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[The results of calcaneal lengthening osteotomy for the treatment of flexible pes planovalgus and evaluation of alignment of the foot].

OBJECTIVES
We evaluated the results of calcaneal lengthening using the modified Evans osteotomy technique in patients with flexible pes planovalgus and the effectiveness of this technique in restoring the alignment of the foot.


METHODS
Calcaneal lengthening osteotomy was performed using the modified Evans technique in 22 feet of 11 patients (6 males, 5 females; mean age at the end of follow-up, 10 years 10 months; range 5 years 6 months to 14 years 8 months) with flexible pes planovalgus deformity. Etiologies were cerebral palsy (n=5), sequela of myelomeningocele (n=1), and sensorimotor polyneuropathy (n=1); four patients were evaluated as idiopathic. All the patients received long-term conservative therapy preoperatively, and, except for one patient, none had undergone surgery for the deformity. All patients but one were operated on bilaterally at a single session. Clinical assessment was based on 10 parameters, and radiographic assessment was based on seven parameters on standard anteroposterior and lateral radiographs. The mean follow-up was 18 months (range 13 to 75 months).


RESULTS
Radiographically, union was achieved in all the patients after a mean of seven weeks (range 6 to 8 weeks). Clinical results were perfect in 17 feet (77.3%), good in three feet (13.6%), fair in one foot (4.6%), and poor in one foot. Radiographically, five feet (22.7%), 13 feet (59.1%), and four feet (18.2%) were assessed as perfect, good, and fair, respectively. An average of 7.3 mm (range 4 to 9 mm) of calcaneal lengthening was obtained (p<0.05). Malpositioning of the graft or overcorrection did not occur. Before surgery, five patients could walk on the heel with (n=3) or without (n=2) support; postoperatively, all the patients but one could perform this without support.


CONCLUSION
Calcaneal lengthening osteotomy for symptomatic pes planovalgus provides pain relief and significant clinical and radiographic correction in the hind foot and forefoot.