Abstract
Background
Lateral column lengthening combining bony and soft tissue procedures has been described for symptom relief and deformity correction in the planovalgus foot. There are relatively few reports on its outcomes in childhood. We present our medium term outcomes using this technique in children.
Methods
Twenty-five symptomatic mobile planovalgus feet in fifteen patients were operated upon between 2005 and 2008. The mean age at surgery was 12 years 6 months. Ten patients had idiopathic pes planovalgus, two had overcorrected congenital talipes equinovarus, and one had skewfoot deformity. The surgery included one or more bony elements - lengthening calcaneal osteotomy, heel shift, medial cuneiform osteotomy - iliac crest tricortical bone graft harvest and one or more soft tissue procedures - peroneus brevis/peroneus longus transfer, plantar fascia release and tibialis posterior advancement. The extent of surgery was decided per-operatively in an a la carte fashion. The Visual Analogue Score for Foot and Ankle (VAS FA) and American Foot and Ankle Association (AOFAS) ankle-hindfoot and midfoot scores were measured. Clinical findings and complications were recorded.
Results
Twenty feet in twelve patients were available for follow up at a mean post-operative interval of 4 years 6 months. The mean VAS FA, AOFAS ankle-hindfoot and midfoot scores were 82 ± 17, 87 ± 14 and 80 ± 10 respectively. In all patients the medial arch was restored. One patient required bilateral lateral column shortening and medial cuneiform osteotomy to address overcorrection and supination, one had bilateral calcaneal screw removal and one had a subsequent heel shift.
Conclusions
A la carte lateral column lengthening combining bony and soft tissue procedures for the symptomatic planovalgus foot is a powerful technique. We have shown satisfactory functional medium term outcomes with this surgery, and believe it can be used in childhood for symptomatic planovalgus foot deformity correction.
