Percutaneous minimal invasive Achilles tendon lengthening improves clinical and radiographic outcomes in severe flexible flatfeet with shortened triceps sureae complex in early childhood: A retrospective study |
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| Institution: | 1. Department of Pediatric Orthopaedics, Schulthess Klinik, Zürich, Switzerland;2. Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland;1. Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan;2. Department of Physical Therapy, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan;1. Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada; Division of Pediatric Orthopaedic Surgery, Department of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada;2. Shriners Hospital for Children, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada;1. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA;2. Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC, USA;3. Departmnt of Orthopaedic Surgery, Loyola University Medical Center, Burr Ridge, IL, USA;4. Department of Traumatology and Orthopedics, University of the Andes Clinic, Las Condes, Chile |
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| Abstract: | BackgroundSevere flexible flatfeet with triceps surae complex shortening are prognostically unfavorable in early childhood and may compromise normal foot development.MethodsThis retrospective, IRB-approved study included 20 children (38 feet) under 6 years with severe flexible flatfeet and triceps surae complex shortening. Treatment included minimally invasive percutaneous achilles tendon lengthening followed by a 4-week cast fixation and corrective orthotic therapy under talo-navicular reposition for at least 6-months. Preoperative weightbearing x-rays and at the last available follow-up included anteroposterior talus-first metatarsal angle and lateral talus pitch, Meary’s and talocalcaneal angle and were compared to reference values. ROM, surgeon-rated clinical outcomes and complications/re-interventions were evaluated.ResultsAge at surgery was 3.7 years (1.3–5.9 y) and follow-up time was 4.3 years (1.1–8.9 y). No complications occurred. Clinical outcome was good (68 %) to very good (26 %). Ratio of normal angles increased significantly for three angles. Dorsiflexion ROM improved from ?5.0 ± 6.8° at baseline to 15.7 ± 7.6°.ConclusionsWith significant improvements in clinical and radiographic outcomes, minimal-invasive percutaneous Achilles tendon lengthening followed by orthotic therapy seems to be a valuable treatment option for selected preschool-aged patients with severe, flexible flatfeet with significantly shortened triceps surae.Level of EvidenceIV |
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| Keywords: | Flatfeet Preschool children Achilles tendon lengthening Shortened triceps surae Minimally invasive flexible flat feet FFF ATL triceps surae complex percutaneous lengthening |
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