Surgery and Trauma Research Center, AJA University of Medical Science, Iran.
Center for Orthopedic Trans-disciplinary Applied Research, Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Foot (Edinb). 2023 Dec;57:101962. doi: 10.1016/j.foot.2023.101962. Epub 2023 Jan 16.
Calcaneal Lengthening Osteotomy is a surgical technique to correct flexible flat foot deformities in patients who did not show any change in their symptoms after conservative treatment. In this study, the effects of CLO on the kinematic and kinetic changes of gait was analyzed and the clinical and quality of life improvements in children treated by CLO for moderate to severe symptomatic flexible flat foot deformities were assessed.
Participants were seven adolescents (13 feet) with symptomatic FFF who underwent during 2019-2022 and seven (10 feet) healthy children as control group. Three items were evaluated in each foot before and after surgery including: 1. Clinical examination 2.quality of life (using Pediatric Quality of Life Inventory version 4 questionnaire) 3. Gait analysis (Vicon motion systems, Oxford metrics Inc., UK). Also, the kinetic and kinematic analysis between patients and healthy groups were compared.
Kinematic results of control was significantly better than FFF group. Ankle range of motion(32.94 ± 13.39 compared to 32.94 ± 13.39,P-Value:0.01),foot progression angle (-9.26 ± 7.67 compared to -16.07 ± 9.00,P-Value:0.01),and internal rotation of ankle was higher in control group compared to FFF. FFF patients demonstrated improvement in kinematic results after CLO surgery. Foot progression angle was improved after surgery (-11.31 ± 6.07 compared to -16.19 ± 7.06, P-value:0.00), maximum plantar flexion decreased after CLO surgery due to achil tendon procedure during CLO surgery. Kinetic results of FFF patients showed significant increase in ankle Power in coronal and transverse plane, Also knee and hip power showed similar results.Quality of life parameters showed significant improve in all parameters (Physical,Social, emotional and school function), Also ADKE and ADKF improved after surgery.
CLO surgery significantly improved patients' quality of life of patients with symptomatic FFF. Also, kinetic results showed improvement in some parameters of gait results after CLO surgery. Thus, our study suggested CLO surgery as an excellent surgical option for symptomatic FFF.
跟骨延长截骨术是一种用于治疗经保守治疗后症状无改善的柔韧性平足畸形的手术技术。本研究分析了 CLO 对步态运动学和动力学变化的影响，并评估了 CLO 治疗中重度症状性柔韧性平足畸形儿童的临床和生活质量改善情况。
参与者为 2019-2022 年期间接受手术的 7 名（13 足）有症状的 FFF 青少年和 7 名（10 足）健康儿童作为对照组。每只脚在手术前后评估 3 项内容，包括：1.临床检查，2.生活质量（使用儿童生活质量问卷第 4 版），3.步态分析（Vicon 运动系统，牛津度量公司，英国）。此外，还比较了患者组和健康组之间的动力学和运动学分析。
对照组的运动学结果明显优于 FFF 组。踝关节活动范围（32.94±13.39 与 32.94±13.39，P 值：0.01）、足前进角（-9.26±7.67 与-16.07±9.00，P 值：0.01）和踝关节内旋在对照组中高于 FFF 组。FFP 患者 CLO 手术后运动学结果得到改善。手术后足前进角改善（-11.31±6.07 与-16.19±7.06，P 值：0.00），由于 CLO 手术中跟腱手术，CLO 手术后最大跖屈度降低。FFP 患者的动力学结果显示，冠状面和横面的踝关节功率显著增加，膝关节和髋关节的功率也显示出类似的结果。所有参数（身体、社会、情感和学校功能）的生活质量参数均显著改善，ADKE 和 ADKF 手术后也得到改善。
CLO 手术可显著改善有症状的 FFF 患者的生活质量。此外，CLO 手术后，步态结果的一些动力学参数也有所改善。因此，我们的研究表明 CLO 手术是治疗有症状的 FFF 的一种优秀手术选择。
