A Comparison of Patient-Reported and Radiographic Outcomes Across Rigid and Flexible Flatfeet Following Calcaneal Lengthening Osteotomy in Pediatric Patients

INTRODUCTION: Calcaneal lengthening osteotomy (CLO) is a common procedure in children presenting with painful flatfeet refractory to conservative treatment. Although most pediatric flatfeet are flexible, a small percentage can present with rigid deformity. The purpose of this investigation is to compare the efficacy of CLO as a corrective procedure across patients with painful, rigid, and flexible flatfeet through radiographic outcomes and patient-reported pain and mobility scores. METHODS: Seventy-two children (114 feet) aged 8 to 18 years undergoing CLO for painful, rigid, or flexible flatfeet with a minimum 6 months follow-up were included. Rigid versus flexible groups were determined based on chart review, noting physical examination findings of rigid flatfoot, including a lack of arch reconstitution when non-weight-bearing or standing on toes. Patients were excluded if they had neuromuscular disorders or prior surgeries affecting mobility, prior flatfoot correction, vertical talus, or tarsal coalition. A retrospective chart review was performed of preoperative and postoperative PROMIS pain and mobility scores. Preoperative and postoperative AP/lateral talo-first metatarsal angle, talonavicular uncoverage percent, incongruency angle, calcaneal pitch, and medial cuneiform-5th metatarsal height were measured. RESULTS: The mean final PROMIS follow-up was 23 months (median: 19; range: 6 to 84). Preoperatively, there were no significant differences in PROMIS pain (P=0.52) or mobility (P=0.79) scores. PROMIS pain significantly declined 7.8 points (P<0.001) in flexible feet and decreased 9.3 points (P=0.045) in rigid feet. Postoperatively, findings were similar, with no significant differences in PROMIS pain (P=0.73) or mobility (P=0.73) scores between flexible and rigid flatfeet. All radiographic parameters improved after surgery (rigid AP talo-first metatarsal angle, P=0.047; rigid lateral talo-first metatarsal angle, P=0.01; rigid incongruency angle, P=0.004; rigid calcaneal pitch, P=0.01; all other measures, P<0.001). Similarly, there were no differences in the postoperative radiographic measurements between groups (P>0.05). CONCLUSIONS: We found significant improvements in radiographic parameters and patient-reported pain after CLO for children with either flexible or rigid flatfeet. Our preliminary findings suggest CLO demonstrates promising short-term outcomes in both groups. LEVEL OF EVIDENCE: Level III-therapeutic studies; investigating the results of treatment.