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KMID : 0361620180530050407
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Journal of the Korean Orthopaedic Association
2018 Volume.53 No. 5 p.407 ~ p.414
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Evaluation of the Outcomes according to Etiology in the Pediatric Pes Planovalgus after Lateral Column Lengthening: By Radiologic and Pedobarographic Measurements
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Lee Won-Gyun
Jung Sung-Taek
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Abstract
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Purpose: Pes planovalgus is one of the most common foot deformities among pediatric orthopedic diseases and is divided into idiopathic and neuromuscular planovalgus according to its etiology. This study evaluated the radiologic and pedobarographic outcomes of the treatment for pes planovalgus in children treated with lateral column lengthening, compared the outcomes according to the etiology, and investigated the correlation between the radiologic and pedobarographic findings.
Materials and Methods: Sixty-three patients (97 feet), who underwent lateral column lengthening, were divided into groups of 30 patients (47 feet) with neuromuscular disease and 33 patients (50 feet) with idiopathic etiology. The preoperative, immediately postoperative, 1 year, and 3 year follow-up radiographic measurements on the plain radiograph antero-posterior (AP) and lateral view were compared. In pedobarography, the foot pressures were subdivided into 4 areas to measure the contact time, contact area, peak pressure, and maximum force. The pre- and postoperative pedobarographic measurements were compared and the correlations between the radiographic and pedobarographic measurements were evaluated.
Results: The radiographic index at the 1st postoperative year and 3rd postoperative follow-up did not show significant differences according to the etiology. In pedobarography, idiopathic planovalgus showed a significant increase in the maximum force in the hindfoot and forefoot. The correlation between the radiologic findings and pedobarographic findings was statistically significant between the tibiocalcaneal angle in the lateral view and the maximum force, and the contact area of hindfoot on pedobarography, between tibiocalcaneal angle in the lateral view and the contact area of the toes in idiopathic planovalgus. In neuromuscular planovalgus, the peak pressure in the hindfoot had a strong negative correlation with talonavicular coverage angle in the AP view and talo-1st metatarsal angle, and the talohorizontal angle in the lateral view.
Conclusion: Lateral column lengthening is an effective surgical procedure for flatfoot patients. On the other hand, the radiographic examination has limitations for accurate assessments of the postoperative results and prognosis. Qualitative and quantitative evaluations are available by pedobarography and it is a useful instrument for an evaluation of planovalgus when used in conjunction with radiography.
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KEYWORD
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flexible flatfoot, lateral column lengthening, pedobarography
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