title: Talonavicular arthrodesis for the treatment of neurological flat foot deformity in pediatric patients: clinical and radiographic evaluation of 29 feet.
abstract: BACKGROUND
  Patients with cerebral palsy, syndromes, myopathies, and other forms of neurological impairment can develop planovalgus foot deformity of variable degrees of severity. Several techniques have already been described to resolve the deformity with variable results. Talonavicular arthrodesis is a well-known technique in adult patients, but to our knowledge, it has not been described in children with neurological impairment.
  
  
  METHODS
  We performed a retrospective chart and radiographic review of 18 neurological patients (10 boys, 8 girls) with a mean age of 11.3 ± 2.6 years (range, 7 to 19 y) who underwent talonavicular arthrodesis for flat foot deformity between 1998 and 2009, at our center.
  
  
  RESULTS
  Of a total of 29 feet, talonavicular arthrodesis was judged satisfactory in 28 feet, whereas 1 had unsatisfactory results according to the Yoo clinical outcome scoring scale. Subjective observations reported that 3 feet from 2 patients were painful preoperatively and none after last follow-up. Functionally, 2 of 13 patients were able to stop using braces after surgery. The significant improvement achieved postoperatively in radiographic measurement angles was maintained at last follow-up without any loss of angle correction.
  
  
  CONCLUSIONS
  Talonavicular arthrodesis seems to achieve a reliable hind foot fixation in flat foot in patients with neurological impairment.
  
  
  METHODS
  Case series.
authors.affiliation: Department of Child and Adolescent, Pediatric Orthopaedic Service, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. geraldo.decoulon@hcuge.ch
authors.forename: Geraldo
authors.initials: G
authors.lastname: de Coulon
authors.forename: Katia
authors.initials: K
authors.lastname: Turcot
authors.forename: Federico
authors.initials: F
authors.lastname: Canavese
authors.forename: Romain
authors.initials: R
authors.lastname: Dayer
authors.forename: Andre
authors.initials: A
authors.lastname: Kaelin
authors.forename: Dimitri
authors.initials: D
authors.lastname: Ceroni
mesh_terms: D000293:Adolescent; D001174:Arthrodesis / Q000379:methods*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D005260:Female; D005413:Flatfoot / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult