Skip to main content

Advertisement

SpringerLink
Log in

Functional and radiographic comparison of subtalar arthroereisis and lateral calcaneal lengthening in the surgical treatment of flexible flatfoot in children

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bouchard M, Mosca VS (2014) Flatfoot deformity in children and adolescents: surgical indications and management. J Am Acad Orthop Surg 22:623–632. https://doi.org/10.5435/JAAOS-22-10-623

    Article  PubMed  Google Scholar 

  2. Chong DY, Macwilliams BA, Hennessey TA, Teske N, Stevens PM (2015) Prospective comparison of subtalar arthroereisis with lateral column lengthening for painful flatfeet. J Pediatr Orthop B 24:345–353. https://doi.org/10.1097/BPB.0000000000000179

    Article  PubMed  Google Scholar 

  3. Suh DH, Park JH, Lee SH, Kim HJ, Park YH, Jang WY, Baek JH, Sung HJ, Choi GW (2019) Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review. Int Orthop 43:1179–1192. https://doi.org/10.1007/s00264-019-04303-3

    Article  PubMed  Google Scholar 

  4. Harris RI, Beath T (1974) Army Foot Survey: An Investigation of Foot Ailments in Canadian Soldiers. Ottawa, Ontario, Canada: National Research Council of Canada

  5. Caravaggi P, Lullini G, Berti L, Giannini S, Leardini A (2018) Functional evaluation of bilateral subtalar arthroereisis for the correction of flexible flatfoot in children: 1-year follow-up. Gait Posture 64:152–158. https://doi.org/10.1016/j.gaitpost.2018.06.023

    Article  PubMed  Google Scholar 

  6. Faldini C, Mazzotti A, Panciera A, Perna F, Stefanini N, Giannini S (2018) Bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot. Musculoskelet Surg 102:11–19. https://doi.org/10.1007/s12306-017-0491-y

    Article  CAS  PubMed  Google Scholar 

  7. Evans D (1975) Calcaneo-valgus deformity. J Bone Joint Surg (Br) 57:270–278

    Article  CAS  Google Scholar 

  8. Mosca VS (1995) Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot. J Bone Joint Surg Am 77:500–512. https://doi.org/10.2106/00004623-199504000-00002

    Article  CAS  PubMed  Google Scholar 

  9. Andreacchio A, Orellana CA, Miller F, Bowen TR (2000) Lateral column lengthening as treatment for planovalgus foot deformity in ambulatory children with spastic cerebral palsy. J Pediatr Orthop 20:501–505

    CAS  PubMed  Google Scholar 

  10. Dumontier TA, Falicov A, Mosca V, Sangeorzan B (2005) Calcaneal lengthening: investigation of deformity correction in a cadaver flatfoot model. Foot Ankle Int 26:166–170. https://doi.org/10.1177/107110070502600209

    Article  PubMed  Google Scholar 

  11. Sangeorzan BJ, Mosca V, Hansen ST Jr (1993) Effect of calcaneal lengthening on relationships among the hindfoot, midfoot, and forefoot. Foot Ankle 14:136–141. https://doi.org/10.1177/107110079301400305

    Article  CAS  PubMed  Google Scholar 

  12. Yoo WJ, Chung CY, Choi IH, Cho TJ, Kim DH (2005) Calcaneal lengthening for the planovalgus foot deformity in children with cerebral palsy. J Pediatr Orthop 25:781–785. https://doi.org/10.1097/01.bpo.0000184650.26852.37

    Article  PubMed  Google Scholar 

  13. Zeifang F, Breusch SJ, Döderlein L (2006) Evans calcaneal lengthening procedure for spastic flexible flatfoot in 32 patients (46 feet) with a followup of 3 to 9 years. Foot Ankle Int 27:500–507. https://doi.org/10.1177/107110070602700704

    Article  PubMed  Google Scholar 

  14. Adams SB Jr, Simpson AW, Pugh LI, Stasikelis PJ (2009) Calcaneocuboid joint subluxation after calcaneal lengthening for planovalgus foot deformity in children with cerebral palsy. J Pediatr Orthop 29:170–174. https://doi.org/10.1097/BPO.0b013e3181982c33

    Article  PubMed  Google Scholar 

  15. Moraleda L, Salcedo M, Bastrom TP, Wenger DR, Albiñana J, Mubarak SJ (2012) Comparison of the calcaneo-cuboid-cuneiform osteotomies and the calcaneal lengthening osteotomy in the surgical treatment of symptomatic flexible flatfoot. J Pediatr Orthop 32:821–829. https://doi.org/10.1097/BPO.0b013e3182648c74

    Article  PubMed  Google Scholar 

  16. Thomas RL, Wells BC, Garrison RL, Prada SA (2001) Preliminary results comparing two methods of lateral column lengthening. Foot Ankle Int 22:107–119. https://doi.org/10.1177/107110070102200205

    Article  CAS  PubMed  Google Scholar 

  17. Pavone V, Vescio A, Canavese F, Costa D, Sessa G, Testa G (2019) Effects of body weight on the clinical and radiological outcomes of children with flexible flatfeet managed with the 'calcaneo-stop' procedure. J Pediatr Orthop B 28:228–234. https://doi.org/10.1097/BPB.0000000000000590

    Article  PubMed  Google Scholar 

  18. Evans AM, Rome K (2011) A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. Eur J Phys Rehabil Med 47:69–89

    CAS  PubMed  Google Scholar 

  19. Megremis P, Megremis O (2019) Arthroereisis for symptomatic flexible flatfoot deformity in young children: radiological assessment and short-term follow-up. J Foot Ankle Surg 58:904–915. https://doi.org/10.1053/j.jfas.2019.01.012

    Article  PubMed  Google Scholar 

  20. Metcalfe SA, Bowling FL, Reeves ND (2011) Subtalar joint arthroereisis in the management of pediatric flexible flatfoot: a critical review of the literature. Foot Ankle Int 32:1127–1139. https://doi.org/10.3113/fai.2011.1127

    Article  PubMed  Google Scholar 

  21. Mosca VS (2010) Flexible flatfoot in children and adolescents. J Child Orthop 4:107–121. https://doi.org/10.1007/s11832-010-0239-9

    Article  PubMed  PubMed Central  Google Scholar 

  22. Davids JR, Gibson TW, Pugh LI (2005) Quantitative segmental analysis of weight-bearing radiographs of the foot and ankle for children: normal alignment. J Pediatr Orthop 25:769–776. https://doi.org/10.1097/01.bpo.0000173244.74065.e4

    Article  PubMed  Google Scholar 

  23. Sayyed-Hosseinian SH, Hassankhani GG, Bagheri F, Alavi N, Shojaie B, Mousavian A (2018) Validation of the Persian version of the American Orthopedic Foot and Ankle Society Score (AOFAS) Questionnaire. Arch Bone Jt Surg 6:233–239

    PubMed  PubMed Central  Google Scholar 

  24. Giannini S, Cadossi M, Mazzotti A, Persiani V, Tedesco G, Romagnoli M, Faldini C (2017) Bioabsorbable calcaneo-stop implant for the treatment of flexible flatfoot: a retrospective cohort study at a minimum follow-up of 4 years. J Foot Ankle Surg 56:776–782. https://doi.org/10.1053/j.jfas.2017.02.018

    Article  PubMed  Google Scholar 

  25. Jerosch J, Schunck J, Abdel-Aziz H (2009) The stop screw technique—a simple and reliable method in treating flexible flatfoot in children. Foot Ankle Surg 15:174–178. https://doi.org/10.1016/j.fas.2009.01.004

    Article  PubMed  Google Scholar 

  26. Viegas GV (2003) Reconstruction of the pediatric flexible planovalgus foot by using an Evans calcaneal osteotomy and augmentative medial split tibialis anterior tendon transfer. J Foot Ankle Surg 42:199–207. https://doi.org/10.1016/s1067-2516(03)70029-5

    Article  PubMed  Google Scholar 

  27. Pavone V, Vescio A, Di Silvestri CA, Andreacchio A, Sessa G, Testa G (2018) Outcomes of the calcaneo-stop procedure for the treatment of juvenile flatfoot in young athletes. J Child Orthop 12:582–589. https://doi.org/10.1302/1863-2548.12.180032

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Morris C, Liabo K, Wright P, Fitzpatrick R (2007) Development of the Oxford ankle foot questionnaire: finding out how children are affected by foot and ankle problems. Child Care Health Dev 33:559–568. https://doi.org/10.1111/j.1365-2214.2007.00770.x

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

    Mohammad Ali Tahririan

  2. School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Sina Ramtin & Pegah Taheri

Authors
  1. Mohammad Ali Tahririan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sina Ramtin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pegah Taheri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammad Ali Tahririan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the Ethics Committee of Isfahan University of Medical Science (IR.MUI.MED.REC.1398.415) and it was registered at irct.ir (IRCT20180823040853N1).

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tahririan, M.A., 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 (SICOT) 45, 2291–2298 (2021). https://doi.org/10.1007/s00264-020-04899-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04899-x

Keywords

Search

Navigation