Management of symptomatic flexible flatfoot in adolescents by Mosca's lateral calcaneal lengthening

Abstract

Introduction There is considerable debate as to the ideal procedure for the treatment of symptomatic flexible flatfoot (FFF) that is not followed by recurrence and that minimizes complications. The purpose of the present study was to evaluate the results of calcaneal lengthening using Mosca's technique in adolescents with FFF in whom conservative treatment had been applied for more than 1 year but had failed. Patients and methods Calcaneal lengthening osteotomy was performed using Mosca's technique in 14 patients including ten males and four females. Five cases were bilateral making the total of 19 feet. The mean age at surgery was 13.53 (range 11.5–16) years. All FFF patients were evaluated as idiopathic. Bilateral cases were operated on at two sessions with an average interval of 15.6 (range 12–21) months. The American Orthopaedic Foot and Ankle Society ankle-hind foot scale was used for clinical assessment, and radiographic assessment was based on six parameters on standard anteroposterior and lateral radiographs. Results The mean follow-up period was 27.89 (range 18–44) months. The mean American Orthopaedic Foot and Ankle Society score increased from 57.53 preoperatively to 96.32 postoperatively. All radiographic parameters significantly improved. Four patients had mild occasional pain. There was no nonunion nor secondary subsidence of the arch. All patients stated that they were satisfied with the procedure. Conclusion Correction of FFF deformity with Mosca's lateral calcaneal lengthening was an effective and reproducible method to restore normal foot alignment and good function.