Calcaneo-Stop: An Effective Surgical Technique to Correct Symptomatic Flexible Flatfoot in Children

TL;DR

This study shows that the calcaneo-stop surgical technique effectively treats painful flexible flatfoot in children with minimal complications.

Contribution

The calcaneo-stop technique is presented as a low-morbidity, cost-effective alternative for treating symptomatic flexible flatfoot in children.

Findings

90% of patients experienced marked improvement or disappearance of symptoms.

Radiographic parameters improved significantly (p < 0.001) in most cases.

The complication rate was 13.6%, mainly due to localized postoperative pain.

Abstract

Objective
 Flexible juvenile valgus flatfoot is a prevalent condition that typically resolves spontaneously but requires surgical treatment if associated with discomfort, pain, and physical limitation. However, certain surgical procedures are associated with higher morbidity, as they involve osteotomies and arthrodesis. In this context, extra-articular talocalcaneal arthroereisis is an option, because it is a cost-effective, low-morbidity, and efficient method of treatment. The aim of the present study is to report the outcomes of the treatment of flexible juvenile valgus flatfoot using the calcaneo-stop technique.

Methods
 Pre-adolescent patients with severe or symptomatic flexible juvenile valgus flatfoot were surgically treated using the calcaneo-stop technique (talocalcaneal arthroereisis). The outcomes were evaluated clinically and radiographically, assessing Meary angles, talonavicular coverage, talus-metatarsal alignment, Moreau-Costa-Bertani angle, calcaneal pitch, and the percentage of talus head coverage by the navicular.

Results
 A total of 23 individuals (44 feet) were evaluated and operated on, with ages ranging from 7 to 13 years (mean: 11) and a mean follow-up of 28 months. There was marked improvement or disappearance of symptoms in 90% of the patients. The complication rate was of 13.6%, primarily associated with localized pain at the surgical site. All radiographic parameters improved significantly (
p
 < 0.001), with values approaching normality in most cases.

Conclusion
 Improvements in both clinical and radiographic parameters suggest that talocalcaneal arthroereisis corrects deformities with a low complication rate.

Objetivo
 O pé plano valgo juvenil flexível é uma doença prevalente que, de modo geral, se resolve de forma espontânea. No entanto, requer tratamento cirúrgico se associado a desconforto, dor e limitação física. Alguns procedimentos cirúrgicos, porém, são associados a maior morbidade, pois envolvem osteotomias e artrodese. Nesse contexto, a artrorrise talocalcânea extra-articular é uma opção por ser um método de tratamento barato, de baixa morbidade e eficaz. O objetivo deste estudo é relatar os resultados do tratamento do pé plano valgo infantil flexível usando a técnica calcâneo-stop.

Métodos
 Pacientes pré-adolescentes com pé plano valgo flexível grave ou sintomático foram submetidos ao tratamento cirúrgico usando a técnica calcâneo-Stop (artrorrise talocalcaneana). Os resultados foram avaliados clínica e radiograficamente, incluindo os ângulos de Meary, a cobertura talonavicular, o alinhamento tálus-metatarso, o ângulo de Moreau-Costa-Bertani, o
pitch
calcâneo e a porcentagem de cobertura da cabeça do tálus pelo navicular.

Resultados
 No total, 23 pacientes (44 pés) foram avaliados e operados. A idade dos pacientes variou de 7 a 13 anos (média: 11) anos, com acompanhamento médio de 28 meses. Houve melhora acentuada ou desaparecimento dos sintomas em 90% dos pacientes. A taxa de complicação foi de 13,6%, associada principalmente à dor localizada no sítio cirúrgico. Todos os parâmetros radiográficos melhoraram significativamente (
p
 < 0,001), com valores próximos da normalidade na maioria dos casos.

Conclusão
 Melhoras nos parâmetros clínicos e radiográficos sugerem que a artrorrise talocalcânea corrige deformidades com baixa taxa de complicações.

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