Sakr Samy Abdel-Hady, Zayda Ahmed Ibrahim, Mesregah Mohamed Kamal, Abosalem Ahmed Abdelazim
Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt.
J Orthop Surg Res. 2023 Jun 13;18(1):429. doi: 10.1186/s13018-023-03890-7.
Symptomatic flexible flatfoot in children and adolescents should be surgically managed only if conservative measures have failed. The aim of this study was to assess functional and radiological results of tibialis anterior rerouting combined with calcaneal lengthening osteotomy as s single-stage reconstruction of symptomatic flexible flatfoot.
The current study was a prospective study of patients with symptomatic flexible flatfoot treated by single-stage reconstruction in the form of tibialis anterior tendon rerouting combined with calcaneal lengthening osteotomy. The American Orthopaedic Foot and Ankle Society score (AOFAS) was utilized to evaluate the functional outcomes. The evaluated radiological parameters included the standing anteroposterior (AP) and lateral talo-first metatarsal angle, talar head coverage angle, and calcaneal pitch angle.
The current study included 16 patients (28 feet) with a mean age of 11.6 ± 2.1 years. There was a statistically significant improvement in the mean AOFAS score from 51.6 ± 5.5 preoperatively to 85.3 ± 10.2 at final follow-up. Postoperatively, there was a statistically significant reduction in the mean AP talar head coverage angle from 13.6 ± 4.4° to 3.9 ± 3°, the mean AP talo-first metatarsal angle from 16.9 ± 4.4° to 4.5 ± 3.6°, and the mean lateral talo-first metatarsal angle from 19.2 ± 4.9° to 4.6 ± 3.2°, P < 0.001. Additionally, the mean calcaneal pitch angle increased significantly from 9.6 ± 1.9° to 23.8 ± 4.8°, P < 0.001. Superficial wound infection occurred in three feet and was treated adequately by dressing and antibiotics.
Symptomatic flexible flatfoot in children and adolescents can be treated with combined lateral column lengthening and tibialis anterior rerouting with satisfactory radiological and clinical outcomes. Level of evidence Level IV.
儿童和青少年有症状的柔韧性扁平足，只有在保守治疗失败后才应进行手术治疗。本研究的目的是评估胫骨前肌转位联合跟骨延长截骨术作为有症状柔韧性扁平足的单阶段重建的功能和影像学结果。
本研究是一项前瞻性研究，对有症状的柔韧性扁平足患者采用胫骨前肌腱转位联合跟骨延长截骨术的单阶段重建方式进行治疗。采用美国矫形足踝协会评分（AOFAS）评估功能结果。评估的影像学参数包括站立位前后位（AP）和侧位距骨-第一跖骨角、距骨头覆盖角和跟骨倾斜角。
本研究纳入16例患者（28足），平均年龄11.6±2.1岁。平均AOFAS评分从术前的51.6±5.5显著提高到末次随访时的85.3±10.2。术后，平均AP距骨头覆盖角从13.6±4.4°显著降低至3.9±3°，平均AP距骨-第一跖骨角从16.9±4.4°降低至4.5±3.6°，平均外侧距骨-第一跖骨角从19.2±4.9°降低至4.6±3.2°，P<0.001。此外，平均跟骨倾斜角从9.6±1.9°显著增加至23.8±4.8°，P<0.001。3足发生浅表伤口感染，经换药和抗生素治疗后痊愈。
儿童和青少年有症状的柔韧性扁平足可采用外侧柱延长联合胫骨前肌转位治疗，影像学和临床结果均令人满意。证据级别：IV级。
