Early Patient-Reported Outcomes Following Calcaneal Lengthening Osteotomy for Symptomatic Flexible Flatfoot

Calcaneal lengthening osteotomy (CLO) is frequently utilized to treat painful flexible flatfoot (FF) in children. The purpose of this investigation is to analyze the impact of CLO on patient reported pain and mobility using Patient Reported Outcome Measurement Information System (PROMIS) scores in a cohort of pediatric patients treated for painful FF.

Children aged 8-18 who underwent CLO for painful FF correction were included. Retrospective chart review for PROMIS scores of pain and mobility were collected. Preoperative PROMIS scores were compared to PROMIS scores collected within 6-12 months postoperatively. Five PROMIS points was determined to be a minimal clinically significant difference, as this is half of the SD of the PROMIS metric. Preoperative and postoperative AP/lateral talo-first metatarsal angles were collected and compared. The patients with residual pain (PROMIS >55) after CLO were evaluated, and the effect of potential factors on residual postoperative pain was assessed.

Twenty-one patients with 31 feet were included in the study, with an average age of 12.2 (range, 9-15) years at the time of surgery. Mean preoperative pain and mobility PROMIS scores were 53.6 (range, 32.2-69.6) and 42.5 (range, 25.5-56.4), respectively. Mean postoperative pain and mobility PROMIS scores were 47.1 (range, 32.0-59.0) and 48.3 (range, 31.6-61.7), respectively. Patients who received CLO had significant improvement in both pain (P = .005) and mobility (P = .017). Average pain and mobility decreased by 6.51 points and increased by 5.81 points, respectively, after CLO, both clinically significant improvements.

In early follow-up, we found the use of calcaneal lengthening osteotomy used to treat children for painful idiopathic flexible flatfoot to be associated with significant improvements in pain and mobility PROMIS scores.

Level IV, retrospective case series study.