Management of the Painful Adolescent Flatfoot

Preliminary Outcomes of Calcaneal Lengthening in Adolescent Flatfoot in Müller-Weiss Disease

BACKGROUND

Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot.

METHODS

The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m² at presentation. The patients were followed up for a mean of 37.8 months.

RESULTS

The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up.

CONCLUSION

Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Effects of body weight on the clinical and radiological outcomes of children with flexible flatfeet managed with the 'calcaneo-stop' procedure

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