Clinical and radiological outcome of calcaneal lengthening osteotomy for flatfoot deformity in skeletally immature patients

Background: The purpose of this study was to evaluate the clinical, functional and radiological outcome of calcaneal lengthening osteotomy for the treatment of symptomatic flatfoot deformity in skeletally immature patients. Methods: A retrospective review was led on 31 prospectively enrolled patients with symptomatic flatfoot. Twenty-seven out of 31 patients met the inclusion criteria, for a total of 38 operated feet. Mean age at time of surgery was 13.3 ± 2.2 years (range 7.8–17). Mean BMI at time of surgery was 19.3 ± 4.9 (range 12.3–32). In order to assess clinical and functional outcome, all patients were evaluated according to Yoo et al., Mosca and AOFAS clinical criteria before surgery and at last follow-up visit. Moreover, all patients underwent anteroposterior and lateral weight-bearing foot radiographs preoperatively, at 3–4-month post-surgery and at last follow-up visit. Results: Average Yoo et al. score was 3.3 ± 1 (range 0–4) preoperatively and improved to 9.8 ± 2.1 (range 3–12) at last follow-up (p < 0.001). Clinical outcome was satisfactory in 34 feet (89%) and unsatisfactory in 4 feet (11%). The same results were observed when Mosca clinical criteria were applied. AOFAS score improved significantly from a preoperative mean value of 49.9 ± 16 (range 23–75) to a postoperative value of 89 ± 15.9 (range 34–100) (p < 0.001). All radiographic parameters improved significantly from mean preoperative to mean 3–4-month postoperative value. Correction was maintained at last follow-up visit. Postoperative radiographs showed calcaneocuboid (C–C) joint subluxation in 29 (76%) feet. Final AP and lateral foot radiographs showed complete bone union and good bone graft remodeling. Furthermore, correct joint alignment was restored in all but two patients (93%). Conclusions: Calcaneal lengthening osteotomy is not contraindicated in symptomatic flatfoot of different etiologies, except neuromuscular disease-related flatfoot that can affect bone quality and reduce foot flexibility. C–C joint subluxation is frequently observed but has little functional impact as it tends to remodel over time. © 2017, Springer-Verlag France.