title: Evans calcaneal lengthening procedure for spastic flexible flatfoot in 32 patients (46 feet) with a followup of 3 to 9 years.
abstract: BACKGROUND
  The purposes of this study were to evaluate the outcome of calcaneal lengthening in severe pediatric flexible flatfoot deformities of spastic origin and to determine the necessity of additional procedures.
  
  
  METHODS
  In a prospective study, 32 patients (46 feet) were evaluated clinically and radiologically. The mean age of patients was 11 (range 4 to 22) years. The mean period of followup was 66 (range 36 to 108) months.
  
  
  RESULTS
  Additional soft-tissue procedures (Strayer procedure, peroneus lengthening, reefing medial capsule) were performed in 39 of 46 feet; other bony procedures were performed in eight. Among the 46 feet, 11 outcomes were classified as excellent, 19 as good, nine as fair, and seven as poor. Poor outcome was related to overcorrection in three and deformity relapse in four. Calcaneocuboid subluxation was seen in nine feet. Radiographic evaluation demonstrated an improvement of all parameters determined.
  
  
  CONCLUSIONS
  The Evans procedure is effective for the correction of severe, flexible flatfoot deformity in children with cerebral palsy in the short and mid term. Additional soft-tissue procedures frequently are required. However, correction of this multiplanar deformity predominantly occurs in the forefoot abduction component of the deformity, and the concomitant naviculocuneiform sag remains uncorrected. Despite successful outcomes, overcorrection and undercorrection remains a problem of clinical relevance.
authors.affiliation: Orthopaedic University Hospital of Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany. Felix.Zeifang@ok.uni-heidelberg.de
authors.forename: Felix
authors.initials: F
authors.lastname: Zeifang
authors.forename: Steffen J
authors.initials: SJ
authors.lastname: Breusch
authors.forename: Leonhard
authors.initials: L
authors.lastname: Döderlein
mesh_terms: D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening / Q000009:adverse effects / Q000379:methods*; D002111:Calcaneus / Q000601:surgery*; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D005260:Female; D005413:Flatfoot / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009128:Muscle Spasticity; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome