Comparison Between Calcaneal Lengthening Osteotomy and Calcaneo-Stop Procedure in the Surgical Treatment of Idiopathic Flatfoot in Children: Retrospective Cohort Study.

Background: This retrospective cohort study aimed to compare the radiographic and clinical outcomes after calcaneal lengthening (CL) osteotomy and calcaneo-stop (C-stop) procedures in children with flatfoot deformity.

Methods: We enrolled 127 children (223 feet) who underwent CL osteotomy (165 feet) or C-stop procedures (58 feet) for flatfoot deformity between May 2003 and December 2022. The Oxford Ankle-Foot Questionnaire (OAFQ) was administered preoperatively and postoperatively. Radiographic assessments, including the anteroposterior (AP) talus-first metatarsal angle, AP talus-second metatarsal angle, talonavicular coverage angle, lateral talus-first metatarsal angle, naviculocuboid overlap, calcaneal pitch angle, and calcaneocuboid joint subluxation, were conducted on preoperative, postoperative, and final foot-ankle standing radiographs. Radiologic and clinical outcomes were compared between the 2 groups.

Results: The immobilization period was significantly longer in the CL group than in the C-stop group (P < .001). All radiographic parameters improved significantly after surgery in both groups. However, between the postoperative period and the final follow-up, AP talus-second metatarsal angle and naviculocuboid overlap significantly increased in both groups, and talonavicular coverage angle significantly increased in the CL group. Additionally, calcaneocuboid subluxation developed after surgery in the CL group but significantly improved at the final follow-up (P < .001). There was no significant difference in complication rates between the 2 groups (P = .521). Major complications, including nonunion of the osteotomy site and Achilles tendon rupture, occurred in 6 feet (3.6%) in the CL group and overcorrection of deformity in 1 foot (1.7%) in the C-stop group. All domains and total scores on the OAFQ significantly improved after surgery in both groups.

Conclusions: Both CL osteotomy and the C-stop procedure showed satisfactory radiologic and clinical outcomes for correcting pediatric flatfoot deformities. Clinicians should take into account that the C-stop procedure is less invasive, and requires a shorter immobilization period compared with CL osteotomy, but it necessitates a secondary procedure for screw removal.