Plantar pressure and radiographic changes after distal calcaneal lengthening in children and adolescents

Eleven feet (nine patients) with symptomatic flatfoot deformities of various etiologies that had failed nonoperative treatment underwent distal calcaneal lengthenings. Pre- and postoperative plantar pressure measurements and radiographic parameters were compared and a postoperative clinical evaluation was performed using the AOFAS ankle and hindfoot scoring system. Follow-up ranged from 4 to 20 months (mean, 11.1 months). Plantar pressure parameters including contact area, mean, and peak pressures indicated significant lateral shifts in the weight-bearing surface of the foot. The most significant radiographic changes were an improvement in the talonavicular coverage angle (mean, 17.3 degrees) on the anteroposterior view and an improvement in the talo-first metatarsal angle (16.2 degrees) on the lateral view. The average postoperative American Orthopedic Foot and Ankle Society score was 90 with seven excellent, three good, and one poor results.