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

Maria Anna Smolle; Martin Svehlik; Katharina Regvar; Andreas Leithner; Tanja  Kraus

doi:10.2340/17453674.2022.2254

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.