A modified lateral column lengthening for the treatment of flexible flatfoot: From clinical applications to finite element analysis

Abstract

Background: Finite element (FE) analysis and clinical follow-up were used to evaluate the efficacy of a modified lateral column lengthening (H-LCL) for treating flexible flatfoot.

Methods: By applying inclusion and exclusion criteria, we selected patients who underwent H-LCL surgery at our institution from January 2019 to January 2023. We compared the Visual Analog Scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Pain Interference (PI), and Physical Function (PF) scores in Patient-Reported Outcomes Measurement Information System (PROMIS) between preoperative and final follow-up assessments of patients, as well as FE submodels. Furthermore, evaluate the H-LCL's biomechanical characteristics and clinical outcome before and after surgery.

Results: A total of 66 patients met the criteria. The average surgery time was 69.47 ± 13.22 min, and the follow-up duration was 15.18 ± 6.40 months. In the last follow-up, VAS and PI decreased compared to before surgery, while AOFAS and PF increased compared to before surgery. Meary's angle (dorsoplantar image and lateral image), calcaneal valgus angle, and talonavicular coverage angle decreased compared to before surgery, while the pitch angle increased compared to before surgery. In FE analysis, postoperative tension on the plantar fascia (PF), spring ligament (SL), and posterior tibial tendon (PTT) decreased compared to before surgery, pressure on the talonavicular joint and subtalar joints also decreased compared to before surgery, and there was no significant change in pressure on the calcaneocuboid joint.

Conclusion: H-LCL in correcting flexible flatfoot resulted in a significant improvement of clinical outcome scores and led to good radiological correction of flatfoot deformities. It can reduce the soft tissue and interosseous pressure in maintaining the foot arch.

Keywords: Calcaneal osteotomy; Finite element; Flexible flatfoot; Modified lateral column lengthening.