Evaluation of Clinical and Radiological Results of Calcaneal Lengthening Osteotomy in Pediatric Idiopathic Flexible Flatfoot

Background: Flexible idiopathic flatfoot is the most common form of flatfoot. First line treatments are parental reassurance and conservative measures; however, surgical treatment may be needed in some cases. A number of surgical techniques with varying results have been described in the literature. Here, we present our clinical and radiological outcomes of calcaneal lengthening osteotomy for pediatric idiopathic flexible flatfoot. Methods: Calcaneal lengthening osteotomy was performed in 20 patients, 30 feet, with idiopathic flexible flatfoot that were resistant to conservative treatment between 2007 and 2011. Patients were evaluated according to ACFAS universal evaluation scoring scale and radiographic indexes. The mean follow up duration was 23.1 ± 9.9 months. Results: The average age was 10.4 ± 0.9 years. Achilles tendon lengthening was performed in 28 feet. ACFAS score at the final follow up had improved significantly compared to pre-operative score (37 to 88, P<0.0001). Radiographic parameters also showed significant improvement after surgery ((P<0.0001)). Distal segment displacement and hardware irritation as postop complications were observed in 2 and 3 cases, respectively, with no long-term clinical impact. Conclusion: Calcaneal lengthening osteotomy is an appropriate and safe operation in symptomatic idiopathic flexible flat foot that is resistant to conservative treatment. Level of evidence: IV