Joint Preserving Surgery for Correction of Spasmodic Flat- Foot in Skeletally Mature Foot

Study Overview
=================
Brief Summary
-----------------
the investigators want to obtain a functional and radiological outcome of peroneus brevis, tertius and extensor digitorum longus muscles lengthening together with calcaneal osteotomies in the treatment of the spasmodic flat- foot.

Detailed Description
-----------------
One of the most common foot complaints is the flatfoot deformity. Clinical evaluation of flatfeet primarily focuses on differentiation between the two main types: flexible and rigid. The rigid flatfoot deformity is an uncommon diagnosis (occurring one-third as often as the flexible type) but often is symptomatic and requires treatment. Multiple causes of rigid flatfeet have been identified such as rheumatoid arthritis, tarsal coalitions (being the most common cause) that are excluded from that research. Triple arthrodesis is used for treatment of rigid flat foot but the patient satisfaction is not good as there is some stiffness in the foot .but here the investigators want to know what is the effect of extensor digitorum longus, peroneus brevis and tertius lengthening together with osteotomies in alignment of spasmodic flat- foot. In patient with rigid flat- foot or spasmodic flat- foot will often have the hind-foot alignment to the outside. Alignment of the heel influences how weight-bearing stress is applied to the foot, ankle, knee and hip. So, these patients may benefit from the calcaneal osteotomies and extensor digitorum longus, peroneus brevis and tertius lengthening to improve that alignment.

Official Title
-----------------
Joint Preserving Surgery for Correction of Spasmodic Flat- Foot in Skeletally Mature Foot

Conditions
-----------------
Flat Foot; Rigid, Flat Foot; Spastic

Intervention / Treatment
-----------------
* Procedure: Joint Preserving Surgery in spasmodic flat foot


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Painful, incorrectable pes Plano valgus after failure of conservative treatment Age: patients with skeletally mature foot as proved by x-ray Exclusion Criteria: coalition bar Ankle subtalar joint arthritis. Previous foot fractures. Severe trophic skin disorders Standard contraindications to any surgery such as poor circulation, concurrent infection, other co-morbidity.

Ages Eligible for Study
-----------------
Minimum Age: 14 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: spasmodic flat foot<br>extensor digitorum longus, peroneus brevis and tertius lengthening together with calcaneal osteotomies in spasmodic flat foot | Procedure: Joint Preserving Surgery in spasmodic flat foot<br>* extensor digitorum longus, peroneus brevis and tertius lengthening together with calcaneal osteotomies<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| assess the foot deformity | assess foot deformity : full correction (valgus<10 degree), partial correction(valgus<15 degree),valgus >15 degree) | Baseline | 
| assess the pain: Visual Analog Score | The Visual Analogue Scale (VAS) consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' and 'pain as bad as it could be'. The patient is asked to mark his pain level on the line between the two endpoints. The distance between 'no pain at all' and the mark then defines the subject's pain. This tool was first used in psychology by Freyd in 1923 | Baseline |