Surgical Treatment for Planovalgus Foot in Children with Generalized Ligamentous Laxity

Bo-Hyun Hwang; Ki-Seok Lee; Hyun-Woo Kim

doi:10.4055/jkoa.2010.45.5.363

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Hwang, Lee, and Kim: Surgical Treatment for Planovalgus Foot in Children with Generalized Ligamentous Laxity

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(5): 363-372.

Published online: 31 October 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.5.363

Surgical Treatment for Planovalgus Foot in Children with Generalized Ligamentous Laxity

Bo-Hyun Hwang, M.D., Ki-Seok Lee, M.D., Hyun-Woo Kim, M.D.

Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Correspondence to: Hyun-Woo Kim, M.D. Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul 120-752, Korea. TEL: +82-2-2228-2180, FAX: +82-2-363-1139, pedhkim@yuhs.ac

Received 27 March 2010 Accepted 5 July 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Planovalgus deformity in children with generalized ligamentous laxity is usually asymptomatic, but it sometimes causes severe deformity and functional problems. The aim of this study was to evaluate, post-operatively, functional outcomes, plantar pressure and radiographic results of symptomatic planovalgus with generalized ligamentous laxity.

Materials and Methods

This retrospective study included a total of 42 feet of 24 patients that had undergone a calcaneal lengthening osteotomy or an extra-articular subtalar arthrodesis. The mean age of the patients at the time of the index operation was 10.5 years (range, 6-15.6 years), and the mean duration of follow-up was 51 months (range, 18-92 months). Patients were evaluated clinically and radiographically using the Oxford Ankle Foot Questionnaire, AOFAS score, Mosca criteria, standard radiographs and dynamic pedobarographs.

Results

Functional outcomes at the latest available follow-up were excellent except for three feet. No foot had a significant limitation affecting the patient's daily activities. Both surgical treatments improved radiographic parameters. The parameters of dynamic pedobarographs, including the relative vertical impulse and the peak pressure, decreased for the medial aspect of the forefoot and midfoot, while they increased for the lateral aspect of the forefoot, midfoot and calcaneus after surgical treatment. The change in the center of pressure indicated a significant lateral shift in the weight-bearing surface of the foot.

Conclusion

Calcaneal lengthening osteotomy and extra-articular subtalar arthrodesis appear to be effective means for pain relief and clinical improvement in children with symptomatic planovalgus deformity and generalized ligamentous laxity. Further follow-up evaluation is needed to obtain long-term clinical and radiographic results with regard to skeletal maturation and changes in generalized ligamentous laxity.

Keywords: planovalgus deformity, generalized ligamentous laxity, calcaneal lengthening osteotomy, extra-articular subtalar arthrodesis

Figures and Tables

Figure 1

(A) Anteroposterior talo-1st metatarsal angle. (B) Anteroposterior talocalcaneal angle. (C) Lateral talo-1st metatarsal angle. (D) Lateral talocalcaneal angle. (E) Calcaneal pitch.

Figure 2

(A) A ten-year-old girl underwent calcaneal lengthening osteotomy 5 years ago. Although radiographs of the left foot show acceptable findings, those of the right foot show loss of reduction and increased anteroposterior and lateral talo-1st metatarsal angle. (B) These radiographs show the decreased anteroposterior and lateral talo-1st metatarsal angle and improved alignment after extra-articular subtalar arthrodesis for the right foot. (C) Although the clinical scores were not excellent, clinical photographs of the patient show acceptable appearances.

Table 1

Patient Demographics

Table 2

Oxford Ankle Foot Questionnaire

Values are mean±standard deviation.

Table 3

Pre- and Post-operative Radiographic Data (Degrees)

Values are mean±standard deviation.

p values are the comparison between the pre-and post-operative.

^*The difference was significant (p<0.05).

Table 4

Pre- and Post-operative Pedobarograph

Values are mean±standard deviation.

p values are the comparison between the pre-operative and post-operative.

^*The difference was significant (p<0.05).

Table 5

Comparison of the Path of Center of Pressure

Values are mean±standard deviation.

^*The difference was significant (p<0.05).

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