Calcaneal-stop procedure for treatment of pediatric flexible flatfoot

Abstract

Background Flexible flatfoot is a common problem of premature patients. There are different procedures described for the treatment of this condition. The calcaneal stop is an easy and simple procedure for its treatment. In this study, we evaluate this technique as a valuable one. Patients and methods This study was performed on 20 feet in 12 patients (seven males and five females) with flexible flatfeet (eight bilateral and four unilateral cases) who were treated with a calcaneal-stop procedure. They had the following inclusion criteria: (a) skeletal-immaturity patients; (b) symptomatic flexible flatfoot deformity (pain, function, and activity limitations) not responsive to conservative treatment. The evaluation was done clinically by American Orthopedic Foot and Ankle Society Ankle–Hindfoot score, and hindfoot valgus angle. Radiological evaluation was done by calcaneal-pitch angles, Kite’s angle, talar-declination angle, lateral Meary’s angle, and talonavicular-coverage angle. Results Clinical and functional outcomes of all patients were evaluated, before surgery, and at 3 and 6 months after surgery. The American Orthopedic Foot and Ankle Society score mean increased from 70.6 (SD 4.8) to 88.4 (SD 7.4) at the end of the study. Heel valgus improved from 11.45 (SD 3.02) to 2.7 (SD 1.3) at the end of the study. The calcaneal-pitch angle increased from 13.4 (SD 1.1) to 16.1 (SD 1.4) at the end of the study. Talar-declination angle decreased from 41.9 (SD 5.0) to 32.8 (SD 4.5) at the end. Kite angle changed from 29.6 (SD 3.1) preoperatively to 26.7 (SD 2.7) finally. Talonavicular-coverage angle improved from 22.4 (SD 5.4) to 11.2 (SD 5.68) at the end. Lateral Meary’s talocalcaneal angle decreased from 20.55±6.9 to 14.3±4.73 at 6 months after surgery. There was significant satisfaction of 11 (91.6%) patients with one patient who showed some pain at the site of operation with no need for screw removal. Conclusion There was significant improvement (P<0.00001) of all clinical and radiological parameters. The changes were mainly after surgery. There was an increased improvement with time, however, it was not statically significant. The main problem of flatfeet is patient dissatisfaction, which requires intervention. The calcaneal-stop procedure is an easy and simple procedure, with a minimal complication for the management of flexible flatfeet.