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

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.

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.

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%).

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.