Osteotomies combined with soft tissue procedures for symptomatic flexible flatfoot deformity in children

Xiaodong Wen; Guanghua Nie; Cheng Liu; Hongmou Zhao; Jun Lu; Xiaojun Liang; Xinwen Wang; Jingqi Liang; Rui Guo; Yi Li

Osteotomies combined with soft tissue procedures for symptomatic flexible flatfoot deformity in children

Am J Transl Res. 2020 Oct 15;12(10):6921-6930. eCollection 2020.

Authors

Xiaodong Wen¹, Guanghua Nie¹, Cheng Liu¹, Hongmou Zhao¹, Jun Lu¹, Xiaojun Liang¹, Xinwen Wang¹, Jingqi Liang¹, Rui Guo², Yi Li¹

Affiliations

¹ Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, China.
² Department of Orthopaedics, Shaanxi University of Chinese Medicine Xianyang 712046, Shaanxi, China.

PMID: 33194082
PMCID: PMC7653612

Abstract

Background: The indications for surgery, timing, and procedure in children with flexible flatfoot deformity remain controversial. This study aims to evaluate the efficacy of osteotomies combined with soft tissue procedures in children with flexible flatfoot aged 9-14 years.

Methods: Twenty-eight children (47 feet) with flexible flatfoot who underwent osteotomy combined with soft tissue surgery between July 2014 and October 2017 were included in this study. The main observational indexes included the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Foot and Ankle Outcome Score (FAOS), talo-navicular coverage angle (TNCA), talar-first metatarsal angle (T1MA) on the foot anteroposterior (AP) view, calcaneal pitch angle and Meary's angle on the foot lateral view, and calcaneus valgus angle (CVA) on the Saltzman view. Intra- and interobserver reliabilities were assessed using intra-class correlation coefficient (ICC). Patient's satisfaction was assessed.

Results: All patients were followed up for an average duration of 29.7±8.6 months. The results showed that the mean AOFAS and FAOS had improved significantly from 56.6±8.0 and 47.4±9.5 preoperatively to 88.4±3.9 and 83.2±6.8 at final follow-up (P<0.001), respectively. There were statistically significant differences between preoperative and postoperative scores in all FAOS subscales (P<0.001). Radiographic parameters, such as TNCA (P<0.001) and T1MT (P<0.001) on foot AP views, calcaneal pitch angle (P=0.014) and Meary's angle (P<0.001) on foot lateral views, and CVA (P<0.001) on Saltzman views, had improved significantly. We observed overall substantial to perfect intra- and inter-observer agreements for all radiographic measurements preoperatively and final follow-up. All patients and their parents were satisfied with the functional outcomes.

Conclusion: Osteotomies combined with soft tissue procedures is an effective strategy for flexible flatfoot deformity in children, as it results in favorable radiographic and functional outcomes.

Keywords: Flexible flatfoot; children; osteotomy; reconstruction; soft tissue procedure.