Arthroereisis Versus Lateral Column Lengthening in the Treatment of Planovalgus Feet
Condition: Flatfeet
MeSH terms: Flatfoot
Study type: Observational

Summary: 
      There is no consensus on the surgical treatment of unremitting, painful flatfeet in children.
      Subtalar arthroereisis has gained notoriety although there is a paucity of literature on its
      biomechanical effects. The goal of the investigators was to compare a group treated with
      subtalar arthroereisis with another group undergoing lateral column calcaneal lengthening.
      The investigators hypothesis was that the results of arthroereisis would be equivalent to the
      more established method of calcaneal lengthening.
    

Detailed description: 
      The purpose of this prospective, non-randomized study was to evaluate two different surgical
      treatments for symptomatic planovalgus feet: lateral column lengthening osteotomy and
      subtalar arthroereisis. The goal of the investigators was to compare the outcomes of these
      two surgeries and determine whether both treatments resulted in clinical improvement. This
      was accomplished through the use of pre- and post-operative kinematics, pedobarography,
      radiographic measurements, and validated outcome measures. The investigators were
      particularly interested in analyzing the kinematic changes to quantify the changes in the
      foot mobility and alignment during ambulation, as it has not been previously studied to our
      knowledge. The investigators hypothesis was that both procedures would show significant
      improvement and be equivalent in their results.

      A prospective trial was conducted. The investigators enrolled fifteen patients (mean age
      12.8y, 24 feet) with painful, planovalgus feet refractory to conservative treatment. Seven
      patients (13 feet) were enrolled in the arthroereisis group, and eight patients (11 feet)
      were enrolled in the calcaneal lengthening group. Though not specifically excluded, none of
      the enrolled patients had an underlying neuromuscular diagnosis. Kinematic motion analysis
      was performed on each patient prior to surgery and at one year of follow-up. Pedobarometry
      studies, radiographs, and validated outcome questionnaires (Oxford Ankle-Foot Questionnaire
      for Children) were also performed to evaluate the outcomes of both groups.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patient ages ranged from 7 to 17 (mean 12.8y) at the time of surgery. Inclusion criteria
        were patients with planovalgus deformity, painful symptoms refractory to conservative
        treatment for at least 6 months, and independent ambulation without the use of assistive
        devices.

        A longitudinally study of two patient cohorts: 1) children with planovalgus foot deformity
        treated with arthroereisis (subtalar implant) and 2) children with planovalgus foot
        deformity treated by calcaneal (lateral column) lengthening.
      
Keywords: Painful flatfeet; Planovagus feet; Subtalar arthroeresis; Lateral column lengthening; Kinematic motion analysis