From the Guidelines
The treatment of severe planovalgus in a 14-year-old boy should prioritize surgical correction, as conservative measures are unlikely to correct the deformity at this age, and untreated severe planovalgus can lead to long-term pain, arthritis, and functional limitations.
Key Considerations
- Prior to surgery, a thorough clinical and radiographic evaluation is essential, including weight-bearing radiographs and possibly CT or MRI to assess the exact nature of the deformity 1.
- Conservative measures can be tried initially, including custom orthotic insoles, supportive footwear, and physical therapy focusing on strengthening the posterior tibial tendon and intrinsic foot muscles, but these are primarily for symptom management rather than correction.
- Orthotics and braces, such as custom orthotic insoles, can be used to reinforce, unload, and protect tendons during activity and are valuable adjuncts to therapy, although few data support definitive conclusions regarding their effectiveness 1.
Surgical Approach
- Surgical correction through procedures such as subtalar arthroereisis, calcaneal osteotomy, or medial column reconstruction, depending on the specific characteristics of the deformity, is recommended.
- The specific surgical approach should be determined by an experienced pediatric orthopedic surgeon based on the individual characteristics of the deformity.
Post-Surgical Rehabilitation
- Post-surgical rehabilitation typically involves 6-8 weeks of non-weight-bearing or partial weight-bearing, followed by physical therapy for 3-4 months to restore strength and function.
- Surgery is justified at this age because the growth plates are nearing closure, making this an appropriate time for definitive correction.
Outcome Prioritization
- The primary goal of treatment is to improve morbidity, mortality, and quality of life by correcting the deformity and preventing long-term complications.
- The treatment plan should prioritize the individual's specific needs and characteristics, with a focus on achieving optimal outcomes and minimizing potential risks and complications.
From the Research
Treatment Options for Severe Planovalgus
- Surgical procedures for the correction and stabilization of pes planovalgus involve a combination of bony and soft tissue reconstructive techniques, taking into account the medial column of the foot, including the tibiocalcaneonavicular ligament complex, the naviculocuneiform joints, and the first tarsometatarsal joint 2.
- Conservative and surgical treatment options are available for rigid pediatric pes planovalgus, which refers to a condition of the foot with a decreased medial longitudinal arch height and significant loss of midfoot and hindfoot motion 3.
- Soft tissue reconstruction and osteotomies can be used to correct pes planovalgus, with the appropriate workup and understanding of the pathomechanics being vital to the correct choice of procedures 4.
Surgical Procedures
- Calcaneal lengthening osteotomy can be used to correct planovalgus deformity in spastic feet, with improvement noted in clinical and radiological parameters, as well as gait analysis 5.
- Osteotomies, such as lateral column lengthening and medial displacement calcaneal osteotomy, can be used to restore normal biomechanics in flexible pes planovalgus deformity, with the tight Achilles tendon being lengthened as well 6.
- The combination double osteotomy technique with a flexor digitorum longus tendon-to-medial cuneiform tendon transfer, débridement or removal of the posterior tibial tendon, and percutaneous heel cord lengthening can be used to treat stage 2 posterior tibial tendon insufficiency, with positive early and intermediate results 6.
Considerations
- The choice of surgical procedure depends on the individual case, with factors such as the severity of the deformity, the presence of any underlying conditions, and the patient's overall health being taken into account 2, 3, 4, 5, 6.
- The potential risks and complications of each procedure, such as calcaneocuboid joint arthrosis, must be carefully considered and discussed with the patient 6.