Long-term clinical and radiological outcomes following surgical treatment for symptomatic pediatric flexible flat feet: a systematic review

Authors

  • Maria Anna Smolle Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
  • Martin Svehlik Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
  • Katharina Regvar Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
  • Andreas Leithner Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria https://orcid.org/0000-0002-2598-2325
  • Tanja Kraus Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz

DOI:

https://doi.org/10.2340/17453674.2022.2254

Keywords:

Foot and ankle, Paediatric orthopaedics

Abstract

Background and purpose: Albeit pediatric flexible flat foot (FFF) is a common condition, only a minority of patients become symptomatic. Long-term outcomes of surgically treated pediatric patients with symptomatic FFF are largely unknown. In this systematic review, studies providing outcomes at a mean follow-up of at least 4 years after the procedure in these patients were analyzed.

Material and methods: A PubMed search was undertaken involving original articles published up to July 2021 on outcome in children aged 6 to 14 with surgically treated FFF and mean (or minimum) follow-up of at least 4 years. Radiographic and clinical outcomes were analyzed.

Results: Of initially 541 entries, 10 could be included in the systematic review (all level IV), involving 846 pediatric patients with 1,536 symptomatic FFF. Pooled mean radiological (n = 8) and clinical follow-up (n = 10) was 5.3 (range 0.5–15) and 7.0 (range 4.1–15) years, respectively. Surgical procedures included arthroereisis (n = 8), lateral column lengthening (n = 1), and Horseman procedure (n = 1). Overall relative frequency of implant-associated complications and wound-healing problems was 3.2% and 1.3%, as well as 2.8% and 1.6% following subtalar arthroereisis only. From preoperative to latest radiological assessment following subtalar arthroereisis (including 3 studies with radiological follow-up < 48 months), pooled median decrease in talonavicular coverage angle (TNCA; –9.2°), anteroposterior talocalcaneal angle (A-TCA; –6.5°), lateral talocalcaneal angle (L-TCA; –3.5°), talar declination angle (TDA; –14°),
Moreau Costa Bertani angle (MCB; –13°), and talo-firstmetatarsal angle (L-T1MA; –10°) was observed, as was an increase in calcaneal pitch (4.5°).

Interpretation: In symptomatic pediatric FFF patients, surgery is associated with a manageable complication profile, and results in satisfactory long-term clinical as well as radiological outcome. Yet scientific evidence is low, warranting larger scaled studies in the future.

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Published

2022-03-18

How to Cite

Smolle, M. A., Svehlik, M., Regvar, K., Leithner, A., & Kraus, T. (2022). Long-term clinical and radiological outcomes following surgical treatment for symptomatic pediatric flexible flat feet: a systematic review. Acta Orthopaedica, 93, 367–374. https://doi.org/10.2340/17453674.2022.2254

Issue

Section

Review, meta-analysis

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