Summary
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Summary
Flexible flatfoot is a normal foot shape that is present in a large percentage of the population. There are more flatfeet in children than in adults. The arch elevates in most children spontaneously during the first decade of life. There is no evidence that a longitudinal arch can be created in a child’s foot by any external forces or devices. Flexible flatfoot with a short Achilles tendon, in contrast to simple flexible flatfoot, is known to cause pain and disability in some adolescents and adults. Surgery is indicated in flexible flatfeet with short Achilles tendons when conservative measurements fail to relieve pain under the head of the plantar flexed talus or in the sinus tarsi area. Joint preserving, deformity-correcting osteotomy techniques should be used along with Achilles tendon lengthening in those cases. Rigid forefoot supination is an additional deformity in many flatfeet that, if present, must be identified and treated concurrently during surgical reconstruction.
Calcaneal osteotomies are powerful, reliable, joint-preserving surgical procedures that are common components of the correction of planovalgus and cavovarus foot deformities. While its historical roots lie in the late 19th century, the procedure continues to evolve in the present day with the development of technique modifications and implant and technology advances. Clinical research studies show good results of calcaneal osteotomies, most of which include the procedure with other procedures. Continued research and development for surgical techniques and outcomes are indicated, as calcaneal osteotomy will foreseeably remain an important reconstructive option in the correction of foot deformity.
Summary
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Lateral column lengthening procedures, either an Evans-type procedure or a calcaneocuboid distraction arthrodesis, clearly have a role to play in the management of a pes planovalgus foot deformity, as is evident from clinical outcome studies. Despite an abundance of literature intricately detailing the biomechanical effects of different operative procedures on the hindfoot, there is no clear consensus as to the best procedure or procedures to perform for a flexible pes planovalgus foot deformity. There is, therefore, no single solution to this problem; the surgeon must treat each patient as an individual and choose the procedure that will work best in their hands for any given foot pathology they are presented with. The surgeon must also be aware that to improve the kinematics of a planovalgus foot deformity, one may often have to perform multiple procedures and not a lateral column lengthening in isolation.
Calcaneal lengthening using the Mosca’s technique was effective in deformity correction and pain relief of painful FFF in adolescents. The procedure corrected all components of FFF while preserving subtalar joint motion. The technique is reproducible with minor complications.
The advantages of calcaneal lengthening osteotomy are as follows: it is technically easy to be applied, has a low risk of neurovascular injury and low loss of blood. In addition, it allows other procedures to be applied in the future contrary to arthrodesis. If arthrodesis is required later in these feet, it will be far easier to do because of the corrected alignment of the foot. However, future long-term studies may be needed to detect any deleterious effects on the subtalar joint caused by the osteotomy. |
