Surgical treatment results for flexible flatfoot in adolescents

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.

Keywords: Adolescent; Flexible flatfoot; Osteotomy; Pes planus.

Fig. 1

a. Preoperative anteroposterior x-ray of foot. Notice accessory navicular bone. b. Preoperative lateral x-ray of foot. Notice accessory navicular bone and talar sag.

Fig. 2

a. Postoperative anteroposterior x-ray of right foot. Excision of navicular accessory bone and repair of posterior tibial tendon with suture anchor was achieved. b. Postoperative lateral x-ray of right foot. Procedures performed were: medializing calcaneal osteotomy, lateral column lengthening, medial cuneiform osteotomy, flexor digitorum longus tendon transfer, and percutaneous Achilles tendon lengthening.

Fig. 3

a. Preoperative front view of right foot. b. Postoperative front view of right foot. c. Postoperative lateral view of right foot.