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Topic:

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Issue:

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Category:

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Title:

Flatfoot Reconstruction for Painful Pediatric Idiopathic Flexible Flatfoot: Prospective Study Demonstrates Improved Alignment, Function, and Patient-reported Outcomes

Author:

DeFrancesco, Christopher J. MD; Conti, Matthew S. MD; Zanini, Silvia MS; Blanco, John MD; Dodwell, Emily MD, MPH; Hillstrom, Howard J. PhD; Scher, David M. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p e267-e277, DOI: 10.1097/BPO.0000000000002603

Level Of Evidence:

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# of Patients:

25

Study Type:

Prospective cohort study

Location:

Not specified

Summary:

This study assessed the outcomes of flatfoot reconstruction surgery in pediatric patients with idiopathic flexible flatfoot, specifically examining improvements in alignment, function, and patient-reported outcomes (PROs) after lateral column lengthening (LCL) and other related procedures.

Methods:

Intervention: All patients underwent Achilles or gastrocnemius lengthening. Additional procedures included medial side soft tissue (MSST) procedures (13 patients), medial cuneiform plantarflexion osteotomy (MCPO, 7 patients), and medializing calcaneal osteotomy (5 patients). Outcome Measures: Radiographic parameters for static foot alignment Clinical arch height indices Arch height flexibility and pedobarography for dynamic foot alignment Patient-reported outcomes (PROs) including PROMIS Pain Interference scores

Exclusions:

Not specified

Results:

All radiographic parameters improved post-surgery (P<0.001). The mean sitting arch height index showed a modest increase (P=0.023). Arch height flexibility was unchanged. Dynamic foot measures improved: The center-of-pressure excursion index increased (P<0.001). The peak pressure under the first metatarsal head (MH) dropped (P<0.001), while the pressure under the fifth MH increased (P=0.018). The ratio of peak pressures between first and second MH decreased without MCPO (P<0.002) but remained stable with MCPO. All PRO scores significantly improved (P<0.001). Patients treated without MSST procedures showed no difference in PROMIS Pain Interference scores compared to those with MSST procedures.

Conclusions:

Flatfoot reconstruction with lateral column lengthening (LCL) and plantarflexor lengthening led to significant improvements in radiographic alignment, dynamic foot function, and PRO scores. LCL surgery altered the distribution of metatarsal head pressure but did not fully normalize it. The addition of medial cuneiform plantarflexion osteotomy (MCPO) helped preserve load-sharing between the metatarsal heads, particularly the first metatarsal head, preventing excessive pressure under it.

Relevance:

Limitations:

Perspective:

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