Abstract
Background: Children with flexible flatfoot is common in clinics and there is no unified conclusion on surgical treatment. And for some patients with severe deformities, the correction of the subtalar joint arthroereisis combine the release of the Achilles tendon or gastrocnemius muscle release is still not satisfactory. The main aim of the present study was to investigate the therapeutic outcomes of subtalar arthroereisis combined with Achilles tendon or gastrocnemius recession and medial soft tissue (spring ligament, talonavicular joint capsule, tibionavicular ligaments and tibiospring ligaments) tightening for treating flexible flatfoot with severe deformities.Methods: Thirty patients (32 feet) with pediatric flexible flatfoot who underwent subtalar arthroereisis and soft tissue procedures during January 2016 to January 2018. There were 18 males (20 feet) and 12 females (12 feet) with an average age of 9.5 years (range, 8–12 years). We used the AOFAS scores and VAS scores combined with angles measure to evaluate the pre-operative and post-operative status.Results: Thirty patients (32 feet) were followed up for 25.3 months on average (range, 18–36 months). There was no infection. Post-operative foot pain, arch collapse, and other symptoms improved. At last follow-up, the Meary angle was decreased from 17.5° ± 4.4° to 4.1° ± 1.2° (P < 0.05), the talar-first metatarsal (AP) was decreased from 15.3° ± 3.1° to 4.8° ± 1.3°(P < 0.05), The mean AOFAS score was rose from 66.6 ± 5.8 to 88.6 ± 7.9 (P < 0.05), the mean VAS score was decreased from 6.6 ± 0.6 to 1.7 ± 0.3 (P < 0.05).Conclusion: The subtalar arthroereisis combined with soft tissue procedures can effectively correct flexible flatfoot in children and it is a significant method for severe forefoot abduction reconstruction.Level of Evidence: IV
Highlights
Children flatfoot is common in clinics, most of which are flexible
Children with flexible flatfoot is common in clinics and there is no unified conclusion on surgical treatment
For some patients with severe deformities, the correction of the subtalar joint arthroereisis combine the release of the Achilles tendon or gastrocnemius muscle release is still not satisfactory
Summary
Children flatfoot is common in clinics, most of which are flexible. Its etiology and pathological process are unclear [1]. Most pediatric orthopedic surgeons believe that radiographic measurements such as Meary’s angle, talonavicular coverage, the lateral talocalcaneal angle and the kite’s angle, and the clinical assessments of foot, especially the forefoot, including foot flexibility, Treatment for Flatfoot in Children the quality and amount of forefoot pronation, triceps surae contracture, longitudinal arch and the valgus of the hindfoot, are very important for diagnosis [2,3,4,5]. Children with flexible flatfoot is common in clinics and there is no unified conclusion on surgical treatment. For some patients with severe deformities, the correction of the subtalar joint arthroereisis combine the release of the Achilles tendon or gastrocnemius muscle release is still not satisfactory. The main aim of the present study was to investigate the therapeutic outcomes of subtalar arthroereisis combined with Achilles tendon or gastrocnemius recession and medial soft tissue (spring ligament, talonavicular joint capsule, tibionavicular ligaments and tibiospring ligaments) tightening for treating flexible flatfoot with severe deformities
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