Necip Selcuk YONTARA, Tahir ÖĞÜT, Mehmet Fatih GÜVEN, Hüseyin BOTANLIOĞLU, GÖKHAN KAYNAK, ATA CAN

Surgical treatment results for ﬂexible ﬂatfoot in adolescents

Contents lists available at ScienceDirect

Objective: Idiopathicﬂexible pes planus (IFPP) is a common foot problem in adolescents and youngadults. Hypothesis for the present study was that combination of procedures for IFPP can achieve resultsin 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 surgicalreconstruction forﬂatfoot deformity. Symptomatic patients who had been unresponsive to conservativetreatment were included in study group. Mean follow-up time was 39.2 months. American OrthopedicFoot and Ankle Society (AOFAS) scores were calculated for all patients, and based onŞnal results, allfamilies 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 lengtheningosteotomy on 21 feet; percutaneous lengthening or gastrocnemius recession for Achilles tendon on 21feet; 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 accessorynavicular bone excision on 2 feet.Preoperative mean AOFAS score increased signiŞcantly from 56.76 to 95.29. All parents stated that theywere satisŞed 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 IFPPin adolescents and young adults.Level of clinical evidence: Level IV, Therapeutic study.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

___

1. Blitz NM, Stabile RJ, Giorgini RJ, DiDomenico LA. Flexible pediatric and adolescent pes planovalgus: conservative and surgical treatment options. Clin Podiatr Med Surg. 2010;27:59e77.

2. Yeagerman SE, Cross MB, Positano R, Doyle SM. Evaluation and treatment of symptomatic flatfoot. Curr Opin Pediatr. 2011;23:60e67.

3. Mosca VS. Flexible flatfoot in children and adolescents. J Child Orthop. 2010;4: 107e121.

4. Manusov EG, Lillegard WA, Raspa RF, Epperly TD. Evaluation of pediatric foot problems: Part II. The hindfoot and the ankle. Am Fam Physician. 1996;54: 1012e1026.

5. Rome K, Ashford RL, Evans A. Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev. 2010;7:CD006311.

6. Roth S, Sestan B, Tudor A, Ostojic Z, Sasso A, Durbesic A. Minimally invasive calcaneo-stop method for idiopathic, flexible pes planovalgus in children. Foot Ankle Int. 2007;28:991e995.

7. Jay RM, Din N. Correcting pediatric flatfoot with subtalar arthroereisis and gastrocnemius recession: a retrospective study. Foot Ankle Spec. 2013;6: 101e107.

8. Oh I, Williams BR, Ellis SJ, Kwon DJ, Deland JT. Reconstruction of the symptomatic idiopathic flatfoot in adolescents and young adults. Foot Ankle Int. 2011;32:225e232.

9. Akimau P, Flowers M. Medium term outcomes of planovalgus foot correction in children using a lateral column lengthening approach with additional procedures ‘a la carte’. Foot Ankle Surg. 2014;20:26e29.

10. Roye Jr DP, Raimondo RA. Surgical treatment of the child's and adolescent's flexible flatfoot. Clin Podiatr Med Surg. 2000;17:515e530.

11. Haddad SL, Mann R. Flatfoot deformity in adults. In: Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. Philadelphia: Mosby Elsevier; 2007:1033e1039.

12. D'Amico JC. The flat-footed child-to treat or not to treat: what is the clinician to do? J Am Podiatr Med Assoc. 2008;98:386e393.

13. Harris EJ. The natural history and pathophysiology of flexible flatfoot. Clin Podiatr Med Surg. 2010;27:1e23.

14. Moraleda L, Salcedo M, Bastrom TP, Wenger DR, Albinana J, Mubarak SJ. ~ Comparison of the calcaneo-cuboid-cuneiform osteotomies and the calcaneal lengthening osteotomy in the surgical treatment of symptomatic flexible flatfoot. J Pediatr Orthop. 2012;32:821e829.

15. Yarmel D, Mote G, Treaster A. The Cotton osteotomy: a technical guide. J Foot Ankle Surg. 2009;48:506e512.

16. Templin D, Jones K, Weiner DS. The incorporation of allogenic and autogenous bone graft in healing of lateral column lenghtening of the calcaneus. J Foot Ankle Surg. 2008;47:283e287.

17. Kwon JY, Myerson MS. Management of the flexible flat foot in the child: a focus on the use of osteotomies for correction. Foot Ankle Clin. 2010;15:309e322.

18. Ehrler DM, Vaccaro AR. The use of allograft bone in lumber spine surgery. Clin Orthop. 2000;371:38e45.

19. Senses I, Kiter E, Gunal I. Restoring the continuity of the tibialis posterior tendon in the treatment of symptomatic accessory navicular with flat feet. J Orthop Sci. 2004;9:408e409.

20. Jacobs AM. Soft tissue procedures for the stabilization of medial arch pathology in the management of flexible flatfoot deformity. Clin Podiatr Med Surg. 2007;24:657e665.

21. Sullivan JA, Miller WA. The relationship of the accessory navicular to the development of the flat foot. Clin Orthop Relat Res. 1979;144:233e237.

22. Prichasuk S, Sinphurmsukskul O. Kidner procedure for symptomatic accessory navicular and its relation to pes planus. Foot Ankle Int. 1995;16(8): 500e503.

23. Viegas GV. Reconstruction of the pediatric flexible planovalgus foot by using an Evans calcaneal osteotomy and augmentative medial split tibialis anterior tendon transfer. J Foot Ankle Surg. 2003;42:199e207.

24. van der Krans A, Louwerens JW, Anderson P. Adult acquired flexible flatfoot, treated by calcaneocuboid distraction arthrodesis, posterior tibial tendon augmentation, and percutaneous Achilles tendon lengthening: a prospective outcome study of 20 patients. Acta Orthop. 2006;77:156e163.

25. Den Hartog BD. Flexor digitorum longus transfer with medial displacement calcaneal osteotomy. Biomechanical rationale. Foot Ankle Clin. 2001;6:67e76.