Comparative Study between Arthroereisis and Corrective Osteotomies for the Management of Symptomatic Flexible Pes Planovalgus in Adolescents

Abstract

Abstract pes planovalgus is a common foot deformity observed in adolescents which is characterized by a loss of the medial longitudinal arch and malalignment of the foot; hindfoot valgus and forefoot abduction which could progress with time causing pain that occur secondary to pressure medially over the prominent talar head. The treatment of this deformity should be directed to correct the foot malalignment, secure the stability of the foot during stance and correct the abnormal gait. The aim of the treatment is to obtain a foot with normal alignment which exhibits no pain and preventing the degenerative changes that may take place in the future. Surgical options should be offered to patients when conservative treatment failed. Numerous surgical procedures were described in pesplanovalgus correction that varies from bony osteotomies, subtalar extra-articular arthroeresis, intraarticular arthrodesis and triple arthrodesis accompanied with soft tissue procedures as indicated. When these are compared, all techniques have advantages and disadvantages. This study was conducted to evaluate the short term outcome of two methods of correction of pesplanovalgus; the extra-articular subtalar arthroereisis using subtalar sinus tarsi implant and bony corrective osteotomies in correction of flexible PPV in adolescents. Soft tissue procedures added to the operation if indicated mainly (gastroconemius recession and accessory navicular excision) Our study included 40 feet (25 patients) with pesplanovalgus. The patients divided into two groups 20 feet each. Group A underwent arthroereisis and group B underwent corrective osteotomies. The inclusion criteria were; Idiopathic flexible flatfoot deformity, symptomatic patients only and age between 10-14 years old. While the exclusion criteria were rigid flatfoot, flatfoot in adults (above 14 yrs old), severe talonavicular uncoverage angle (>40), neurogenic cases (cerebral palsy patient), patients with generalized ligamentous laxity. The outcome was assessed clinically by patient satisfaction, heel valgus angle, AOFAS hindfoot score and FAAM score. Radiologically the outcome was assessed by comparing the preoperative and postoperative measures of the lateral TCA, the AP and lateral talo-1st MTS angles, talonavicular coverage angle and the calcaneal pitch angle. Clinically the patient satisfaction was comparable in each of Group A were 17 patients (85.0%) were Satisfied; and 3 patients (15.0%) were unsatisfied compared to Group B were 18 patients (90.0%) were Satisfied and 2 patients (10.0%) were unsatisfied. Additionally, the two groups were comparable in heel valgus angle with the mean±SD in each of group A and group B was 2.75±2.62 compared to 2.05±2.01 respectively. Furthermore, the two groups were comparable in AOFAS score with the mean±SD in each of group A and group B was 89.25±8.34 compared to 91.25±8.97 respectively. As well as, the two groups were comparable in FAAM score with the mean & ±SD in each of group A and group B was 91.08±6.51, compared to 95.75±7.23 respectively. Radiologically; The two groups were comparable in lateral talus 1st met angle with the mean±SD in each of group A and group B was 3.45±3.06 compared to 2.02±2.08 respectively. Additionally, the two groups were comparable in lateral talocalc angle with the mean±SD in each of group A and group B was 32.65±5.05 compared to 30.50±5.62 respectively. Furthermore, the two groups were comparable in calc pitch angle with the mean±SD in each of group A and group B was 15.75±4.64 compared to 15.70±3.77 respectively. As well as, the two groups were comparable in AP talus 1st met angle with the mean±SD in each of group A and group B was 6.72±5.17 compared to 4.55±4.18 respectively. Also, the two groups were comparable in AP talonavicular coverage with the mean±SD in each of Group A and Group B was 6.95±4.77 compared to 4.10±3.30 respectively. There is no statistically significant difference between the group A and group B in all clinical and radiological measures. The extra-articular subtalar arthroereisis and bony corrective osteotomies in our study had been proved to be effective procedure for correction of flexible PPV feet in adolescents with comparable results.