title: Reconstruction of the pediatric flexible planovalgus foot by using an Evans calcaneal osteotomy and augmentative medial split tibialis anterior tendon transfer.
abstract: Seventeen consecutive pediatric patients (34 feet) underwent reconstruction of flexible pes planovalgus deformity between 1994 and 1999. The average follow-up was 24.9 months (range, 8 to 48 months). All patients underwent a medial split tibialis anterior tendon transfer/tenodesis in combination with an Evans calcaneal-lengthening osteotomy, Kidner or modified Kidner procedure, and tendo-Achilles lengthening. Various angular parameters were measured both preoperatively and postoperatively, and improvement in each was noted. The calcaneal pitch improved by an average of 26 degrees (85.88%), the lateral talometatarsal angle improved by an average of 26.4 degrees (96.15%), the lateral talocalcaneal angle improved by an average of 14.8 degrees (34.26%), the anteroposterior talometatarsal angle improved by an average of 21.9 degrees (81.92%), the anteroposterior talocalcaneal angle improved by an average of 15.9 degrees (37.95%), the cuboid abduction angle improved by an average of 13.8 degrees (87.34%), and the talonavicular coverage angle improved by an average of 26.7 degrees (94.68%). Postoperative improvement of all angular measurements was statistically significant at the 95% confidence level (P =.05). In addition, American Orthopedic Foot and Ankle Society hindfoot/ankle scoring was performed preoperatively, 3 months after the second foot surgery, and at the time of maximal follow-up. A preoperative average score of 68.59 improved to 85.76 at 3 months after the second foot surgery, and improved to 96.55 at the time of the last follow-up. All 17 patients were satisfied with their surgical result because all returned for correction of the contralateral foot. All patients indicated a uniform willingness to have these procedures performed again.
authors.affiliation: gvviegas@owc.net
authors.forename: Godfrey V
authors.initials: GV
authors.lastname: Viegas
mesh_terms: D000293:Adolescent; D002111:Calcaneus / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005413:Flatfoot / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D013709:Tendon Transfer / Q000379:methods*