title: Calcaneal Z Lengthening Osteotomy Combined With Subtalar Arthroereisis for Severe Adolescent Flexible Flatfoot Reconstruction.
abstract: BACKGROUND
  The timing and strategy for operative treatment of flatfoot are still controversial. The purpose of this study was to evaluate clinical outcomes and radiographic changes following calcaneal Z osteotomy combined with subtalar arthroereisis for severe adolescent flexible flatfoot.
  
  
  METHODS
  Data were analyzed for 16 patients (20 feet) who had flatfoot without tibialis posterior tendon dysfunction and were treated by calcaneal Z osteotomy combined with arthroereisis between October 2011 and February 2015. The mean age of patients at the time of surgery was 12.8 ± 1.4 years (range, 10-14 years). Preoperative and postoperative measurements included changes in hindfoot valgus angles; changes in talonavicular uncoverage angles on anteroposterior (AP) radiographic view; and changes in talo-first metatarsal angles, talar pitch angles, and calcaneal pitch angles on lateral radiographic view. The American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AH) was used to assess foot function. The mean follow-up was 18.9 ± 6.9 months (range, 13-33 months).
  
  
  RESULTS
  The hindfoot valgus angle improved from 14.9 ± 4.2 degrees to 2.3 ± 1.7 degrees. On the AP view, the preoperative and postoperative talonavicular uncoverage angles were 30.5 ± 9.4 degrees and 9.8 ± 4.8 degrees, respectively. On lateral radiographs, the preoperative talo-first metatarsal angle, talar pitch angle, and calcaneal pitch angle were -22.1 ± 7.9 degrees, 36.1 ± 4.4 degrees, and 14.4 ± 4.0 degrees, respectively. Postoperative lateral radiographs demonstrated talo-first metatarsal angle, talar pitch angle, and calcaneal pitch angle of -6.2 ± 4.7 degrees, 27.3 ± 4.9 degrees, and 19.0 ± 4.3 degrees, respectively. The AOFAS-AH score improved from 66.8 ± 24.1 preoperatively to 96.5 ± 3.4 postoperatively.
  
  
  CONCLUSIONS
  For adolescents with flatfoot, calcaneal Z osteotomy combined with subtalar arthroereisis provided satisfactory results.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.|Shanghai Institute of Traumatology and Orthopedics, Shanghai, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.|Shanghai Institute of Traumatology and Orthopedics, Shanghai, China.
authors.forename: Xing-Chen
authors.initials: XC
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China xu664531@hotmail.com.|Shanghai Institute of Traumatology and Orthopedics, Shanghai, China.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Xu
mesh_terms: D002111:Calcaneus / Q000503:physiopathology / Q000601:surgery*; D005413:Flatfoot / Q000503:physiopathology / Q000601:surgery*; D005531:Foot Deformities, Acquired / Q000503:physiopathology*; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D037081:Posterior Tibial Tendon Dysfunction / Q000503:physiopathology*; D011859:Radiography; D012189:Retrospective Studies; D013710:Tendons / Q000503:physiopathology*
keywords: arthroereisis; flatfoot; lateral column lengthening; reconstruction