Treatment of Symptomatic Flexible Flat Foot in Pediatrics with A Modified Mosca's Lateral Column Lengthening

Background: The optimal treatment of flat foot is still controversial. In this study, we evaluated the outcome the Mosca's lateral column lengthening with the advancement of the tibialis posterior. Methods: In a retrospective study . fifty symptomatic pediatric flexible flat feet with or without hindfoot valgus were ‎included in this study. Lateral column lengthening was done as described by Mosca. ‎The tibialis posterior advancement was made on the navicular bone instead of the medial cuneiform. Radiographic measures of outcome were evaluated before the surgery and immediately ‎after the surgery and included Calcaneal Inclination (Pitch) Angle, Talonavicular Coverage ‎Angle, Talo-1st metatarsal Angle (Meary's Angle), Lateral Talocalcaneal Angle, Anteroposterior ‎Talocalcaneal Angle (kite's angle), and Talar Declination Angle (Talo-Horizontal Angle).‎ A paired t-test or its nonparametric counterpart (Wilcoxon T-test) was used to compare the mean value of preoperative and postoperative measures. A chi-square test was used to compare qualitative variables Results: The mean age of the patients was ‎9.2±2.2‎‏ years‎. ‎The mean follow‎-‎up of the patients was ‏‎2.6±1.1‎‏ ‏years‎. All radiographic measures were significantly improved after the surgery. According to the radiographic measures, under-correction was seen in seven feet. Overcorrection was seen in one of the patients. Union of the osteotomy site was observed in all feet. No patients had postoperative pain or limited ankle range of motion. One superficial infection occurred that was managed with oral antibiotics. Conclusion: Lateral column lengthening and advancement of tibials posterior on navicular bone is a safe and effective procedure in the treatment of the symptomatic pediatric flexible flat foot.