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  • Title: Limitation of flatfoot surgery in overcorrected clubfeet after extensive surgery.
    Author: Eberhardt O, Wachowsky M, Wirth T, Fernandez Fernandez F.
    Journal: Arch Orthop Trauma Surg; 2018 Aug; 138(8):1037-1043. PubMed ID: 29633074.
    Abstract:
    INTRODUCTION: Flatfoot is a severe complication of extensive clubfoot surgery. In this retrospective study, we evaluated our results following flatfoot surgery in overcorrected clubfeet. The aim was to analyze the success of different surgical techniques, including tarsal osteotomies and arthrodesis, in correcting different types of flatfeet. MATERIAL AND METHOD: Between January 1, 2011 and December 31, 2015 we treated 25 severe cases of flatfeet after extensive clubfoot surgery. We classified the hindfoot deformities into rotational valgus, hinge valgus or translatory valgus based on AP standing X-rays. Tarsal osteotomies (Mitchell, Evans, Cotton) and arthrodesis were adapted based on age and severity. Age, gender, pain, hindfoot valgus and function were documented. Function and X-rays were compared pre- and postoperatively. RESULTS: There were 17 male and 4 female patients. Age at operation ranged from 11 to 26 years with an average age of 14.3 years. The mean follow-up was 27.6 months (7-60 months). Primary surgical treatment was a tarsal osteotomy in 19 cases and in six cases it was arthrodesis. Hindfoot valgus (Ø 18.6°-3.2°), calcaneal pitch (Ø 6.2°-14.6°), Costa Bartani angle (Ø155°-142°) and Meary angle (Ø 2.0°-8.8°) improved pre- to postoperatively. Range of motion did not improve after surgical correction. 81% were satisfied with the postoperative results. All flatfeet with translatory valgus, initially treated with a tarsal osteotomy, needed further arthrodesis due to primary undercorrection. CONCLUSION: Tarsal osteotomies are successful methods for correcting flatfeet following extensive clubfoot surgery with rotational valgus and mild hinge valgus. Tarsal osteotomies are unable to successfully correct flatfeet that have a translatory valgus. In such cases, we recommend double or triple arthrodesis. The functional outcome is limited by the preop range of motion and the appearance of talus deformities.
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