SLR - July 2016 - Mina M. Hanna

How to Approach the Pediatric Flatfoot

Reference: Vulcano E, Maccario C, Myerson MS. How to Approach the Pediatric Flatfoot. World J Orthop. 2016 Jan 18;7(1):1-7.

Scientific Literature Review

Reviewed by: Mina M. Hanna, DPM
Residency Program: Morristown Memorial Hospital

Podiatric Relevance: Pes planovalgus is a common condition that may present in children. As podiatric surgeons, we must understand the etiology and management of each deformity. The purpose of this article was to highlight the surgical treatment of a pediatric flatfoot, which can be divided into three main categories: soft-tissue procedures, bony procedures and arthroereisis.

Methods: The article discusses the authors’ approach to treating different pediatric flatfoot deformities based on their widespread surgical experiences.

Results: The soft-tissue procedures usually involved in the treatment of pediatric flatfeet involve the Achilles tendon/gastrocnemius, posterior tibial tendon and rarely the peroneal tendons. They found that a gastrocnemius contracture was almost always presents in the pediatric flatfoot. Arthroereisis should only be used to correct hindfoot valgus and is more effective in children with less than 10 percent of cases needing removal of the implant compared to 50 percent in adults. Medial displacement calcaneal osteotomy (MDCO) is a more powerful correction of hindfoot valgus due to medializing the Achilles tendon relative to the subtalar joint axis.  For navicular syndrome, a modified Kidner procedure with advancement of PTT was the preferred treatment method. Lateral column lengthening was performed to correct midfoot abduction but did not work if the foot was too rigid. An opening wedge osteotomy of the medial cuneiform was performed if the forefoot was supinated more than 15 degrees. Tarsal coalitions were almost always involved in a rigid flatfoot, and resection of the coalition was always preferred.

Conclusions: Pediatric flatfoot should be classified as either flexible vs rigid. A combination of soft-tissue and bony procedures are almost always necessary to properly realign the foot and prevent recurrence. Excellent adjunctive procedures that are often overlooked include a gastrocnemius recession to correct equinus and medial cuneiform osteotomy to correct fixed forefoot supinatus.

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