De Pellegrin Maurizio, Marcucci Lorenzo, Brogioni Lorenzo, Fracassetti Dario
Piccole Figlie Hospital, Parma, Italy.
Azienda Ospedaliera Universitaria Integrata Verona Sede di Borgo Trento, Verona, Italy.
Foot Ankle Orthop. 2024 Mar 21;9(1):24730114241233598. doi: 10.1177/24730114241233598. eCollection 2024 Jan.
Calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions are the most common cause of rigid flatfoot in children. After resection, correction of the most frequent valgus-hindfoot deformity usually requires a second-step surgery. We report results of a retrospective study of patients treated with a one-step correction.
Between 2008 and 2019, data were collected on 26 patients (19 male, 7 female) affected by CNC (n = 18) and TCC (n = 13), all with rigid symptomatic flatfeet. Average age at surgery was 12.5 ± 1.1 (SD) years (range, 9.8-15.2). All patients (26/26) underwent resection, 20 of 26 underwent at the same time subtalar extraarticular screw arthroereisis (SESA) for correction of residual hindfoot valgus deformity. Pre- and postoperative talocalcaneal angle according to Costa Bartani and Talar inclination angle in weightbearing were measured. Twenty-five of 26 patients had postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score.
Pre- and postoperative talocalcaneal average angle for CNC was respectively 141.5 ± 7.7 degrees and 130.5 ± 5.2 degrees ( < .0001) and 143.7 ± 7.7 degrees and 129.7 ± 7.0 degrees ( < .0001) for TCC. Talar inclination average angle for CNC was 29.2 ± 5.3 degrees and 19.3 ± 1.6 degrees ( < .0001) and 31.2 ± 6.4 degrees and 21.4 ± 3.4 degrees ( < .0001) for TCC. Average follow-up (FU) was 4.7 ± 3.0 years (range, 6 months-11.9 years, median 4.9 years), with a mean age at FU of 17.2 ± 5.8 (SD) years (min 12.1, max 25.3, median 16.8 years). The mean AOFAS ankle-hindfoot score for CNC and for TCC was 96.6 (range 83-100) for resection and valgus correction as one-step procedure with no statistical difference ( = .5) between CNC and TCC. No patients had additional surgery for complications or recurrence.
Symptomatic rigid flatfeet affected by CNC and TCC treated with coalition resection and minimally invasive subtalar arthroereisis (SESA) for residual hindfoot valgus correction in one step in adolescent age achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided.
Level IV, retrospective study.
跟舟（CNC）和距跟（TCC）联合是儿童僵硬扁平足最常见的原因。切除术后，矫正最常见的外翻后足畸形通常需要二期手术。我们报告了一项对接受一步矫正治疗的患者的回顾性研究结果。
2008年至2019年期间，收集了26例患者（19例男性，7例女性）的数据，这些患者患有CNC（n = 18）和TCC（n = 13），均为有症状的僵硬扁平足。手术平均年龄为12.5±1.1（标准差）岁（范围9.8 - 15.2岁）。所有患者（26/26）均接受了切除术，26例中的20例同时接受了距下关节外螺钉关节成形术（SESA）以矫正残留的后足外翻畸形。测量了根据科斯塔·巴尔塔尼法的术前和术后距跟角以及负重时的距骨倾斜角。26例患者中的25例有术后美国矫形足踝协会（AOFAS）踝 - 后足评分。
CNC的术前和术后距跟平均角度分别为141.5±7.7度和130.5±5.2度（P <.0001），TCC的分别为143.7±7.7度和129.7±7.0度（P <.0001）。CNC的距骨倾斜平均角度为29.2±5.3度和19.3±1.6度（P <.0001），TCC的分别为31.2±6.4度和21.4±3.4度（P <.0001）。平均随访（FU）为4.7±3.0年（范围6个月 - 11.9年，中位数4.9年），随访时的平均年龄为17.2±5.8（标准差）岁（最小12.1岁，最大25.3岁，中位数16.8岁）。作为一步手术进行切除和外翻矫正时，CNC和TCC的平均AOFAS踝 - 后足评分为96.6（范围83 - 100），CNC和TCC之间无统计学差异（P =.5）。没有患者因并发症或复发而进行额外手术。
青少年时期，对受CNC和TCC影响的有症状僵硬扁平足采用联合切除及微创距下关节成形术（SESA）一步矫正残留后足外翻，所有病例均取得了良好至优异的效果。避免了进一步的手术来矫正畸形。
IV级，回顾性研究。
