Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents

Abstract

Background Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. Methods We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites. Results The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001). Conclusions Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.

Is There a Benefit to Rigid Fixation in Calcaneal Lengthening Osteotomy in Painful Pediatric Idiopathic Flatfoot Deformity? Comparing Results of Kirschner Wire Versus Plate Fixation

“…We also found improvement in pain and mobility PROMIS scores among patients undergoing this procedure. Our findings are similar to those of previous studies which reported improvement in American College of Foot and Ankle Surgeons (ACFAS) and American Orthopedic Foot & Ankle Society (AOFAS) scores after CLO 9,13,19–23 . Importantly, we found no statistical differences in pain and mobility PROMIS scores between the K-wire and the plate fixation group at follow-up.…”

“…Our findings are similar to those of previous studies which reported improvement in American College of Foot and Ankle Surgeons (ACFAS) and American Orthopedic Foot & Ankle Society (AOFAS) scores after CLO. 9,13,[19][20][21][22][23] Importantly, we found no statistical differences in pain and mobility PROMIS scores between the K-wire and the plate fixation group at follow-up. In both cohorts, compared with preoperative scores, mobility scores achieved a clinically notable improvement at 12 months, but pain scores improved as early as 6 months.…”

Optimisation of methods of diagnosis and correction of heel foot in children with cerebral palsy

“…When analysing radiographs of the foot in children aged 6 to 12 years, some authors found that the values of the main 11 clinical useful angles change with age. To evaluate the main radiological parameters, it is necessary to take into account the age of patients, as well as anthropometric data [23,26,33]. The analysis of the radiological parameters of the foot in children aged 12-17 years shows that the range of differences in the indicators is within 20⁰-25⁰.…”