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Purpose: One of the most widespread diseases of children's orthopaedic problems is flatfoot. If conservative therapy failed, surgical treatment would be indicated. Lateral calcaneal lengthening (LCL) and subtalar arthroereisis (SA) are two types of operations used to correct symptomatic flexible flatfoot (FFF). The purpose of this study is to compare the functional and radiographic features of these two surgical procedures. Patients and methods: In this prospective randomized clinical trial study, we recruited 66 patients between 2018 and 2019. For clinical assessment, American Orthopedics Foot and Ankle Society (AOFAS), visual analog scale (VAS), subtalar motion, presence of medial longitudinal arch, and family satisfaction were measured. Evaluation of radiographic angles was based on AP (AP Tal-1Met) and Lat (Lat Tal-1Met) view of Talus-1st metatarsal angle (Meary's angle) and calcaneal pitch. Result: There was no significant difference between the two types of surgery regarding Lat Tal-1Met and AP Tal-1Met. The significantly larger angle in the LCL group was calcaneal pitch (P value < 0.001). AOFAS significantly increased from 68.71 ± 5.70 to 87.87 ± 7.14 (P value < 0.001) and from 67.28 ± 6.01 to 86.14 ± 7.56 (P value < 0.001) in LCL and SA respectively. Family satisfaction was significantly higher in the SA (8.14 ± 0.97) comparing to LCL (7.29 ± 0.86) at the latest follow-up (P value < 0.001). Conclusion: While both groups have substantial improvement in clinical and radiographic aspects, the SA technique is less-invasive, rapid symptom relief, and has early weight-bearing capacity. Trial registration: IRCT20180823040853N1 [ABSTRACT FROM AUTHOR]

Abstract Background Several risk factors for adult acquired flatfoot deformity (AAFD) have been identified in literature. To this date, little attention has been paid to the lateral ligament complex and its influence on AAFD, although its anatomic course and anatomic studies suggest a restriction to flatfoot deformity. The aim of this study was to assess the influence of the anterior talofibular ligament (ATFL) on AAFD and on radiologic outcome following common operative correction by lateral calcaneal lengthening. Methods We reviewed all patients that underwent lateral calcaneal lengthening for correction of AAFD between January 2008 and July 2018 at our clinic. Patients were grouped according to the preoperative MRI findings into those with an intact ATFL and those with an injured ATFL. Two independent readers assessed common radiographic flatfoot parameters on preoperative and postoperative radiographs. Results Sixty-four flatfoot corrections in 63 patients were included, whereby the ATFL was intact in 29 cases, and in 35 cases the ligament was injured. An ATFL lesion was overall radiologically associated with increased flatfoot deformity with a statistically significant difference between the two groups for preoperative talometatarsal-angle (p = 0.002), talocalcaneal-angle (p = 0.000) and talonavicular uncoverage-angle (p = 0.005). No difference between the two groups could be observed regarding the success of operative correction or operative consistency after lateral calcaneal lengthening. Conclusion The ATFL seems to influence the extent of AAFD. In patients undergoing lateral calcaneal lengthening, the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.

Background: Several risk factors for adult acquired flatfoot deformity (AAFD) have been identified in literature. To this date, little attention has been paid to the lateral ligament complex and its influence on AAFD, although its anatomic course and anatomic studies suggest a restriction to flatfoot deformity. The aim of this study was to assess the influence of the anterior talofibular ligament (ATFL) on AAFD and on radiologic outcome following common operative correction by lateral calcaneal lengthening.Methods: We reviewed all patients that underwent lateral calcaneal lengthening for correction of AAFD between January 2008 and July 2018 at our clinic. Patients were grouped according to the preoperative MRI findings into those with an intact ATFL and those with an injured ATFL. Two independent readers assessed common radiographic flatfoot parameters on preoperative and postoperative radiographs.Results: Sixty-four flatfoot corrections in 63 patients were included, whereby the ATFL was intact in 29 cases, and in 35 cases the ligament was injured. An ATFL lesion was overall radiologically associated with increased flatfoot deformity with a statistically significant difference between the two groups for preoperative talometatarsal-angle (p = 0.002), talocalcaneal-angle (p = 0.000) and talonavicular uncoverage-angle (p = 0.005). No difference between the two groups could be observed regarding the success of operative correction or operative consistency after lateral calcaneal lengthening.Conclusion: The ATFL seems to influence the extent of AAFD. In patients undergoing lateral calcaneal lengthening, the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result. [ABSTRACT FROM AUTHOR]