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 r… Show more
“…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.…”
Section: Discussionsupporting
confidence: 91%
“…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.…”
Introduction:
Flexible flatfoot (FF) is a common pediatric condition that is mostly asymptomatic, and surgical intervention is only considered when painful FF is refractory to conservative treatment. Calcaneal lengthening osteotomy (CLO) is one of the most commonly used procedures to address painful FF. Traditionally, Kirschner wires (K-wires) were used for fixation, but there has been a recent increase in the use of plates. We compared the clinical and radiographic outcomes of these 2 fixation methods.
Methods:
This single-center retrospective study included children aged 8 to 18 years with symptomatic FF that received CLO using K-wire or plate fixation. Primary outcomes include weight-bearing radiographic measurements and complications after surgery. Secondary outcomes included patient-reported outcomes. Statistical significance was held at 0.05.
Results:
Among 102 feet (65 patients), 42 feet (41.2%) underwent K-wire and 60 feet (58.8%) underwent plate fixation. No differences in casting duration (P=0.525) and time-to-radiographic healing (P=0.17) were noted. Total complications were higher in the plate cohort (12 vs. 2, P=0.04) due to a higher rate of reoperations (16.7%) for hardware-related pain [10 vs. 0; odds ratio 17.74, 95% CI (1.01, 310.54), P<0.05], and infection rates were similar. Both interventions significantly improved (P ≤ 0.001) aneteroposterior (AP) Talo-first metatarsal and calcaneal pitch angles. Irrespective of intervention, CLO significantly improved pain at 6 months and mobility scores at 12 months. Neither modality demonstrated superior pain or mobility scores at final follow-up.
Conclusion:
Both K-wire and plate fixations lead to similar radiographic and functional outcomes after CLO in painful, pediatric flatfeet. Compared with K-wire fixation, plates cause a 17.7-fold increased risk of reoperations for painful hardware, with 16.7% of plated cases requiring reoperation. Noting this, along with the higher costs associated with using plates, our study advocates for K-wire fixation for children undergoing CLO.
Level of Evidence:
Level III
“…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.…”
Section: Discussionsupporting
confidence: 91%
“…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.…”
Introduction:
Flexible flatfoot (FF) is a common pediatric condition that is mostly asymptomatic, and surgical intervention is only considered when painful FF is refractory to conservative treatment. Calcaneal lengthening osteotomy (CLO) is one of the most commonly used procedures to address painful FF. Traditionally, Kirschner wires (K-wires) were used for fixation, but there has been a recent increase in the use of plates. We compared the clinical and radiographic outcomes of these 2 fixation methods.
Methods:
This single-center retrospective study included children aged 8 to 18 years with symptomatic FF that received CLO using K-wire or plate fixation. Primary outcomes include weight-bearing radiographic measurements and complications after surgery. Secondary outcomes included patient-reported outcomes. Statistical significance was held at 0.05.
Results:
Among 102 feet (65 patients), 42 feet (41.2%) underwent K-wire and 60 feet (58.8%) underwent plate fixation. No differences in casting duration (P=0.525) and time-to-radiographic healing (P=0.17) were noted. Total complications were higher in the plate cohort (12 vs. 2, P=0.04) due to a higher rate of reoperations (16.7%) for hardware-related pain [10 vs. 0; odds ratio 17.74, 95% CI (1.01, 310.54), P<0.05], and infection rates were similar. Both interventions significantly improved (P ≤ 0.001) aneteroposterior (AP) Talo-first metatarsal and calcaneal pitch angles. Irrespective of intervention, CLO significantly improved pain at 6 months and mobility scores at 12 months. Neither modality demonstrated superior pain or mobility scores at final follow-up.
Conclusion:
Both K-wire and plate fixations lead to similar radiographic and functional outcomes after CLO in painful, pediatric flatfeet. Compared with K-wire fixation, plates cause a 17.7-fold increased risk of reoperations for painful hardware, with 16.7% of plated cases requiring reoperation. Noting this, along with the higher costs associated with using plates, our study advocates for K-wire fixation for children undergoing CLO.
Level of Evidence:
Level III
“…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.…”
Section: оригінальні дослідження ортопедіяmentioning
The main cause of heel foot is muscle imbalance due to dysfunction of the triceps femoris muscle. Literature data indicate the need to study issues related to changes in the anatomy and function of the foot flexor muscles and calcaneus and to determine indications for optimal methods of correction of heel foot. Purpose - to study the anatomical and functional changes in the calf muscle and bones in children with heel foot to determine the optimal methods of diagnosis and correction of deformity. Materials and methods. We analysed the results obtained during the treatment of 14 patients (28 cases) aged 11 to 17 years with cerebral palsy complicated by calcaneal foot formation. Two groups were formed: the main group of 6 patients (12 cases), in which posterior calcaneal osteotomy with Achilles tendon plasty and transposition of the tibialis anterior tendon was performed; the comparison group of 8 patients (16 cases), in which only soft tissue surgery was performed. The comparative group was divided into 2 subgroups, which differed in radiological parameters of Bohler and Kite Danilov angles: the subgroup A - 3 patients (6 cases), the subgroup B - 5 patients (10 cases). Clinical and radiological methods were used to examine patients. Results. The structure and shape of the calcaneus change in the presence of heel foot, which leads to changes in the Danilov angle and the angles between the trabecular lines. Correction of the shape of the calcaneus is a prerequisite for creating optimal biomechanical gait conditions. Transplantation of the tibialis anterior tendon eliminates the pathological effect of its retraction; achilloplasty eliminates the functional deficiency of the triceps tendon. Conclusions. The results of surgical correction on soft tissues showed effectiveness at Bohler, Kite <35⁰, Danilov <40⁰ angles. At higher values, it is necessary to supplement the intervention with a posterior calcaneal osteotomy. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committees of all institutions participating in the study. Informed consent was obtained from the patients. No conflict of interests was declared by the authors.
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