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

## TL;DR

This study shows that combining two surgical techniques improves outcomes for children with flexible flatfoot, with most achieving good to excellent results after two years.

## Contribution

The study introduces a combined surgical approach for flexible flatfoot in children and evaluates its effectiveness.

## Key findings

- 82% of cases had optimal postoperative outcomes, and 89% achieved complete surgical correction of deformity.
- 84% of cases achieved complete consolidation of arthrodesis within 3 months.
- Postoperative pain was absent in 88% of cases at 24-month follow-up.

## Abstract

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.

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.

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.

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.