Citation Information :
Rangasamy K, Ghosh AK, Ksheerasagar VP, Khatri JP, Gopinathan NR. Effectiveness of Lateral Column Lengthening in Symptomatic Flexible Flatfoot of the Pediatric and Adolescent Population: An Updated Systematic Review. J Foot Ankle Surg Asia-Pacific 2023; 10 (2):66-75.
Background: Pes planovalgus is one of the most common pediatric foot deformities; one can manage it most conservatively. Surgery is only indicated for symptomatic flexible flatfoot with failed conservative treatment. In children, lateral column lengthening surgery is advantageous as it preserves the growth and development of the foot without fusing the joints. Research question: Is lateral column lengthening effective in managing pediatric and adolescent symptomatic idiopathic flexible flatfeet? Materials and methods: Four electronic databases [PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Google Scholar] were searched for relevant articles reporting the outcomes of lateral column lengthening surgery in idiopathic flexible flatfeet of children with a minimum 1-year follow-up. Pre and postoperative radiological outcomes were recorded using talometatarsal angles, talonavicular coverage, calcaneal pitch, and talocalcaneal angle. The functional results were recorded as pre and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores. Rehabilitation protocol and complications were noted. Results: A total of 16 studies were included for the final review, with a total of 336 patients (468 feet) with a mean age of 11.65 years. An autologous tricortical iliac crest was the most commonly used graft during lateral column lengthening. There was a statistically significant improvement in the postoperative radiological parameters like anteroposterior (AP) talocalcaneal angle, AP talometatarsal angle, AP talonavicular angle, and in lateral views talocalcaneal angle, talometatarsal angle, and calcaneal pitch in comparison to preoperative values (p < 0.00001). The mean postoperative AOFAS scores had a standard mean difference of −5.24 [95% confidence interval (CI); −6.39, −4.09] from the mean preoperative AOFAS scores, and this difference is statistically significant (p < 0.00001). Complications like pain in the foot, infection, under-correction, graft displacement, and calcaneocuboid or talonavicular joint subluxation were noted. Conclusion: Lateral column lengthening surgery is promising with good midterm clinical and radiological outcomes with acceptable complications for treating symptomatic flexible flatfeet in pediatric and adolescent populations.
Pfeiffer M, Kotz R, Ledl T, et al. Prevalence of flat foot in preschool-aged children. Pediatrics 2006;118(2):634–639. DOI: 10.1542/peds.2005-2126
Mosca VS. Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot. J Bone Joint Surg Am 1995;77(4):500–512. DOI: 10.2106/00004623-199504000-00002
Cappello T, Song KM. Determining treatment of flatfeet in children. Curr Opin Pediatr 1998;10(1):77–81. DOI: 10.1097/00008480-199802000-00016
Evans D. Calcaneo-valgus deformity. J Bone Joint Surg Br 1975;57(3):270–278. DOI: 10.1302/0301-620X.57B3.270
Lai CC, Wang TM, Chang CH, et al. Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents. BMC Musculoskelet Disord 2021;22(1):977. DOI: 10.1186/s12891-021-04855-9
John S, Child BJ, Hix J, et al. A retrospective analysis of anterior calcaneal osteotomy with allogenic bone graft. J Foot Ankle Surg 2010;49(4):375–379. DOI: 10.1053/j.jfas.2009.12.007
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: 10.1136/bmj.n71
Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions. BMJ 2016;355:i4919. DOI: 10.1136/bmj.i4919
McGuinness LA, Higgins JPT. Risk-of-bias visualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth 2021;12(1):55–61. DOI: 10.1002/jrsm.1411
Xu Y, Li XC, Xu XY. Calcaneal Z lengthening osteotomy combined with subtalar arthroereisis for severe adolescent flexible flatfoot reconstruction. Foot Ankle Int 2016;37(11):1225–1231. DOI: 10.1177/1071100716658975
Doğan A, Albayrak M, Akman YE, et al. The results of calcaneal lengthening osteotomy for the treatment of flexible pes planovalgus and evaluation of alignment of the foot. Acta Orthop Traumatol Turc 2006;40(5):356–366.
Oeffinger DJ, Pectol RW, Tylkowski CM. Foot pressure and radiographic outcome measures of lateral column lengthening for pes planovalgus deformity. Gait & Posture 2000;12(3):189–195. DOI: 10.1016/s0966-6362(00)00075-8
Conklin MJ, Strom SF, Seidenstein AH, et al. Risk factors for nonunion in pediatric lateral column lengthening (mosca) procedures. Foot Ankle Orthop 2022;7(1):2473011421S00153. DOI: 10.1177/2473011421S00153
Elshafey EAF, Hegazy M, Bassiouni H. Calcaneal lengthening for correction of symptomatic flexible flat foot in children. Benha Med J 2020;36(3):98–106. DOI: 10.21608/BMFJ.2020.75839
Marengo L, Canavese F, Mansour M, et al. Clinical and radiological outcome of calcaneal lengthening osteotomy for flatfoot deformity in skeletally immature patients. Eur J Orthop Surg Traumatol 2017;27(7):989–996. DOI: 10.1007/s00590-017-1909-9
Templin D, Jones K, Weiner DS. The incorporation of allogeneic and autogenous bone graft in healing of lateral column lengthening of the calcaneus. J Foot Ankle Surg 2008;47(4):283–287. DOI: 10.1053/j.jfas.2008.02.018
Yontar NS, Ogut T, Guven MF, et al. Surgical treatment results for flexible flatfoot in adolescents. Acta Orthop Traumatol Turc 2016;50(6):655–659. DOI: 10.1016/j.aott.2016.02.002
El-Tayeby HM. The severe flexible flatfoot: a combined reconstructive procedure with rerouting of the tibialis anterior tendon. J Foot Ankle Surg 1999;38(1):41–49. DOI: 10.1016/s1067-2516(99)80087-8
Mohsen M, Éi MM, Megahed RM, et al. Mosca's technique in surgical treatment of symptomatic flexible flat foot in children and adolescents. Egypt J Hospital Med 2022;88(1):3812–3818. DOI: 10.21608/EJHM.2022.252222
Tarraf E, El N, Sheta R. Original article lateral calcaneal lengthening osteotomy in management symptomatic flexible flat foot. J Int Med Res 2017;3. DOI: 10.21276/aimdr.2017.3.6.OR6
Ahmed A, Ahmed ASA. Management of symptomatic flexible flatfoot in adolescents by Mosca's lateral calcaneal lengthening. Egypt Orthop J 2016;51(1). DOI: 10.4103/1110-1148.194428
Kehayov R, Nikolova S. Rare, but existing complications after calcaneal lengthening osteotomy for the treatment of symptomatic planovalgus deformity in children and adolescent. J Bulg Orthop Trauma Assoc 2022;59(1):36–43.
Nejib K, Delpont M. Medium-term results of calcaneus lengthening in idiopathic symptomatic flat foot in children and adolescents. J Child Orthop 2020;14(4):286–292. DOI: 10.1302/1863-2548.14.200073
Baghdadi T, Mazoochy H, Guity M, et al. Evaluation of clinical and radiological results of calcaneal lengthening osteotomy in pediatric idiopathic flexible flatfoot. Arch Bone Jt Surg 2018;6(5):402–411.
Viegas GV. Reconstruction of the pediatric flexible planovalgus foot by using an Evans calcaneal osteotomy and augmentative medial split tibialis anterior tendon transfer. J Foot Ankle Surg 2003;42(4):199–207. DOI: 10.1016/s1067-2516(03)70029-5
Zairi M, Msakni A, Mohseni AA, et al. Calcaneal lengthening osteotomy in the management of idiopathic flatfoot in children: case series of twenty-one feet. Int J Surg Case Rep 2022;99:107634. DOI: 10.1016/j.ijscr.2022.107634
Luna IE, Kehlet H, Peterson B, et al. Early patient-reported outcomes versus objective function after total hip and knee arthroplasty: a prospective cohort study. Bone Joint J 2017;99-B(9):1167–1175. DOI: 10.1302/0301-620X.99B9.BJJ-2016-1343.R1
Westberry DE, Davids JR, Anderson JP, et al. The operative correction of symptomatic flat foot deformities in children. Bone Joint J 2013;95-B(5):706–713. DOI: 10.1302/0301-620X.95B5.30594
Xu Y, Cao Y, Li X, et al. Double calcaneal osteotomy for severe adolescent flexible flatfoot reconstruction. J Orthop Surg Res 2017;12(1):153. DOI: 10.1186/s13018-017-0655-3
Akimau P, Flowers M. Medium term outcomes of planovalgus foot correction in children using a lateral column lengthening approach with additional procedures ‘a la carte’. Foot Ankle Surg 2014;20(1):26–29. DOI: 10.1016/j.fas.2013.08.005
Ghaznavi A, Hemmatyar A, Mahdavi SM, et al. Treatment of symptomatic flexible flat foot in pediatrics with a modified Mosca's lateral column lengthening. Med J Islam Repub Iran 2022;36(1):93. DOI: 10.47176/mjiri.36.93
Nahla AM, Lotfy AH, Mohammed AAEld, et al. Calcaneal lateral column lengthening osteotomy for symptomatic flexible flatfoot. Egypt J Hosp Med 2021;85(1):3436–3440. DOI: 10.21608/EJHM.2021.199597
Mackenzie A, Rome K, Evans A. The efficacy of nonsurgical interventions for pediatric flexible flat foot. J Pediatr Orthop 2012;32(8):830–834. DOI: 10.1097/BPO.0b013e3182648c95
Halabchi F, Mazaheri R, Mirshahi M, et al. Pediatric flexible flatfoot; clinical aspects and algorithmic approach. Iran J Pediatr 2013;23(3):247–260.
Soomekh DJ, Baravarian B. Pediatric and adult flatfoot reconstruction: subtalar arthroereisis versus realignment osteotomy surgical options. Clin Podiatr Med Surg 2006;23:695–708. DOI: 10.1016/j.cpm.2006.08.003
Suh DH, Park JH, Lee SH, et al. Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review. Int Orthop 2019;43(5):1179–1192. DOI: 10.1007/s00264-019- 04303-3
Malige A, Chang H, Mellor X, et al. Flexible flat foot, short tendo-Achilles, and altered gait. Cureus 2022;14(2):e21983. DOI: 10.7759/cureus.21983
Vosseller JT, Ellis SJ, O'Malley MJ, et al. Autograft and allograft unite similarly in lateral column lengthening for adult acquired flatfoot deformity. HSS J 2013;9(1):6–11. DOI: 10.1007/s11420-012-9317-5
Kumar S, Sonanis SV. Lateral column lengthening for adolescent idiopathic pes planovalgus deformity – systematic review. J Orthop 2017;14:571–576. DOI: 10.1016/j.jor.2017.07.013
Momberger N, Morgan JM, Bachus KN, et al. Calcaneocuboid joint pressure after lateral column lengthening in a cadaveric planovalgus deformity model. Foot Ankle Int 2000;21(9):730–735. DOI: 10.1177/107110070002100903
Cuijpers P, Weitz E, Cristea IA, et al. Pre-post effect sizes should be avoided in meta-analyses. Epidemiol Psychiatr Sci 2017;26(4):364–368. DOI: 10.1017/S2045796016000809