Functional outcome after the nonsurgical treatment for adolescent spasmodic valgus foot

Abstract

Background: Adolescent spasmodic valgus foot is usually associated with resistant pain and deformity. It shows controversy regarding its incidence, etiology, and treatment. Our study aimed to evaluate the functional outcome after the nonsurgical treatment for such condition. Methods: This study included 50 planovalgus feet secondary to peroneal or peroneo-extensor spasm in 33 adolescents with a mean age of 14 + 2.8 years. The procedure included foot manipulation under general anesthesia, sinus tarsi injection with corticosteroids, and a walking cast in the neutral position. Patients were evaluated functionally (using the American Orthopedic Foot and Ankle Society (AOFAS)) and radiologically before the procedure, after cast removal, and 3, 9, and 18 months later with special attention given for recurrence during the follow-up period with a mean duration of 22.5 + 3.5 months. Results: Once general anesthesia had been conducted, the deformity was corrected without any manipulation, and full passive inversion could be easily obtained in 26 feet, the deformity was corrected only after manipulation, and full passive inversion had been obtained in 14 feet, while 10 feet remained stiff even after manipulation. The mean AOFAS score was significantly improved (p < 0.001) from 40.9 + 3.5 at presentation to 73.56 + 5.2 at the last follow-up in which 12 feet was painless and freely mobile and 24 feet had partial relapse, while 14 feet had complete relapse. Conclusion: The nonsurgical treatment for adolescent spasmodic valgus foot could be a simple and effective treatment. Apart from limited complete recurrence, the overall functional outcome was satisfactory. Level of evidence: type IV case series.

Joint preservation surgery for correcting adolescents’ spasmodic flatfoot deformity: early results from a specialized North African foot and ankle unit

“…Todd, in 1939 [ 31 ], reported that 5.7% of individuals with FFD had the unique entity of SFFD; he reported that those were adolescent patients who were involved in laborious work requiring standing for long periods; furthermore, he mentioned that in most of the unilateral cases, a history of foot and ankle trauma was detected, and in bilateral cases, the severity was not equal. Rizk and Kandil [ 17 ] and Blockey [ 13 ] reported that their patients started complaining at 12 to 14 years old after being involved in strenuous activities or having repeated traumas. Furthermore, Pauk and Ezerskiy cautioned about being overweight combined with an increase in physical activities as risk factors for FFD complication progression [ 32 ].…”

“…Regardless of SFFD aetiology, a management plan should be initiated if this condition becomes symptomatic, starting with conservative lines such as physiotherapy, serial casting, and local injections, up to surgical correction in refractory cases [ 17 , 18 ].…”

“…Conservative management, including local sinus tarsi injection, serial casting, stretching exercises, insoles, common peroneal nerve block, and abstaining from sports activities, proved efficacy in some reports [ 12 , 17 , 18 , 26 ]. However, the caveats of these lines are that it mainly depends on the patient’s compliance to the instructions, orthoses might worsen the condition as trying to invert the rigidly everted subtalar joint or dorsiflex a rigidly plantarflexed ankle joint will eventually exacerbate the pain, and the unpredicted rate or recurrence, reaching up to 40% of complete relapse [ 1 , 13 , 17 ]. In the current study, we exhausted conservative management lines (mainly medical and physiotherapy) for at least six months before deciding on surgical management.…”

“…In a study by Rizk and Kandil [ 17 ], including 50 feet with SFFD secondary to peroneal or peroneo-extensor spasm in 33 patients having a mean age of 14 + 2.8 years, they managed all their cases conservatively by manipulation under anaesthesia, local steroid injection to the sinus tarsi, and a walking cast. By a mean last follow-up of 22.5 ± 3.5 months, they reported significant improvement in the AOFAS score from 40.9 + 3.5 at presentation to 73.56 + 5.2 ( P < 0.001); however, they reported that only 12 feet were painless and mobile, and partial or complete relapse occurred in 38 (76%) feet.…”

“…Conservative lines for managing SFFD were reported in the literature [ 17 , 18 ]; even more, surgical interventions, including subtalar and triple arthrodesis, were described [ 19 , 20 ]. However, joint-preserving surgeries (bony osteotomies with or without soft tissue procedures) were rarely described for managing SFFD in adolescents.…”