Comparativestudy between the calcaneo stop procedure and endorthesis in the management of pediatric symptomatic flexible flatfoot

Abstract

Purpose
The aim of the study was to compare the results of using the calcaneo stop procedure and endorthesis in the management of symptomatic flexible flatfoot (FFF) in pediatrics.


Patients and methods
This is a prospective randomized study using the closed envelope technique. It was conducted on 30 feet of 19 patients admitted in the National Institute of Neuromotor System. All cases presented with symptomatic flexible pes planovalgus. The current study started in May 2020 and ended in January 2022. Written detailed informed consents were obtained from parents. Inclusion criteria were age 7–14 years, symptomatic idiopathic FFF, failed conservative treatment, and no previous foot surgery. Exclusion criteria were children young than 7 years or older than 14 years, rigid flatfeet, asymptomatic FFF, patients with major congenital malformations, severe neurological disorders, patients with neuromuscular disorders, patients subjected to other foot surgery, and patients with traumatic flatfeet. The patients were randomly assigned into two groups: group 1 included 15 feet of nine patients (six bilateral and three unilateral) who underwent the calcaneo stop technique, and group 2 included 15 feet of 10 patients (five bilateral and five unilateral) who underwent endorthesis by subtalar fit implant. The mean age of group 1 was 9.90 ± 2.86 years (range, 7–14 years), whereas of group 2 was 9.70 ± 1.50 years (range, 8–14 years). There were 10 male patients (five underwent calcaneo stop and five endorthesis) and nine female patients (five underwent calcaneo stop and four endorthesis). The right foot was operated upon in 16 cases, and the left foot was operated upon in 14 cases. The average AOFAS preoperative score in group 1 was 68.7 ± 5.7 (range, 58–78), which was subdivided into 6.7% with good score and 86.3% with fair score, whereas in group 2, it was 70.13 ± 5.5 (range, 58–78), which was subdivided into 26.8% with good score and 73.2% with fair score.


Results
There were statistically significant improvements in both groups, with no difference in their outcomes. Both groups showed significantly improved hindfoot and midfoot motion and positioning. Hindfoot range of motion was preserved. Radiography also revealed significant improvements.


Conclusion
Both procedures are valid options for the surgical management of idiopathic symptomatic flatfoot in pediatric patients.