Abstract

Background: To The aim of this study is to assess the correction of adult Stage II/A flexible flatfoot deformity using a combination of gastrocnemius aponeurosis lengthening, arthroereisis and percutaneous medializing calcaneal osteotomy.

Methods: From 2014 to 2018, data were collected on 35 feet over 31 patients, with 4 bilateral cases, who underwent this combination technique. The average age of the patients was 37 years. Inclusion criteria were Stage II/A flexible flatfoot, whereas the exclusion criteria were other Stages of flatfoot, rigid flatfoot, synostoses and flatfoot with congenital and neurological malformation. We used the lateral and anteroposterior talocalcaneal angles as well as medial arch angle and talo-first metatarsal angle measurements to assess efficacy of our technique. All data were analyzed statistically with Student’s t test.

Results: The mean values of the preoperative and postoperative weightbearing radiographic angles are 137^° vs 123^° for the Medial Arch Angle, 8^° vs 3^° for the Talo-first metatarsal angle, 34^° vs 27^° for the anteroposterior Talocalcaneal divergence angle and 42^° vs 39^° for the lateral Talocalcaneal divergence angle (p<0.001). In 33 of 35 feet (94%) the results we observed show the improvement of radiographic measurements as well as normal foot function at 6 months. Mean follow up time was 37 months. American Orthopedic Foot and Ankle Society (AOFAS) scores were calculated for all patients, and based on final results; it showed improvement on the 3 scales of pain, function and alignment.

Conclusion: Based on the literature and on our statistical results we find that combining gastrocnemius aponeurosis lengthening with arthroereisis and percutaneous medializing calcaneal osteotomy is an optimal surgery for the correction of Stage II/A flexible flatfoot.

Keywords: Arthroereisis; Percutaneous; Calcaneal Osteotomy; Gastrocnemius lengthening