Outcomes of Flexible Flatfoot Deformity Reconstruction in the Young Patient

Abstract

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Surgical correction of the collapsing flatfoot deformity has been well studied in the literature, with the average patient being a female in her 50s. While reconstruction of the flexible, symptomatic flatfoot in children and adolescents has been described, assessment of outcomes across age groups is limited. Therefore, the purpose of our study is to compare the clinical and radiographic outcomes in younger patients 30 years or less undergoing flatfoot reconstruction with that of older patients. In addition, the procedures performed for reconstruction and the incidence of subsequent reoperations were compared between the two groups. Methods: Ninety-four feet (51 left, 43 right) in 87 patients who underwent reconstruction for flexible collapsing flatfoot deformity were divided into 2 groups based on age: 30 years (n=72). Exclusion criteria included tarsal coalition or neuromuscular disease. Average age and BMI was 20.8 years (range, 13 to 30) and 26.8 (range, 18 to 38) in the younger cohort, and 57.5 years (range, 35 to 81) and 29.8 (range, 18 to 46) in the older cohort. Preoperative and minimum 2-year postoperative PROMIS scores were compared. Average follow-up was 30.6 and 27 months in the younger and older cohorts, respectively. We assessed five radiographic parameters both preoperatively and postoperatively, including talonavicular (TN) coverage angle, lateral talo-first metatarsal angle (Meary’s), lateral talocalcaneal angle, calcaneal pitch, and hindfoot moment arm (HMA). Operative reports and hospital records were reviewed to compare procedures performed for reconstruction as well as subsequent reoperations. Results: Younger patients demonstrated significant preoperative to postoperative improvements in Physical Function (p=0.01), Pain Interference (p<0.01), and Pain Intensity (p<0.01), with significantly greater improvement in Physical Function by 4.2 points (95% CI = 0.9 to 7.6, p=0.01) compared to the older cohort. All radiographic parameters demonstrated significant improvement (p<0.01) with no differences between the two groups. Younger patients were more likely to undergo Cotton osteotomy and deltoid ligament repair (p=0.01), and less likely to undergo flexor digitorum longus transfer, first tarsometatarsal fusion, spring ligament repair, and posterior tibial tendon repair (p<0.01). There were 8 (36.4%) reoperations in the younger group with painful hardware removal (ROH), and 27 (37.5%) in the older group (1 conversion to triple arthrodesis, 3 non-unions, 4 repeat medializing calcaneal osteotomies, 19 ROH). Conclusion: While the approach to surgical correction of younger patients with symptomatic, collapsing flatfoot deformity is similar to that of older adult patients, our data suggest that age may play a role in clinical outcomes, procedures indicated, and subsequent corrective reoperations. These findings point towards the efficacy of surgical correction in addressing this symptomatic pathology at a younger age.