Dynamics of feet dorsiflexion after percutaneous Achilles lengthening for correction of flat feet in children

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Abstract

BACKGROUND: Achilloplasty is one of the most common procedures in the reconstruction of various foot deformities. Achilles tendon lengthening is often used in most reconstructive interventions in patients with flatfeet. Literature data reflecting the dynamics of foot dorsiflexion after percutaneous achilloplasty are limited.

AIM: This study aimed to determine the foot dorsiflexion dynamics in children with flatfeet at different time points after foot reconstruction in combination with percutaneous Achilles tendon lengthening.

MATERIALS AND METHODS: The study included the observation results of 159 children (260 feet) aged 12 (9–17) years having flatfeet with Achilles tendon shortening after flatfoot reconstruction and percutaneous Achilles tendon lengthening. Dynamic follow-up was performed for 3 years after foot reconstruction. The obtained data were analyzed statistically by nonparametric one-factor analysis of variance, Kruskal–Wallis and post hoc test, pairwise comparisons, and Dwass–Steel–Critchlow–Fligner test.

RESULTS: At follow-up after Achilles tendon lengthening, significant differences were obtained in the magnitude of the initial foot dorsiflexion up to 2 years after surgery, and other indicators were not significantly different. Foot dorsiflexion with tarsal joint stabilization was significantly different at all stages of follow-up compared with baseline. Foot dorsiflexion tended to decrease throughout the follow-up period.

CONCLUSIONS: After reconstructive interventions on the feet in combination with percutaneous Achilles tendon lengthening, the dorsiflexion of the feet decreased over time. At 2 and 3 years after Achilles surgery, dorsiflexion was not significantly different from baseline. The angle of dorsiflexion of the feet with the tarsal joint stabilization 3 years after Achilles tendon lengthening was significantly different from the initial level, but throughout the follow-up there was also a tendency to its gradual decrease.

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About the authors

Andrey V. Sapogovskiy

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: sapogovskiy@gmail.com
ORCID iD: 0000-0002-5762-4477
SPIN-code: 2068-2102

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Olga E. Agranovich

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN-code: 4393-3694

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Vladimir M. Kenis

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: kenis@mail.ru
ORCID iD: 0000-0002-7651-8485
SPIN-code: 5597-8832

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

Svetlana I. Trofimova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: trofimova_sv@mail.ru
ORCID iD: 0000-0003-2690-7842
SPIN-code: 5833-6770

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Ekaterina V. Petrova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: pet_kitten@mail.ru
ORCID iD: 0000-0002-1596-3358
SPIN-code: 2492-1260

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

References

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Research design

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3. Fig. 2. Preliminary sample calculation with a power of more than 90% and a hypothetical effect size of 0.7

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4. Fig. 3. Radiographs depicting the different options for reconstruction of feet with flatfeet: a, arthroereisis of the subtalar joint with insertion of a screw into the talus; b, arthroereisis of the subtalar joint with insertion of a screw into the calcaneal bone; c, lengthening osteotomy of the calcaneal bone

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5. Fig. 4. Schematic representation of percutaneous achilloplasty using the Hoke technique. The sequence of incisions is denoted by the numerals

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6. Fig. 5. Method for determining the degree of foot dorsiflexion: a, dorsiflexion of the foot; b, dorsiflexion with extension of the big toe

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7. Fig. 6. Graph illustrating alterations in hindfoot valgus at different times after surgical treatment

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8. Fig. 7. Graphs depicting the dynamics of the foot dorsiflexion parameters when monitoring the natural course of the disease and at different durations following the feet reconstruction in combination with percutaneous achilloplasty: a, foot dorsiflexion; b, dorsiflexion with extension of the big toe. The red line indicates the initial median values of dorsiflexion

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9. Fig. 8. Graphs illustrating the foot dorsiflexion dynamics after percutaneous achilloplasty during one-way analysis of variance: a, foot dorsiflexion; b, dorsiflexion with extension of the big toe. Square brackets above the graphs indicate significant intergroup differences (p < 0.05; pairwise comparisons — Dunn test, Holm method)

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