J Korean Orthop Assoc.  2018 Oct;53(5):407-414. 10.4055/jkoa.2018.53.5.407.

Evaluation of the Outcomes according to Etiology in the Pediatric Pes Planovalgus after Lateral Column Lengthening: By Radiologic and Pedobarographic Measurements

• Lee WG
• Jung ST

• KMID: 2424099
• DOI: http://doi.org/10.4055/jkoa.2018.53.5.407

Abstract

PURPOSE
Pes planovalgus is one of the most common foot deformities among pediatric orthopedic diseases and is divided into idiopathic and neuromuscular planovalgus according to its etiology. This study evaluated the radiologic and pedobarographic outcomes of the treatment for pes planovalgus in children treated with lateral column lengthening, compared the outcomes according to the etiology, and investigated the correlation between the radiologic and pedobarographic findings.
MATERIALS AND METHODS
Sixty-three patients (97 feet), who underwent lateral column lengthening, were divided into groups of 30 patients (47 feet) with neuromuscular disease and 33 patients (50 feet) with idiopathic etiology. The preoperative, immediately postoperative, 1 year, and 3 year follow-up radiographic measurements on the plain radiograph antero-posterior (AP) and lateral view were compared. In pedobarography, the foot pressures were subdivided into 4 areas to measure the contact time, contact area, peak pressure, and maximum force. The pre- and postoperative pedobarographic measurements were compared and the correlations between the radiographic and pedobarographic measurements were evaluated.
RESULTS
The radiographic index at the 1st postoperative year and 3rd postoperative follow-up did not show significant differences according to the etiology. In pedobarography, idiopathic planovalgus showed a significant increase in the maximum force in the hindfoot and forefoot. The correlation between the radiologic findings and pedobarographic findings was statistically significant between the tibiocalcaneal angle in the lateral view and the maximum force, and the contact area of hindfoot on pedobarography, between tibiocalcaneal angle in the lateral view and the contact area of the toes in idiopathic planovalgus. In neuromuscular planovalgus, the peak pressure in the hindfoot had a strong negative correlation with talonavicular coverage angle in the AP view and talo-1st metatarsal angle, and the talohorizontal angle in the lateral view.
CONCLUSION
Lateral column lengthening is an effective surgical procedure for flatfoot patients. On the other hand, the radiographic examination has limitations for accurate assessments of the postoperative results and prognosis. Qualitative and quantitative evaluations are available by pedobarography and it is a useful instrument for an evaluation of planovalgus when used in conjunction with radiography.

Keyword

flexible flatfoot; lateral column lengthening; pedobarography

MeSH Terms

Child
Evaluation Studies as Topic
Flatfoot
Follow-Up Studies
Foot
Foot Deformities
Hand
Humans
Metatarsal Bones
Neuromuscular Diseases
Orthopedics
Prognosis
Radiography
Toes

Figure

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  Figure 1 Radiographic parameters for an evaluation of pes planovalgus. A, talocalcaneal angle; B, talonavicular coverage angle; C, talo-1st metatarsal angle (antero-posterior view); D, talo-1st metatarsal angle (lateral view); E, calcaneal pitch; F, talocalcaneal angle; G, talo-horizontal angle; H, tibiocalcaneal angle.

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