Medium term outcomes of planovalgus foot correction in children using a lateral column lengthening approach with additional procedures ‘a la carte’

• Published in: Foot and ankle surgery 2014-03, Vol.20 (1), p.26-29
• Main Authors: Akimau, Pavel, MD, PhD, MRCSEd, Flowers, Mark, MBBS, FRCS(Orth)
• Format: Article
• Language: English
• Subjects: Adolescent; Bone Lengthening; Bone Transplantation; Child; Child, Preschool; Children; Column; Deformity; Female; Flatfoot - surgery; Foot Deformities - surgery; Humans; Lateral; Male; Orthopedics; Osteotomy; Planovalgus; Treatment Outcome
• ISSN: 1268-7731; 1460-9584
• DOI: 10.1016/j.fas.2013.08.005

Abstract Background We report our medium term outcomes following surgery for symptomatic planovalgus malalignment in children. The technique we describe commences with lateral column lengthening and includes subsequent bony and soft tissue procedures which are carried out ‘a la carte’ in response to the underlying pathology and the behaviour of the foot to the lateral column lengthening. Methods Surgery was undertaken on twenty five symptomatic planovalgus feet in 15 patients at a mean age of 12 years and 6 months (5 years 7 months to 16 years and 3 months). The case-mix was principally idiopathic pes planovalgus but included overcorrected club foot and skewfoot deformity. Following lateral column lengthening (using a tricortical interpositional os calcis bone graft) the ‘a la carte’ elements of the surgery undertaken included both bony and soft tissue elements: heel shift; medial cuneiform osteotomy with iliac crest tricortical bone grafting, peroneus brevis/peroneus longus transfer; plantar fascia release; tibialis posterior advancement. VAS FA and AOFAS scores, clinical findings and complications were recorded. Results Twelve patients (20 feet) were available for follow up at a mean of 4 years and 6 months years (2 years and 8 months to 6 years and 3 months). VAS FA and AOFAS scores were 82 ± 17 (50–99), 87 ± 14 (61–100) and 80 ± 10 (62–100), respectively. In all patients the reconstituted medial arch was maintained. Three patients (5 feet) required a second corrective procedure. Conclusion We propose lateral column lengthening with additional ‘a la carte’ procedures in the surgical treatment of symptomatic pes planovalgus in childhood as a reliable corrective surgical procedure on the basis of favourable medium term functional outcomes.