Conclusion. Subtalar Kalix II arthroereisis significantly reduced clinical symptoms and improved the CP and MA directly postoperatively, which persisted during follow-up, irrespective of Kalix removal. Therefore, subtalar arthroereisis is a considerable intervention to reduce symptoms in children with symptomatic flexible flatfeet.Levels of Evidence: Level IV: Case series.
Collapse
Affiliation(s)
- Robin T A L de Bot
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
| | - Jasper Stevens
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
| | - Joris P S Hermus
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
| | - Heleen M Staal
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
| | | | - Adhiambo M Witlox
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
| |
Collapse
|
16
|
Surgical Treatment of Severe Idiopathic Flexible Flatfoot by Evans-Mosca Technique in Adolescent Patients: A Long-Term Follow-Up Study. Adv Orthop 2021; 2021:8843091. [PMID: 33542839 PMCID: PMC7840266 DOI: 10.1155/2021/8843091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/29/2020] [Accepted: 01/09/2021] [Indexed: 12/30/2022] Open
Abstract
Flexible idiopathic flatfoot is very common in growing age and rarely causes pain or disability. Surgery is indicated only in severe symptomatic cases that are resistant to conservative treatment, and numerous surgical procedures have been proposed. Lateral column calcaneal lengthening as described by Evans and modified by Mosca is a widely used surgical technique for the correction of severe symptomatic flexible flatfoot. In the present study, we report the long-term clinical and radiographic results in 14 adolescent patients (mean age: 12.8 years) affected by severe symptomatic flexible flatfoot, surgically treated by Evans–Mosca procedure, for a total of 26 treated feet (12 cases bilateral and 2 unilateral). In all cases, surgery was indicated for the presence of significant symptoms resistant to nonsurgical management. Clinical evaluation was made according to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Foot and Ankle Disability Index (FADI) Score, and Yoo et al.'s criteria. Radiographic evaluation was made using anteroposterior and lateral weight-bearing radiographs of the feet to evaluate Meary's angle and Costa–Bertani's angle and to evaluate possible osteoarthritic changes in the midtarsal joints. At follow-up (mean: 7 years and 7 months), we observed a satisfactory result in all patients. The mean average score of the AOFAS Ankle-Hindfoot Scale improved from 60.03 points to 95.26; the mean FADI score improved from 71.41 to 97.44; and according to Yoo et al.'s criteria, the average clinical outcome score was 10.96. At radiographic examination, nonunion of the calcaneal osteotomy was never observed. Meary's angle improved from an average preoperative value of 25° to 1.38° at follow-up; Costa–Bertani's angle improved from an average preoperative value of 154.2° to 130.9° at follow-up. In no case, significant radiographic signs of midtarsal joint arthritis were observed. According to our results, we believe that Evans–Mosca technique is a valid option of surgical treatment for severe idiopathic flexible flatfoot and allows a satisfactory correction of the deformity with a low rate of complications.
Collapse
|
17
|
Kim HY, Cha YH, Lee JS, Kil KM, Choy WS. Changes in Gait and Radiographic and Clinical Results of Calcaneal Lengthening Osteotomy in Children with Idiopathic Flexible Flatfoot. Clin Orthop Surg 2020; 12:386-395. [PMID: 32904106 PMCID: PMC7449851 DOI: 10.4055/cios19150] [Citation(s) in RCA: 2] [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: 10/25/2019] [Accepted: 01/13/2020] [Indexed: 11/25/2022] Open
Abstract
Backgroud In this study, we aimed to analyze kinematic and kinetic changes in gait and to assess radiographic and clinical improvement after calcaneal lengthening osteotomy (CLO) in children with idiopathic symptomatic flexible flatfoot deformities. Methods The study group consisted of 22 children (28 feet) with idiopathic symptomatic flexible flatfoot, which was treated by CLO as an index operation. We excluded patients with flatfoot that developed secondary to neuromuscular diseases. There were 18 boys (22 feet) and 4 girls (6 feet). The average age of the patients was 10.8 ± 1.51 years. Surgical results were assessed by radiologic imaging, clinical evaluation, and gait analysis, which were performed before surgery and 1 year after surgery. Medical records were reviewed to check postoperative complications. Results Talonavicular coverage was recovered to 16.7° from 32.7° (p < 0.01). Lateral talo-first metatarsal angle and calcaneal pitch angle increased by 20.1° and 9.9°, respectively (p < 0.01). Weight-bearing radiographs demonstrated a decrease in the anteroposterior angle and lateral talocalcaneal angle by 6.9° and 10°, respectively (p < 0.01). Hindfoot valgus was corrected to near neutral position after CLO. Kinematic results showed that the ankle valgus angle in the coronal plane was reduced from 35.48° preoperatively to 16.64° postoperatively during gait (p < 0.05). The preoperative out-toeing gait (preoperative foot progression angle, 20.31°) was also normalized to 14.21° postoperatively. The kinetics results showed that the push-off moment (maximum ankle plantar flexion) on the sagittal plane increased from 0.66 Nm/kg preoperatively to 0.83 Nm/kg postoperatively (p < 0.01). The mean Yoo score was 9.2 ± 1.05 postoperatively: satisfactory in 24 cases (86%) and unsatisfactory in 4 cases. Of the 4 unsatisfactory cases, 2 cases were overcorrection and 2 cases were undercorrection, and 3 of them were well managed by wedge foot insoles. Conclusions The 3-dimensional deformities of the flexible flatfoot were effectively corrected by CLO, based on the morphological assessment using radiologic imaging. The correction was well maintained during gait at 1 year after the operation.
Collapse
Affiliation(s)
- Ha Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Yong Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jong Shin Lee
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Kyung-Min Kil
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea
| | - Won Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| |
Collapse
|
18
|
Nejib K, Delpont M. Medium-term results of calcaneus lengthening in idiopathic symptomatic flat foot in children and adolescents. J Child Orthop 2020; 14:286-292. [PMID: 32874361 PMCID: PMC7453174 DOI: 10.1302/1863-2548.14.200073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Calcaneus lengthening can be used in symptomatic flat foot in children, but few details on its medium-term results and complementary procedures are available. METHODS A total of 20 flexible, symptomatic, idiopathic valgus flat feet (in 15 children; mean age 13.9 years (10 to 17)) were operated on. Complementary procedures were based on preoperative and intraoperative analyses. Radiographic measurements were obtained preoperatively and with at least four years follow-up. RESULTS At a mean of 8.3 years (4 to 15) postoperatively, 13 feet had good clinical and radiological results, with significant improvement in American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scale scores and radiological measurements. Seven feet had residual pain. Six of them had no osteotomy of the first cuneiform. CONCLUSION Calcaneus lengthening with adequate complementary musculo-tendinous and/or bone procedures according to preoperative and intraoperative foot deformation leads to good medium-term results. Forefoot supination is the most frequent residual defect. If present intraoperatively, first cuneiform pronation-flexion osteotomy is indicated. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Khouri Nejib
- Hôpital Necker-Enfants Malades, Department of Orthopedic Surgery, Paris, France,Correspondence should be sent to Nejib Khouri, Hôpital Necker-Enfants Malades, Department of Orthopedic Surgery.164 rue de Sèvres, 75015 Paris, France. E-mail:
| | - Marion Delpont
- CHU Montpellier, Hôpital Lapeyronie, Department of Pediatric Surgery, University of Montpellier, Montpellier, France,CHU Armand-Trousseau, Department of Pediatric Orthopedic Surgery, Paris. France
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Sung KH, Kwon SS, Chung CY, Lee KM, Park MS. Radiographic changes of the mid-tarsal joint after calcaneal lengthening for planovalgus foot deformity. Foot Ankle Surg 2020; 26:110-115. [PMID: 30611558 DOI: 10.1016/j.fas.2018.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/16/2018] [Accepted: 12/21/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study evaluate the radiographic changes in the mid-tarsal joint, including the calcaneocuboid and talonavicular (TN) joints after calcaneal lengthening for planovalgus deformity in children. METHODS This study included 38 patients (68 feet) who underwent calcaneal lengthening for planovalgus deformity. Radiographic osteoarthritic changes at the CC or TN joint were defined as modified Kellgren-Lawrence grade of ≥1. RESULTS Among the 68 feet, 31 feet (45.6%) showed radiographic osteoarthritic changes at the CC joint and 20 (29.4%) showed changes at the TN joint. Risk of radiographic osteoarthritic changes at the CC joint was associated with increased age at surgery (OR = 1.2, p = 0.038). Risk of radiographic osteoarthritic changes at the TN joint was associated with increased age at surgery (OR = 2.2; p = 0.002), preoperative AP talus-1st metatarsal angle (OR = 1.1; p = 0.044), and degree of CC subluxation (OR = 2.1; p = 0.007). CONCLUSIONS Surgeons should consider the risk factors in the surgical correction of planovalgus deformity to prevent mid-tarsal arthritis.
Collapse
Affiliation(s)
- Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi 13620, South Korea.
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, 206 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi 16499, South Korea.
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi 13620, South Korea.
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi 13620, South Korea.
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Seongnam, Gyeonggi 13620, South Korea.
| |
Collapse
|
21
|
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.
Collapse
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.
| |
Collapse
|
22
|
Ghanem I, Massaad A, Assi A, Rizkallah M, Bizdikian AJ, El Abiad R, Seringe R, Mosca V, Wicart P. Understanding the foot's functional anatomy in physiological and pathological conditions: the calcaneopedal unit concept. J Child Orthop 2019; 13:134-146. [PMID: 30996737 PMCID: PMC6442506 DOI: 10.1302/1863-2548.13.180022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A thorough review of the available orthopaedic literature shows significant controversies, inconsistencies and sparse data regarding the terminology used to describe foot deformities. This lack of consensus on terminology creates confusion in professional discussions of foot anatomy, pathoanatomy and treatment of deformities. The controversies apply to joint movements as well as static relationships between the bones. DESCRIPTION The calcaneopedal unit (CPU) is a specific anatomical and physiological entity, represented by the entire foot excepted the talus. The calcaneus, midfoot and forefoot are solidly bound by three strong ligaments that create a unit that articulates with the talus. The movement of the CPU is complex, as it rotates under the talus, around the axis of Henke that coincides with the talo-calcaneal ligament of Farabeuf.This calcaneopedal unit is deformable. It is compared with a twisted plate, able to adapt to many physiological situations in standing position, in order to acheive a plantigrade position.Moreover, the calcaneopedal unit and the talo-tibiofibular complex are interdependent; rotation of the latter produces morphologic modifications inside the former and vice versa. PURPOSE This paper is a review article of this concept and of its physiopathological applications.
Collapse
Affiliation(s)
- I. Ghanem
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon,Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon, Correspondence should be sent to I. Ghanem, MD, Hôtel-Dieu de France Hospital, A. Naccache Avenue- Achrafieh, University of Saint-Joseph, Beirut, Lebanon. E-mail:
| | - A. Massaad
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - A. Assi
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - M. Rizkallah
- Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon
| | - A. J. Bizdikian
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - R. El Abiad
- Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon
| | - R. Seringe
- Orthopedic Surgery Department, Cochin University Hospital – University of Rene Descartes, Paris, France
| | - V. Mosca
- Department of Orthopedic Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - P. Wicart
- Orthopedic Surgery Department, Hôpital Necker-Enfants Malades, University of Paris Descartes, Paris, France
| |
Collapse
|
23
|
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.
Collapse
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.
| |
Collapse
|
24
|
Lima TC, Volpon JB. Calcaneal lateral column lengthening osteotomy for symptomatic flexible flatfoot in children and adolescents: a systematic review. ACTA ACUST UNITED AC 2018; 45:e1969. [PMID: 30569951 DOI: 10.1590/0100-6991e-20181969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/11/2018] [Indexed: 11/22/2022]
Abstract
Flexible flatfoot is a common condition in small children, which shows a strong tendency to spontaneously correct with their growth or to become moderate or mild in adults, which will not cause future problems. However, in a small number of cases, this condition is more severe, does not improve spontaneously, which may cause mechanical impairment, deformity, and, eventually, pain. In such cases, surgical treatment should be considered. The aim of this systematic review was to evaluate the literature results on the treatment of the symptomatic flexible flatfoot in children or adolescents through a very frequent procedure: calcaneal lateral column lengthening osteotomy, A systematic electronic search in PubMed, Web of Science, Cochrane, CINAHL, SciELO, SCOPUS and LILACS databases was performed. We searched articles published between March 1975 and September 2016. After applying the eligibility criteria, the selected publications were evaluated in relation to their clinical and radiographic results and complications. We found 341 articles in the mentioned databases, but selected only eight studies, according to the inclusion and exclusion criteria. These studies included a total of 105 patients and 167 treated feet. Only three authors performed prospective studies, but without case-control or randomization. The majority of publications were descriptive studies or case series (level of evidence III or IV), with great methodological variations, but with a high satisfaction rate on the part of both patients and surgeons in relation to the results. However, more prospective and randomized studies are required, with adequate control groups and validated evaluation criteria.
Collapse
Affiliation(s)
- Thiago Coelho Lima
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto, SP, Brasil
| | - José Batista Volpon
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto, SP, Brasil
| |
Collapse
|
25
|
Canavese F, Dimeglio A, Bonnel F. Postoperative CT-scan 3D reconstruction of the calcaneus following lateral calcaneal lengthening osteotomy for flatfoot deformity in children. Is the surgical procedure potentially associated with subtalar joint damage? Foot Ankle Surg 2018; 24:453-459. [PMID: 29409196 DOI: 10.1016/j.fas.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/20/2017] [Accepted: 05/19/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several anatomical studies have shown that the articular facets of the calcaneus can present with different anatomy. This study assessed the 3D anatomy of lateral calcaneal lengthening (LCL) osteotomy in relation to the anterior and middle facet of the calcaneus in a group of skeletally immature patients treated for symptomatic flatfoot deformity. METHODS During the study period, 14 consecutive patients (10 males, 4 females) presenting symptomatic flatfoot (20 feet) with different aetiologies underwent LCL osteotomy and CT scan with 3D reconstruction of the operated feet. Anatomy of articular factes of the calcaneus were graded according to Bunning & Barnett's classification. In order to assess clinical and functional outcome, all patients were evaluated according to Yoo et al.'s, Mosca's and AOFAS clinical criteria before surgery and at last follow-up visit. RESULTS Despite proving difficult to assess (10 out of 20 feet), dimensions of bone and joint structures revealed significant anatomical variations. In particular, working to Bunning & Barnett's classification, anatomy of the articular facet varied significantly among patients, and in Bunning & Barnett type-B1 or B2 the LCL osteotomy necessarily violates the articular surface of the anterior and middle facet of the calcaneus due to the fact that the two facets are fused together (single articular surface). CONCLUSIONS These biometric notions allow a better understanding of the impact on articular facets of the calcaneus of the osteotomy procedure suggested by Evans and Mosca. We anticipate that the findings reported here should lead to improved techniques for assessing all bone structures of the hindfoot, support logical classifications of the different pathological situations, and ultimately lead to improved treatment strategies.
Collapse
Affiliation(s)
- Federico Canavese
- Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France.
| | - Alain Dimeglio
- University of Montpellier, Faculty of Medicine, 2 Rue de l'École de Médecine, 34090 Montpellier, France
| | - François Bonnel
- University of Montpellier, Faculty of Medicine, 2 Rue de l'École de Médecine, 34090 Montpellier, France
| |
Collapse
|
26
|
Prasad SA, Rajasekhar SSSN. Morphometric analysis of talus and calcaneus. Surg Radiol Anat 2018; 41:9-24. [DOI: 10.1007/s00276-018-2101-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
|
27
|
Moore SH, Carstensen SE, Burrus MT, Cooper T, Park JS, Perumal V. Porous Titanium Wedges in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity. Foot Ankle Spec 2018; 11:347-356. [PMID: 29073794 DOI: 10.1177/1938640017735890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
UNLABELLED Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult-acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 to October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo-first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was measured. Patients were followed from a minimum of 6 months up to 4 years (mean 16.1 months). Postoperative radiographs demonstrated significant correction in all 3 radiographic criteria and the hindfoot valgus angle. We had no cases of nonunion, no wedge migration, and no wedges have been removed to date. The most common complication was calcaneocuboid joint pain (14.7%). Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications. LEVELS OF EVIDENCE Level IV: Case series.
Collapse
Affiliation(s)
- Spencer H Moore
- University of Virginia Medical Center, Charlottesville, Virginia
| | | | - M Tyrrell Burrus
- University of Virginia Medical Center, Charlottesville, Virginia
| | - Truitt Cooper
- University of Virginia Medical Center, Charlottesville, Virginia
| | - Joseph S Park
- University of Virginia Medical Center, Charlottesville, Virginia
| | - Venkat Perumal
- University of Virginia Medical Center, Charlottesville, Virginia
| |
Collapse
|
28
|
Abstract
Pediatric flatfeet are common, are usually asymptomatic, and typically improve over time as young children age. It is critical to differentiate flexible from rigid flatfeet and to assess for associated Achilles contracture with a careful history, physical examination, and initial radiographs. Although there are limited data, nonsurgical management of symptomatic flatfeet, both flexible and rigid, should be exhausted before considering surgical intervention. If patients fail conservative treatment, surgical management with joint-preserving, deformity-corrective techniques is typically used for pediatric flexible flatfeet in conjunction with deformity-specific soft tissue procedures.
Collapse
|
29
|
Kumar S, Sonanis SV. Lateral column lengthening for adolescent idiopathic pes planovalgus deformity - Systematic review. J Orthop 2017; 14:571-576. [PMID: 28883689 DOI: 10.1016/j.jor.2017.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/30/2017] [Indexed: 10/19/2022] Open
Abstract
Pes planovalgus is the commonest foot deformity in children and presents with wide range of severity and symptoms. Surgery is mostly indicated for significant malalignment, resistant to non-surgical management. Lateral column lengthening is considered an appealing option as does not involve arthrodesis and allows for further growth and foot development. METHODS We conducted a systematic review on lateral column lengthening for pes planovalgus deformity in line with PRISMA-P Checklist. We carried out detailed literature search on PubMed, Cochrane, EMBASE, CINAHL, Google Scholar and Bibliographies. We analysed selected studies for patient demographics, radiological, clinical outcome and complications. RESULTS We identified seven studies with 103 patients involving 156 feet. The mean age was 13.3 years (Range 5.7-42) and mean follow up was 70.2 Months (Range 24.9-156). There was statistical significant improvement in Calcaneal pitch, Lateral Talo-metatarsal and AP Talo-navicular angles (p-value 0.001). The mean preoperative AOFAS Score (71 Feet) was 58.85 (Range 34-78) and mean postoperative AOFAS Score (91 Feet) was 92.25 (Range 73-100). Two studies (32 Feet) used author specified criteria has reported Good/Excellent result in 72% (23/32 feet) and Fair/Poor result in 18% (9/32) feet. Complications were reported in 17.5% (18/103) included nerve related, pseudo arthrosis, non-union and metal related complications. CONCLUSION Surgical intervention with lateral column lengthening has good radiological and clinical outcome with high patient satisfaction and acceptable complications. The literature is mostly retrospective and there is need for prospective, multi-centre studies using patient centred validated outcome measure.
Collapse
Affiliation(s)
- Sanjay Kumar
- Department of Orthopaedics, Luton & Dunstable Hospital NHS Foundation Trust, Lewsey Rd, Luton LU4 0DZ, United Kingdom
| | - S V Sonanis
- Department of Orthopaedics, Hywel Dda University Health Board, Caradoc Road, Aberystwyth SY23 1ER, United Kingdom
| |
Collapse
|
30
|
Marengo L, Canavese F, Mansour M, Dimeglio A, Bonnel F. Clinical and radiological outcome of calcaneal lengthening osteotomy for flatfoot deformity in skeletally immature patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:989-996. [PMID: 28120097 DOI: 10.1007/s00590-017-1909-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/14/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical, functional and radiological outcome of calcaneal lengthening osteotomy for the treatment of symptomatic flatfoot deformity in skeletally immature patients. METHODS A retrospective review was led on 31 prospectively enrolled patients with symptomatic flatfoot. Twenty-seven out of 31 patients met the inclusion criteria, for a total of 38 operated feet. Mean age at time of surgery was 13.3 ± 2.2 years (range 7.8-17). Mean BMI at time of surgery was 19.3 ± 4.9 (range 12.3-32). In order to assess clinical and functional outcome, all patients were evaluated according to Yoo et al., Mosca and AOFAS clinical criteria before surgery and at last follow-up visit. Moreover, all patients underwent anteroposterior and lateral weight-bearing foot radiographs preoperatively, at 3-4-month post-surgery and at last follow-up visit. RESULTS Average Yoo et al. score was 3.3 ± 1 (range 0-4) preoperatively and improved to 9.8 ± 2.1 (range 3-12) at last follow-up (p < 0.001). Clinical outcome was satisfactory in 34 feet (89%) and unsatisfactory in 4 feet (11%). The same results were observed when Mosca clinical criteria were applied. AOFAS score improved significantly from a preoperative mean value of 49.9 ± 16 (range 23-75) to a postoperative value of 89 ± 15.9 (range 34-100) (p < 0.001). All radiographic parameters improved significantly from mean preoperative to mean 3-4-month postoperative value. Correction was maintained at last follow-up visit. Postoperative radiographs showed calcaneocuboid (C-C) joint subluxation in 29 (76%) feet. Final AP and lateral foot radiographs showed complete bone union and good bone graft remodeling. Furthermore, correct joint alignment was restored in all but two patients (93%). CONCLUSIONS Calcaneal lengthening osteotomy is not contraindicated in symptomatic flatfoot of different etiologies, except neuromuscular disease-related flatfoot that can affect bone quality and reduce foot flexibility. C-C joint subluxation is frequently observed but has little functional impact as it tends to remodel over time.
Collapse
Affiliation(s)
- Lorenza Marengo
- Pediatric Orthopedic Department, University Hospital Estaing, 1, Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Federico Canavese
- Pediatric Orthopedic Department, University Hospital Estaing, 1, Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
| | - Mounira Mansour
- Pediatric Orthopedic Department, University Hospital Estaing, 1, Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - François Bonnel
- Faculty of Medicine, University of Montpellier, Montpellier, France
| |
Collapse
|
31
|
Abstract
BACKGROUND Children with flatfeet are frequently referred to pediatric orthopaedic clinics. Most of these patients are asymptomatic and require no treatment. Care must be taken to differentiate patients with flexible flatfeet from those with rigid deformity that may have underlying pathology and have need of treatment. Rigid flatfeet in infants may be attributable to a congenital vertical talus (CVT); whereas those in older children and adolescents may be due to an underlying tarsal coalition. We performed a review of the recent literature regarding evaluation and management of pediatric flatfeet to discuss new findings and suggest areas where further research is needed. METHODS We searched the PubMed database for all papers related to the treatment of pediatric flatfoot, tarsal coalition, and CVT published from January 1, 2011 to December 31, 2014, yielding 85 English language papers. RESULTS A total of 18 papers contributed new or interesting findings. CONCLUSIONS The pediatric flexible flatfoot (FFF) remains poorly defined, making the understanding, study, and treatment of the condition extremely difficult.Pediatric FFF is often unnecessarily treated. There is very little evidence for the efficacy of nonsurgical intervention to affect the shape of the foot or to influence potential long-term disability for children with FFF. The treatment of tarsal coalition remains challenging, but short-term and intermediate-term outcome studies are satisfactory, whereas long-term outcome studies are lacking. Management of the associated flatfoot deformity may be as important as management of the coalition itself. The management of CVT is still evolving; however, early results of less invasive treatment methods seem promising. LEVEL OF EVIDENCE Level 4-literature review.
Collapse
|
32
|
Yontar NS, Ogut T, Guven MF, Botanlioglu H, Kaynak G, Can A. Surgical treatment results for flexible flatfoot in adolescents. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:655-659. [PMID: 27842935 PMCID: PMC6197395 DOI: 10.1016/j.aott.2016.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Abstract
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. Level of clinical evidence Level IV, Therapeutic study.
Collapse
|
33
|
Carr JB, Yang S, Lather LA. Pediatric Pes Planus: A State-of-the-Art Review. Pediatrics 2016; 137:e20151230. [PMID: 26908688 DOI: 10.1542/peds.2015-1230] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 11/24/2022] Open
Abstract
Flatfoot (pes planus) is common in infants and children and often resolves by adolescence. Thus, flatfoot is described as physiologic because it is usually flexible, painless, and of no functional consequence. In rare instances, flatfoot can become painful or rigid, which may be a sign of underlying foot pathology, including arthritis or tarsal coalition. Despite its prevalence, there is no standard definition for pediatric flatfoot. Furthermore, there are no large, prospective studies that compare the natural history of idiopathic, flexible flat feet throughout development in response to various treatments. The available literature does not elucidate which patients are at risk for developing pain and disability as young adults. Current evidence suggests that it is safe and appropriate to simply observe an asymptomatic child with flat feet. Painful flexible flatfoot may benefit from orthopedic intervention, such as physical therapy, bracing, or even a surgical procedure. Orthotics, although generally unproven to alter the course of flexible flatfoot, may provide relief of pain when present. Surgical procedures include Achilles tendon lengthening, bone-cutting procedures that rearrange the alignment of the foot (osteotomies), fusion of joints (arthrodesis), or insertion of a silicone or metal cap into the sinus tarsi to establish a medial foot arch (arthroereisis). It is important for a general pediatrician to know when a referral to an orthopedic specialist is indicated and which treatments may be offered to the patient. Updated awareness of the current evidence regarding pediatric flatfoot helps the provider confidently and appropriately counsel patients and families.
Collapse
Affiliation(s)
- James B Carr
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Scott Yang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Leigh Ann Lather
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
34
|
Abstract
Talocalcaneal coalitions present with complaints of flatfeet, foot or ankle pain after minor injury, or recurrent ankle sprains. Physical examination findings include limited subtalar motion and prominence inferior to the medial malleolus. Use of computed topography (CT) scan is recommended for preoperative planning. Confirmation of resection with intraoperative CT. Resection of talocalcaneal coalitions with fat-graft interposition has superior results to primary arthrodesis. Improved outcomes have been reported after resection, with foot scores averaging 90/100 (AOFAS).
Collapse
|
35
|
Prospective comparison of subtalar arthroereisis with lateral column lengthening for painful flatfeet. J Pediatr Orthop B 2015; 24:345-53. [PMID: 25856275 DOI: 10.1097/bpb.0000000000000179] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We prospectively compared subtalar arthroereisis with lateral column calcaneal lengthening for the treatment of painful flatfeet. Twenty-four feet (mean age of patients 12.8 years) were treated. Kinematic motion analysis, pedobarometry, and radiography were performed, and the Oxford Ankle-Foot Questionnaire for Children was administered for each patient before surgery and at the 1-year follow-up. We found statistically significant improvements in both groups, with no difference in their outcomes. Both groups showed significantly improved hindfoot and midfoot motion and positioning. Hindfoot range of motion was preserved. Radiography and pedobarometry also revealed significant improvements. Subtalar arthroereisis is a valid and potentially less-invasive alternative to lateral column lengthening that merits further investigation.
Collapse
|
36
|
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.
Collapse
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.
| |
Collapse
|
37
|
Abstract
BACKGROUND C sign is used to alert the physician of the possible presence of talocalcaneal coalition (TCC), so that advanced imaging can be ordered. The purpose of this study was to know the prevalence of the C sign among patients with TCC and its relationship to the presence of a TCC or to hindfoot alignment. METHODS Retrospective reviews of the presence of C sign in radiographs of 88 feet with TCC (proved by computed tomography scan or surgical findings) and 260 flexible flatfeet were conducted. C sign was classified as complete and interrupted (types A, B, and C). The interobserver variability of the C sign was studied. Seven radiographic parameters were measured to analyze the relationship of these measurements with the presence or absence of the C sign. RESULTS C sign was present in 68 feet (77%) with TCC: 14.5% complete and 62.5% interrupted (26% type A, 19.5% type B, and 17% type C). C sign was present in 116 flatfeet (45%), all of them interrupted (0.4% type A, 5.5% type B, and 39% type C). The talo-first metatarsal angle, the talohorizontal angle, the calcaneal pitch, the calcaneo-fifth metatarsal angle, and the naviculocuboid overlap presented a more pathologic value when a C sign was present. The κ-value for the presence of a C sign was 0.663. CONCLUSIONS The so-called true C sign (complete or interrupted type A) indicates the presence of a TCC and it is not related to flatfoot deformity. However, it is only present in 41% of the cases. The interrupted C sign is much more likely to be related to flatfoot deformity than to the presence of a TCC, specifically when a type C is found. LEVEL OF EVIDENCE Diagnostic Study level I.
Collapse
|
38
|
Abstract
Most children with flatfeet are asymptomatic and will never require treatment. In general, flatfoot deformity is flexible and will not cause pain or disability; it is a normal variant of foot shape. Thus, it is essential to reassure and educate patients and parents. A flatfoot with a contracture of the Achilles tendon may be painful. In these cases, a stretching program may help relieve pain. Scant convincing evidence exists to support the use of inserts or shoe modifications for effective relief of symptoms, and there is no evidence that those devices change the shape of the foot. The surgeon must be vigilant to identify the rare rigid flatfoot. Indications for flatfoot surgery are strict: failure of prolonged nonsurgical attempts to relieve pain that interferes with normal activities and occurs under the medial midfoot and/or in the sinus tarsi. In nearly all cases, an associated contracture of the heel cord is present. Osteotomies with supplemental soft-tissue procedures are the best proven approach for management of [corrected] flatfoot.
Collapse
|
39
|
Ahn JY, Lee HS, Kim CH, Yang JP, Park SS. Calcaneocuboid Joint Subluxation After the Calcaneal Lengthening Procedure in Children. Foot Ankle Int 2014; 35:677-82. [PMID: 24677218 DOI: 10.1177/1071100714528494] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated radiographic changes of calcaneocuboid (CC) joint subluxation following calcaneal lengthening procedure for the treatment of pediatric planovalgus foot deformities. METHODS This study included 44 cases of planovalgus foot deformities in 24 patients with mean age of 9.7 (range, 8 to 13) years who underwent calcaneal lengthening between 1999 and 2011. The mean follow-up period was 25 (range, 12 to 159) months. Anteroposterior (AP) and lateral radiographs of the weight-bearing view of the foot from immediate postoperative, 3-month postoperative, and last follow-up evaluations were reviewed and also used for trend analysis. Percentage of CC joint subluxations was measured on both AP and lateral view of the foot. Correlations between the percentage of CC joint subluxation and follow-up periods were assessed. RESULTS All of the feet showed dorsal subluxation of their CC joint on the immediate postoperative lateral plain radiographs. The median percentage of dorsal subluxation of the CC joint improved from 26.0% (range, 10.0 to 67.0) at the immediate postoperative evaluation to 16.5% (range, 7.0 to 47.0, P = .0001) at the 3-month postoperative evaluation and to 11% (range, 2.0 to 30.0, P = .0003) at last follow-up. The trend analysis over time indicated that the CC joint subluxation percentage with calcaneal lengthening generally decreased over time (r s = -.67, P = .001). No patients showed osteoarthritic changes in the CC joint or nonunion at the calcaneal osteotomy site at last follow-up. CONCLUSION At midterm follow-up, the CC joint subluxation was gradually resolving over time, with no evidence of osteoarthritic change in the CC joint. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Ji-Yong Ahn
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Ho-Seong Lee
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Chul-Ho Kim
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Jin-Pil Yang
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Soo-Sung Park
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, South Korea
| |
Collapse
|