OBJECTIVE: Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA).
METHODS: A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6-17). Mean follow-up was 7 ± 2.9 years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01.
RESULTS: Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing.
CONCLUSIONS: SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications.
METHODS: IV.

BACKGROUND: While surgical stabilisation of the subtalar joint (arthroeresis) in children remains controversial in the USA, it is widely practised worldwide, with reportedly good outcomes. We are presenting a series of patients who met our criteria for calcaneal lengthening, but whose parents chose the less invasive option of talo-tarsal stabilisation (TTS). The goal of this surgery was to forestall or prevent hindfoot osteotomy.
METHODS: With IRB approval, we conducted this retrospective review of 32 patients (60 ft), who underwent TTS for flexible planovalgus deformity and had a minimum of 1-year follow-up. The aetiology was idiopathic for the majority, with a few being neurogenic or syndromic. The age range was 6-15 years; the younger patients had neuromuscular aetiology or underlying syndromes. Concomitant procedures included percutaneous Achilles lengthening (33 ft), Kidner (9 ft) and guided growth for ankle valgus (2).
RESULTS: In the early post-immobilisation phase, peroneal spasm occurred in four patients (6 ft). This resolved with Botox injection in the peroneus brevis in three patients and required transfer of the peroneus brevis to the peroneus longus in one patient. At follow-up, ranging from 1 to 4.5 years, 50 implants (83.4%) were retained and the patients reported satisfactory outcomes. Henceforth, those patients will be monitored on a p.r.n. basis. Due to lingering discomfort, implants were repositioned in one and removed in five patients (10 ft = 16.6%). Upon further follow-up, these patients have not manifested recurrent deformity. Therefore, subsequent salvage by osteotomy and/or lengthening of the calcaneus has not been necessary.
CONCLUSIONS: TTS for the symptomatic flatfoot, combined with other procedures as indicated, offers advantages over the currently more accepted methods of medial shift osteotomy or calcaneal lengthening. The outcome at 1 year is a good forecast of whether or not further treatment will be required. This is a simpler and preferred option as compared to other methods of surgical management and, in our experience, has obviated the need for osteotomy or lengthening of the calcaneus.
METHODS: IV retrospective case series.
UNASSIGNED: Stevens P, Lancaster A, Khwaja A. Talar-tarsal Stabilisation: Goals and Initial Outcomes. Strategies Trauma Limb Reconstr 2021;16(3):168-171.

UNASSIGNED: Tarsal coalitions in the general population are low, possibly due to the asymptomatic nature. In the symptomatic group, however, the presentation is usually during adolescence or early adulthood. The occurrence of a triple tarsal coalition is extremely rare, especially if not associated with a syndrome.
UNASSIGNED: We report a case that has the unique configuration of talocalcaneal, talonavicular, and calcaneocuboid coalitions with a planovalgus foot. We review the available literature on this rare occurrence and outline our management in this case to achieve a plantigrade, painless functional foot.
UNASSIGNED: Symptomatic triple coalition planovlagoid cases, require a surgical corrective procedure in order to achieve a plantigrade foot.

BACKGROUND: Posture disorders not treated in early childhood may lead to serious diseases and dysfunctions later. The aim of the study was to assess the incidence of lower limb defects in pre-school children.
METHODS: The study covered 513 children (252 girls and 261 boys) aged 4-6, in chosen kinder-gartens of the Łódź agglomeration . The child\'s body posture was assessed using a visual method based on the Kasperczyk scoring scale in own modification.
RESULTS: Foot defects occurred in the examined group with a frequency of 85.58% (439/513): in 4-year-olds: 82.59%, in 5- and 6-year-olds: 87.5%. Foot defects were more common in girls in the entire study group (86.9 vs. 84.29%), in 4-year-olds (87.88 vs. 77.45%) and 6-year-olds (88.89 vs. 86.25%), and in boys in the 5-year-olds group (91.14 vs. 83.95%). Defects of the knee joints, including varus and valgus knee, occurred in the study group with a frequency of 52.83% (271/513): in 4-year-olds: 56.72%, in 5-year-olds: 45.63% and in 6-year-olds: 55.26%. Defects were more frequent in girls in the entire study group (54.37 vs. 51.34) and in 4-year-olds (58.59 vs. 54.90%), and in boys in the 5-year-old group (50.63 vs. 40.74%). In the 6-year-olds group, the defects were statistically significantly more common in girls than boys (63.89 vs. 47.5%, p = 0.0442).
CONCLUSIONS: A high percentage of lower limb defects rate at more than half of the examined pre-school children population is disturbing and requires effective systemic action.

BACKGROUND: Calcaneal lengthening is used to correct symptomatic planovalgus foot deformity, but outcomes have been less satisfactory in children with cerebral palsy. This study aimed to define limits of calcaneal lengthening by analyzing the risk factors for undercorrection of deformity.
METHODS: We retrospectively reviewed 20 cases of children with cerebral palsy who underwent calcaneal lengthening of 30 planovalgus feet at a mean age of 11.9 years. Foot deformities were evaluated by the anteroposterior talo-first metatarsal angle (normal, 10 ± 7.0 degrees), lateral talo-first metatarsal angle (normal, 13 ± 7.5 degrees), and lateral calcaneal pitch angle (normal, 17 ± 6.0 degrees) on standing foot radiographs. Among these parameters, a corrected foot was defined as 2 or 3 parameters being corrected to within a normal range, and an undercorrected foot was only 1 or no parameter being corrected to within a normal range. Factors were compared between the corrected group and undercorrected group for significant predictors, and cutoff values of predictors were calculated for use as a clinical guideline.
RESULTS: Seventeen planovalgus feet were corrected satisfactorily by calcaneal lengthening, while the other 13 feet were undercorrected. Undercorrected feet had a greater preoperative anteroposterior talonavicular angle (33.7 vs 22.8 degrees, P = .001) and a smaller lateral calcaneal pitch (-1.7 vs 5.6 degrees, P = .03). A talonavicular angle of more than 24 degrees and calcaneal pitch less than -5 degrees were identified as cutoff values using a receiver operating characteristic curve. The predicted probability of undercorrection was 100% (9/9 feet) for 2 positive predictors, 50% (8/16 feet) for 1 positive predictor, and 0 (0/5 feet) for zero predictors.
CONCLUSIONS: A talonavicular lateral subluxation of more than 24 degrees on the anteroposterior radiograph and a calcaneal pitch angle less than -5 degrees on the lateral radiograph were 2 independent predictors that could be used to identify a planovalgus deformity that would be beyond the corrective capacity of calcaneal lengthening to restore normal alignment. Level of Evidence Retrospective case control study, level III.

BACKGROUND: We investigated radiographic changes of calcaneocuboid (CC) joint subluxation following calcaneal lengthening procedure for the treatment of pediatric planovalgus foot deformities.
METHODS: This study included 44 cases of planovalgus foot deformities in 24 patients with mean age of 9.7 (range, 8 to 13) years who underwent calcaneal lengthening between 1999 and 2011. The mean follow-up period was 25 (range, 12 to 159) months. Anteroposterior (AP) and lateral radiographs of the weight-bearing view of the foot from immediate postoperative, 3-month postoperative, and last follow-up evaluations were reviewed and also used for trend analysis. Percentage of CC joint subluxations was measured on both AP and lateral view of the foot. Correlations between the percentage of CC joint subluxation and follow-up periods were assessed.
RESULTS: All of the feet showed dorsal subluxation of their CC joint on the immediate postoperative lateral plain radiographs. The median percentage of dorsal subluxation of the CC joint improved from 26.0% (range, 10.0 to 67.0) at the immediate postoperative evaluation to 16.5% (range, 7.0 to 47.0, P = .0001) at the 3-month postoperative evaluation and to 11% (range, 2.0 to 30.0, P = .0003) at last follow-up. The trend analysis over time indicated that the CC joint subluxation percentage with calcaneal lengthening generally decreased over time (r s = -.67, P = .001). No patients showed osteoarthritic changes in the CC joint or nonunion at the calcaneal osteotomy site at last follow-up.
CONCLUSIONS: At midterm follow-up, the CC joint subluxation was gradually resolving over time, with no evidence of osteoarthritic change in the CC joint.
METHODS: Level IV, case series.