1-year results after surgery for flexible adult-acquired flatfoot deformity: a cohort study based on 190 patients from the Swedish Foot and Ankle Surgery Register
DOI:
https://doi.org/10.2340/17453674.2026.45942Keywords:
AAFD, Calcaneal Osteotomy, Flatfoot, Foot and ankle, Hindfoot arthrodesi, PROMAbstract
Background and purpose: Surgical outcomes in patients with flexible adult-acquired flatfoot deformity (AAFD) have not been evaluated in large prospective register studies. Calcaneal osteotomy and hindfoot arthrodesis are commonly used. We aimed to compare the results of these 2 procedures using preoperative and 1-year postoperative patient-reported outcome data from the Swedish Quality Register for Foot and Ankle Surgery (Swefoot).
Methods: We analyzed data regarding feet that had primary surgery for flexible (grade II) AAFD between 2017 and 2022 in Sweden. The primary outcome was the Self-Reported Foot and Ankle Score (SEFAS), range 0–48 (minimal important difference 5). Secondary outcomes were EQ-5D and satisfaction.
Results: 190 feet (63% women, median age 62 years, interquartile range 54–68) were surgically treated during the study period. Mean improvement in SEFAS score was 12 (95% confidence interval [CI] 10–13) in grade IIa and 10 (CI 8–12) in grade IIb, and in the EQ-5D index 0.27 (CI 0.20–0.34) and 0.23 (CI 0.15–0.31), respectively. Compared with preoperatively a higher percentage of patients were satisfied with postoperative foot appearance (77% vs 39%) and foot strength (66% vs 23%). The mean SEFAS score improvement was 11 (CI 10–13) in the osteotomy group and 10 (CI 5–15) in the arthrodesis group; adjusted mean difference was 2.7 (CI –1.2 to 6.5).
Conclusion: Surgical treatment of flexible AAFD significantly improves function and quality of life at 1 year postoperatively. No differences in postoperative patient-reported outcomes were observed between patients who underwent calcaneal osteotomy compared with hindfoot arthrodesis.
Downloads
References
Henry J K, Shakked R, Ellis S J. Adult-acquired flatfoot deformity. Foot Ankle Orthop 2019; 4(1): 2473011418820847. doi: 10.1177/2473011418820847. DOI: https://doi.org/10.1177/2473011418820847
Abousayed M M, Alley M C, Shakked R, Rosenbaum A J. Adult-acquired flatfoot deformity: etiology, diagnosis, and management. JBJS Rev 2017; 5(8): e7. doi: 10.2106/JBJS.RVW.16.00116. DOI: https://doi.org/10.2106/JBJS.RVW.16.00116
Cöster M C, Coster A, Svensson F, Callreus M, Montgomery F. Swefoot: the Swedish national quality register for foot and ankle surgery. Foot Ankle Surg 2022; 28(8): 1404-10. doi: 10.1016/j.fas.2022.07.010. DOI: https://doi.org/10.1016/j.fas.2022.07.010
Cöster M, Karlsson M K, Nilsson J A, Carlsson A. Validity, reliability, and responsiveness of a self-reported foot and ankle score (SEFAS). Acta Orthop 2012; 83(2): 197-203. doi: 10.3109/17453674.2012.657579. DOI: https://doi.org/10.3109/17453674.2012.657579
Cöster M C, Nilsdotter A, Brudin L, Bremander A. Minimally important change, measurement error, and responsiveness for the Self-Reported Foot and Ankle Score. Acta Orthop 2017; 88(3): 300-4. doi: 10.1080/17453674.2017.1293445. DOI: https://doi.org/10.1080/17453674.2017.1293445
Cöster M C, Rosengren B E, Karlsson M K, Carlsson A. Age- and gender-specific normative values for the Self-Reported Foot and Ankle Score (SEFAS). Foot Ankle Int 2018; 39(11): 1328-34. doi: 10.1177/1071100718788499. DOI: https://doi.org/10.1177/1071100718788499
Cöster M C, Bremander A, Rosengren B E, Magnusson H, Carlsson A, Karlsson M K. Validity, reliability, and responsiveness of the Self-reported Foot and Ankle Score (SEFAS) in forefoot, hindfoot, and ankle disorders. Acta Orthop 2014; 85(2): 187-94. doi: 10.3109/17453674.2014.889979. DOI: https://doi.org/10.3109/17453674.2014.889979
Christensen R, Ranstam J, Overgaard S, Wagner P. Guidelines for a structured manuscript: statistical methods and reporting in biomedical research journals. Acta Orthop 2023; 94: 243-9. doi: 10.2340/17453674.2023.11656. DOI: https://doi.org/10.2340/17453674.2023.11656
Jakobsen J C, Gluud C, Wetterslev J, Winkel P. When and how should multiple imputation be used for handling missing data in randomised clinical trials: a practical guide with flowcharts. BMC Med Res Methodol 2017; 17(1): 162. doi: 10.1186/s12874-017-0442-1. DOI: https://doi.org/10.1186/s12874-017-0442-1
Cöster M C, Rosengren B E, Bremander A, Karlsson M K. Surgery for adult acquired flatfoot due to posterior tibial tendon dysfunction reduces pain, improves function and health related quality of life. Foot Ankle Surg 2015; 21(4): 286-9. doi: 10.1016/j.fas.2015.04.003. DOI: https://doi.org/10.1016/j.fas.2015.04.003
Osbeck I, Cöster M, Montgomery F, Atroshi I. Surgically treated adult acquired flatfoot deformity: register-based study of patient characteristics, health-related quality of life and type of surgery according to severity. Foot Ankle Surg 2023. doi: 10.1016/j.fas.2023.03.003. DOI: https://doi.org/10.1016/j.fas.2023.03.003
Myerson M S, Thordarson D B, Johnson J E, Hintermann B, Sangeorzan B J, Deland J T, et al. Classification and nomenclature: progressive collapsing foot deformity. Foot Ankle Int 2020; 41(10): 1271-6. doi: 10.1177/1071100720950722. DOI: https://doi.org/10.1177/1071100720950722
Orr J D, Nunley J A 2nd. Isolated spring ligament failure as a cause of adult-acquired flatfoot deformity. Foot Ankle Int 2013; 34(6): 818-23. doi: 10.1177/1071100713483099. DOI: https://doi.org/10.1177/1071100713483099
Brodell J D Jr, MacDonald A, Perkins J A, Deland J T, Oh I. Deltoid-spring ligament reconstruction in adult acquired flatfoot deformity with medial peritalar instability. Foot Ankle Int 2019; 40(7): 753-61. doi: 10.1177/1071100719839176. DOI: https://doi.org/10.1177/1071100719839176
Davies J P, Ma X, Garfinkel J, Roberts M, Drakos M, Deland J, et al. Subtalar fusion for correction of forefoot abduction in stage II adult-acquired flatfoot deformity. Foot Ankle Spec 2020:1938640020951050. doi: 10.1177/1938640020951050. DOI: https://doi.org/10.1177/1938640020951050
Swefoot – National Quality Register for Foot and Ankle Surgery. Available from: https://registercentrum.blob.core.windows.net/fot/r/RIKSFOT-rsrapport-23_slutv-8tAEujDGM.pdf
Rolfson O, Bohm E, Franklin P, Lyman S, Denissen G, Dawson J, et al. Patient-reported outcome measures in arthroplasty registries Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries Part II: Recommendations for selection, administration, and analysis. Acta Orthop 2016; 87 (Suppl 1(Suppl 1): 9-23. doi: 10.1080/17453674.2016.1181815. DOI: https://doi.org/10.1080/17453674.2016.1181816
Wilson I, Bohm E, Lübbeke A, Lyman S, Overgaard S, Rolfson O, et al. Orthopaedic registries with patient-reported outcome measures. EFORT Open Rev 2019; 4(6): 357-67. doi: 10.1302/2058-5241.4.180080. DOI: https://doi.org/10.1302/2058-5241.4.180080
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2026 Ida Karin Johanna Osbeck, Maria Cöster, Isam Atroshi
This work is licensed under a Creative Commons Attribution 4.0 International License.
