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Changes in Gait and Radiographic and Clinical Results of Calcaneal Lengthening Osteotomy in Children with Idiopathic Flexible Flatfoot.
Clin Orthop Surg. 2020 Sep; 12(3):386-395.CO

Abstract

Backgroud

In this study, we aimed to analyze kinematic and kinetic changes in gait and to assess radiographic and clinical improvement after calcaneal lengthening osteotomy (CLO) in children with idiopathic symptomatic flexible flatfoot deformities.

Methods

The study group consisted of 22 children (28 feet) with idiopathic symptomatic flexible flatfoot, which was treated by CLO as an index operation. We excluded patients with flatfoot that developed secondary to neuromuscular diseases. There were 18 boys (22 feet) and 4 girls (6 feet). The average age of the patients was 10.8 ± 1.51 years. Surgical results were assessed by radiologic imaging, clinical evaluation, and gait analysis, which were performed before surgery and 1 year after surgery. Medical records were reviewed to check postoperative complications.

Results

Talonavicular coverage was recovered to 16.7° from 32.7° (p < 0.01). Lateral talo-first metatarsal angle and calcaneal pitch angle increased by 20.1° and 9.9°, respectively (p < 0.01). Weight-bearing radiographs demonstrated a decrease in the anteroposterior angle and lateral talocalcaneal angle by 6.9° and 10°, respectively (p < 0.01). Hindfoot valgus was corrected to near neutral position after CLO. Kinematic results showed that the ankle valgus angle in the coronal plane was reduced from 35.48° preoperatively to 16.64° postoperatively during gait (p < 0.05). The preoperative out-toeing gait (preoperative foot progression angle, 20.31°) was also normalized to 14.21° postoperatively. The kinetics results showed that the push-off moment (maximum ankle plantar flexion) on the sagittal plane increased from 0.66 Nm/kg preoperatively to 0.83 Nm/kg postoperatively (p < 0.01). The mean Yoo score was 9.2 ± 1.05 postoperatively: satisfactory in 24 cases (86%) and unsatisfactory in 4 cases. Of the 4 unsatisfactory cases, 2 cases were overcorrection and 2 cases were undercorrection, and 3 of them were well managed by wedge foot insoles.

Conclusions

The 3-dimensional deformities of the flexible flatfoot were effectively corrected by CLO, based on the morphological assessment using radiologic imaging. The correction was well maintained during gait at 1 year after the operation.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea.Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32904106

Citation

Kim, Ha Yong, et al. "Changes in Gait and Radiographic and Clinical Results of Calcaneal Lengthening Osteotomy in Children With Idiopathic Flexible Flatfoot." Clinics in Orthopedic Surgery, vol. 12, no. 3, 2020, pp. 386-395.
Kim HY, Cha YH, Lee JS, et al. Changes in Gait and Radiographic and Clinical Results of Calcaneal Lengthening Osteotomy in Children with Idiopathic Flexible Flatfoot. Clin Orthop Surg. 2020;12(3):386-395.
Kim, H. Y., Cha, Y. H., Lee, J. S., Kil, K. M., & Choy, W. S. (2020). Changes in Gait and Radiographic and Clinical Results of Calcaneal Lengthening Osteotomy in Children with Idiopathic Flexible Flatfoot. Clinics in Orthopedic Surgery, 12(3), 386-395. https://doi.org/10.4055/cios19150
Kim HY, et al. Changes in Gait and Radiographic and Clinical Results of Calcaneal Lengthening Osteotomy in Children With Idiopathic Flexible Flatfoot. Clin Orthop Surg. 2020;12(3):386-395. PubMed PMID: 32904106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in Gait and Radiographic and Clinical Results of Calcaneal Lengthening Osteotomy in Children with Idiopathic Flexible Flatfoot. AU - Kim,Ha Yong, AU - Cha,Yong Han, AU - Lee,Jong Shin, AU - Kil,Kyung-Min, AU - Choy,Won Sik, Y1 - 2020/06/03/ PY - 2019/10/25/received PY - 2020/01/13/accepted PY - 2020/9/9/entrez PY - 2020/9/10/pubmed PY - 2021/1/1/medline KW - Calcaneal lengthening osteotomy KW - Gait analysis KW - Idiopathic flexible flatfoot KW - Kinematics KW - Kinetics SP - 386 EP - 395 JF - Clinics in orthopedic surgery JO - Clin Orthop Surg VL - 12 IS - 3 N2 - Backgroud: In this study, we aimed to analyze kinematic and kinetic changes in gait and to assess radiographic and clinical improvement after calcaneal lengthening osteotomy (CLO) in children with idiopathic symptomatic flexible flatfoot deformities. Methods: The study group consisted of 22 children (28 feet) with idiopathic symptomatic flexible flatfoot, which was treated by CLO as an index operation. We excluded patients with flatfoot that developed secondary to neuromuscular diseases. There were 18 boys (22 feet) and 4 girls (6 feet). The average age of the patients was 10.8 ± 1.51 years. Surgical results were assessed by radiologic imaging, clinical evaluation, and gait analysis, which were performed before surgery and 1 year after surgery. Medical records were reviewed to check postoperative complications. Results: Talonavicular coverage was recovered to 16.7° from 32.7° (p < 0.01). Lateral talo-first metatarsal angle and calcaneal pitch angle increased by 20.1° and 9.9°, respectively (p < 0.01). Weight-bearing radiographs demonstrated a decrease in the anteroposterior angle and lateral talocalcaneal angle by 6.9° and 10°, respectively (p < 0.01). Hindfoot valgus was corrected to near neutral position after CLO. Kinematic results showed that the ankle valgus angle in the coronal plane was reduced from 35.48° preoperatively to 16.64° postoperatively during gait (p < 0.05). The preoperative out-toeing gait (preoperative foot progression angle, 20.31°) was also normalized to 14.21° postoperatively. The kinetics results showed that the push-off moment (maximum ankle plantar flexion) on the sagittal plane increased from 0.66 Nm/kg preoperatively to 0.83 Nm/kg postoperatively (p < 0.01). The mean Yoo score was 9.2 ± 1.05 postoperatively: satisfactory in 24 cases (86%) and unsatisfactory in 4 cases. Of the 4 unsatisfactory cases, 2 cases were overcorrection and 2 cases were undercorrection, and 3 of them were well managed by wedge foot insoles. Conclusions: The 3-dimensional deformities of the flexible flatfoot were effectively corrected by CLO, based on the morphological assessment using radiologic imaging. The correction was well maintained during gait at 1 year after the operation. SN - 2005-4408 UR - https://www.unboundmedicine.com/medline/citation/32904106/Changes_in_Gait_and_Radiographic_and_Clinical_Results_of_Calcaneal_Lengthening_Osteotomy_in_Children_with_Idiopathic_Flexible_Flatfoot_ L2 - https://www.ecios.org/DOIx.php?id=10.4055/cios19150 DB - PRIME DP - Unbound Medicine ER -