Benefits of combined hind-foot alignment and medial arch reconstruction surgery in children with flexible flatfoot: a case-series analysis

Introduction: Although surgical alignment of the rear-foot might be sufficient to achieve acceptable correction of pronation-distortion deformity, concomitant correction of the medial arch might improve functional results. Methods: We present our experience with combined hind-foot alignment and medial arch reconstruction by in-situ naviculocuneiform arthrodesis for treatment of flexible flatfoot in children. We retrospectively evaluated clinical data available from pediatric (< 18 years old) patients treated for flexible flatfoot in our department. Results: We performed 160 surgical corrections of flat foot in 94 children over the study period. Median age was 13 (range, 12-14) years. All patients had a minimum postoperative follow-up of 24 months. Overall postoperative outcomes were optimal in 82% (n = 113/160) of cases, good in 15% (n = 24/160) of cases, and adequate in 3% (n = 3/160) of cases. At 24-month follow-up, complete surgical correction of deformity was achieved in 89% (n = 143/160) procedures. Complete consolidation of arthrodesis was achieved within 3 months form surgery in 84% (n = 134/160) of cases, between 3 and 6 months in 12% (n = 21/160) of cases. There was a significant difference in pre-operative AOFAS score among the different weight categories (p < 0.001). At post-hoc analysis, OB patients had lower AOFAS versus NW or OW patients. At 24-months follow-up, there was a significant difference in AOFAS scores among the different weight categories (p = 0.04). At post-hoc analysis, OB patients had lower AOFAS versus OW patients. There was no difference in AOFAS scores at final follow-up (p = 0.12). Postoperative pain was absent in 88% (n = 140/160) of cases. Conclusion: At a minimum 24-month follow-up, patients who undergo flat-foot deformity correction using a surgical technique combining sinus tarsi arthroeresis and medial arch reconstruction by naviculocuneiform arthrodesis experience good short-term results.