Lateral calcaneal lengthening osteotomy versus subtalar arthroereisis in symptomatic flexible flat foot in children

Abstract

Abstract Background Pediatric Flexible flat foot is the prevalent type of flat foot. Conservative measures are the first line of treatment. However, surgery may be required in some cases. Objective To compare outcomes of lateral calcaneal lengthening osteotomy versus subtalar arthroereisis for the pediatric flexible flat foot. Methods Calcaneal lengthening osteotomy was operated on 25 feet and subtalar arthroereisis was operated on 19 feet. Patients were evaluated preoperative and postoperative according to the American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, Meary’s angle and Talonavicular coverage angle. The follow-up duration was 18 months. Results Lateral calcaneal lengthening osteotomy showed better clinical and radiological outcome versus subtalar arthroereisis. In LCL group,American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score (68.2 ± 1.45 preoperative to 98 ± 5 postoperative) and Talonavicular coverage angle (18.8 ± 5.6 preoperative to 3.96 ± 2.46 postoperative) improved versus SA group, the AFOAS (68.62 ± 2.93 preoperative to 96.55 ± 3.48 postoperative) and Talonavicular coverage angle (23.98 ± 5.88 preoperative to 5.94 ± 4.59 postoperative) respectively. Significant difference was found postoperative between the two groups regarding Meary’s angle, in LCL group improved from 17 ± 5.04 preoperative to 4.44 ± 1.66 postoperative while in SA group the angle improved from 23.62 ± 7.74 preoperative to 2.98 ± 1.27 postoperative. Conclusion Calcaneal lengthening osteotomy achieved more improvement in AOFAS score than subtalar arthroereisis group with better clinical and radiological outcomes but subtalar arthroereisis is less invasive procedure with early weight bearing and mobilization.