SLR - November 2023 - Zucchero
Title: Tibialis Anterior Rerouting combing with calcaneal lengthening osteotomy as a single-stage reconstruction of symptomatic flexible flatfoot in children and adolescentsReference: Samy Abdel‐Hady Sakr1, Ahmed Ibrahim Zayda1, Mohamed Kamal Mesregah1* and Ahmed Abdelazim Abosalem1 Journal of Orthopaedic Surgery and Research
Reviewed by: Holly Zucchero, DPM
Residency Program: East Liverpool City Hospital
Podiatric Relevance: Flexible flatfoot deformity is a condition that podiatric physicians will see over the course of their career. Surgical intervention should be considered when nonsurgical treatment fails in the symptomatic population. Rerouting the tibialis anterior tendon plantarly to support the talar head, in conjunction with a lateral column lengthening osteotomy, should be considered as a surgical treatment of symptomatic flexible flatfoot deformity.
Methods: A level IV prospective case series was performed by a single pediatric orthopedic surgeon using single-stage reconstruction by rerouting the tibialis anterior tendon combined with a lateral column lengthening calcaneal osteotomy. A total of 16 patients (28 feet) were included in this study. Functional outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic outcomes were measured by comparing pre-operative and post-operative talonavicular coverage angle, AP talo-first metatarsal angle, lateral talo-first metatarsal angle, and calcaneal pitch angle.
Results: The average AOFAS score increased from 51.6 to 85.3 at final follow up. The talonavicular coverage angle decreased from 13.6 to 3.9 degrees. The AP talo-first metatarsal angle reduced from 16.9 to 4.5 and the calcaneal pitch angle increased from 9.6 to 23.8 postoperatively. No major complications were noted during the two-year follow up period.
Conclusions: Based on results of this study, rerouting of the tibialis anterior tendon combined with lateral column lengthening calcaneal osteotomy proves to be a viable option for correction of symptomatic pediatric flatfoot deformity. Outcomes were measured both functionally, using AOFAS score, and radiographically. There are some limitations to this study, such as, a low sample size of feet and a relatively short follow up period. Further investigation into this technique over a longer period of time may give more accurate long-term outcomes.