Flatfoot Reconstruction for Painful Pediatric Idiopathic Flexible Flatfoot: Prospective Study Demonstrates Improved Alignment, Function, and Patient-reported Outcomes.
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
25 Dec 2023
25 Dec 2023
Historique:
medline:
25
12
2023
pubmed:
25
12
2023
entrez:
25
12
2023
Statut:
aheadofprint
Résumé
This prospective study was undertaken to report outcomes following reconstructive surgery for patients with painful pediatric idiopathic flexible flatfoot. Twenty-five patients with pediatric idiopathic flexible flatfoot were evaluated pre- and post- flatfoot reconstruction with lateral column lengthening (LCL). All patients had lengthening of the Achilles or gastrocnemius, while 13 patients had medial side soft tissue (MSST) procedures, 7 underwent medial cuneiform plantarflexion osteotomy (MCPO), and 5 had medializing calcaneal osteotomy. Measures of static foot alignment-both radiographic parameters and clinical arch height indices-were compared, as were measures of dynamic foot alignment and loading, including arch height flexibility and pedobarography. Preoperative and postoperative patient-reported outcome (PRO) scores were compared between those treated with or without MSST procedures. The median subject age was 13.8 years (range: 10.3 to 16.5) at the time of surgery. All radiographic parameters improved with surgery (P<0.001). The mean sitting arch height index showed a modest increase after surgery (P=0.023). Arch height flexibility was similar after surgery. The mean center-of-pressure excursion index increased from 14.1% to 24.0% (P<0.001), and the mean first metatarsal head (MH) peak pressure dropped (P<0.001), while the mean fifth MH peak pressure increased (P=0.018). The ratio of peak pressure in the fifth MH to peak pressure in the second MH increased (P=0.010). The ratio of peak pressure in the first MH to peak pressure in the second MH decreased when an MCPO was not used (P<0.002), but it remained stable when an MCPO was included. Mean scores in all PRO domains improved (P<0.001). Patients treated without MSST procedures showed no difference in PROMIS Pain Interference scores compared to those without MSST procedures. Flatfoot reconstruction surgery using an LCL with plantarflexor lengthening results in improved PROs. LCL changes but does not normalize the distribution of MH pressure loading. The addition of an MCPO can prevent a significant reduction in load-sharing by the first MH.
Sections du résumé
BACKGROUND
BACKGROUND
This prospective study was undertaken to report outcomes following reconstructive surgery for patients with painful pediatric idiopathic flexible flatfoot.
METHODS
METHODS
Twenty-five patients with pediatric idiopathic flexible flatfoot were evaluated pre- and post- flatfoot reconstruction with lateral column lengthening (LCL). All patients had lengthening of the Achilles or gastrocnemius, while 13 patients had medial side soft tissue (MSST) procedures, 7 underwent medial cuneiform plantarflexion osteotomy (MCPO), and 5 had medializing calcaneal osteotomy. Measures of static foot alignment-both radiographic parameters and clinical arch height indices-were compared, as were measures of dynamic foot alignment and loading, including arch height flexibility and pedobarography. Preoperative and postoperative patient-reported outcome (PRO) scores were compared between those treated with or without MSST procedures.
RESULTS
RESULTS
The median subject age was 13.8 years (range: 10.3 to 16.5) at the time of surgery. All radiographic parameters improved with surgery (P<0.001). The mean sitting arch height index showed a modest increase after surgery (P=0.023). Arch height flexibility was similar after surgery. The mean center-of-pressure excursion index increased from 14.1% to 24.0% (P<0.001), and the mean first metatarsal head (MH) peak pressure dropped (P<0.001), while the mean fifth MH peak pressure increased (P=0.018). The ratio of peak pressure in the fifth MH to peak pressure in the second MH increased (P=0.010). The ratio of peak pressure in the first MH to peak pressure in the second MH decreased when an MCPO was not used (P<0.002), but it remained stable when an MCPO was included. Mean scores in all PRO domains improved (P<0.001). Patients treated without MSST procedures showed no difference in PROMIS Pain Interference scores compared to those without MSST procedures.
CONCLUSIONS
CONCLUSIONS
Flatfoot reconstruction surgery using an LCL with plantarflexor lengthening results in improved PROs. LCL changes but does not normalize the distribution of MH pressure loading. The addition of an MCPO can prevent a significant reduction in load-sharing by the first MH.
Identifiants
pubmed: 38145389
doi: 10.1097/BPO.0000000000002603
pii: 01241398-990000000-00455
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
D.M.S.: paid consultant for Bionic Power; POSNA Board/Committee member. M.S.C.: AOFAS Board/Committee member. H.J.H.: research support from Moximed, Novel Electronics, and Sports Engineering Institute. J.B.: paid consultant for Orthopaediatrics and Wishbone. E.D.: HSS Journal editorial board; JAAOS editorial board; IHDI Board/Committee member; POSNA Board/Committee member. The remaining authors declare no conflicts of interest.
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