Hello, I'm Dr. Mike Conklin I'm a pediatric orthopedist at University of Alabama Birmingham and Children's of Alabama. And I'd like to talk about our experience with the double calcaneal osteotomy for correction of idiopathic pediatric flat foot deformity, like to thank my co authors, some excellent research fellows ease and Kotari and Sean young, as well as my partner, Dr. Skip Gilbert. We have no disclosures. So the double calcaneal osteotomy for correction of pediatric flat foot in our hands is a posterior medial calcaneal slide, and a lateral lateral column lengthening. We know that some authors have noted some increased lateral contact forces with large lateral column lengthenings, perhaps some discomfort with weight bearing, and even the concern about predisposition to later calcaneal cuboid arthritis. So doing a medial calcaneal slide concomitant with a lateral column lengthening allows one to do a smaller lateral column lengthening and still achieve correction. We could find no significant literature on this in children. So we did a retrospective analysis of our pediatric and adolescent patients who underwent a double calcaneal osteotomy over the last five years. This is primarily a radiographic study, as we did not prospectively collect clinical foot scores. So we compared pre and post-operative weight bearing radiographs and compared those to known normals for pediatric feet. We also looked at other factors, but primarily we looked for complications. The radiographic normal or radiographic parameters that we measured were the lateral Mary's angle, the lateral talocalcaneal angle, the calcaneal pitch, the tibiocalcaneal angle, and the talonevicular coverage angle. We had 26 feet in 20 patients. We found significant differences towards correction. For four of the five parameters, the only parameter that didn't really change was the lateral talocalcaneal angle. We noted complications in three feet, one with infection, one with some longstanding discomfort at the osteotomy site, and one with some screw extrusion. These are our radiographic results. You can see these P values here corrected nicely on four of the five parameters. We compared these ranges that you see post-operatively with normals described by John Davids for pediatric feet, and these four parameters all corrected to within normal range. This is just an example of one of our post-operative parameters. You see a pre-op and post-op x-ray and measurement of the calcaneal pitch. In conclusion, we thought that the double calcaneal osteotomy performed well in the correction of pediatric flat feet with very few complications noted. On the average, four of the five parameters corrected significantly between pre- and post-op x-rays and corrected to within normal range noted by John Davids. We feel that the double calcaneal osteotomy should be strongly considered for patients with painful pediatric and adolescent flat feet that do not respond to conservative treatment. These are the references, and thank you. For more information, visit www.FEMA.gov

Dr. Mike Conklin

pediatric orthopedist

double calcaneal osteotomy

pediatric flat foot deformity

retrospective analysis