J Korean Orthop Assoc.  2010 Oct;45(5):363-372.

Surgical Treatment for Planovalgus Foot in Children with Generalized Ligamentous Laxity

• Hwang BH
• Lee KS
• Kim HW

Abstract

PURPOSE
Planovalgus deformity in children with generalized ligamentous laxity is usually asymptomatic, but it sometimes causes severe deformity and functional problems. The aim of this study was to evaluate, post-operatively, functional outcomes, plantar pressure and radiographic results of symptomatic planovalgus with generalized ligamentous laxity. MATERIALS AND
METHODS
This retrospective study included a total of 42 feet of 24 patients that had undergone a calcaneal lengthening osteotomy or an extra-articular subtalar arthrodesis. The mean age of the patients at the time of the index operation was 10.5 years (range, 6-15.6 years), and the mean duration of follow-up was 51 months (range, 18-92 months). Patients were evaluated clinically and radiographically using the Oxford Ankle Foot Questionnaire, AOFAS score, Mosca criteria, standard radiographs and dynamic pedobarographs.
RESULTS
Functional outcomes at the latest available follow-up were excellent except for three feet. No foot had a significant limitation affecting the patient's daily activities. Both surgical treatments improved radiographic parameters. The parameters of dynamic pedobarographs, including the relative vertical impulse and the peak pressure, decreased for the medial aspect of the forefoot and midfoot, while they increased for the lateral aspect of the forefoot, midfoot and calcaneus after surgical treatment. The change in the center of pressure indicated a significant lateral shift in the weight-bearing surface of the foot.
CONCLUSION
Calcaneal lengthening osteotomy and extra-articular subtalar arthrodesis appear to be effective means for pain relief and clinical improvement in children with symptomatic planovalgus deformity and generalized ligamentous laxity. Further follow-up evaluation is needed to obtain long-term clinical and radiographic results with regard to skeletal maturation and changes in generalized ligamentous laxity.

Keyword

planovalgus deformity; generalized ligamentous laxity; calcaneal lengthening osteotomy; extra-articular subtalar arthrodesis

MeSH Terms

Animals
Ankle
Arthrodesis
Calcaneus
Child
Congenital Abnormalities
Follow-Up Studies
Foot
Humans
Ligaments
Osteotomy
Surveys and Questionnaires
Retrospective Studies
Weight-Bearing

Figure

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  Figure 1 (A) Anteroposterior talo-1st metatarsal angle. (B) Anteroposterior talocalcaneal angle. (C) Lateral talo-1st metatarsal angle. (D) Lateral talocalcaneal angle. (E) Calcaneal pitch.

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  Figure 2 (A) A ten-year-old girl underwent calcaneal lengthening osteotomy 5 years ago. Although radiographs of the left foot show acceptable findings, those of the right foot show loss of reduction and increased anteroposterior and lateral talo-1st metatarsal angle. (B) These radiographs show the decreased anteroposterior and lateral talo-1st metatarsal angle and improved alignment after extra-articular subtalar arthrodesis for the right foot. (C) Although the clinical scores were not excellent, clinical photographs of the patient show acceptable appearances.

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