International Orthopaedics

, Volume 43, Issue 5, pp 1179–1192 | Cite as

Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review

  • Dong Hun Suh
  • Jung Ho Park
  • Soon Hyuck Lee
  • Hak Jun Kim
  • Young Hwan Park
  • Woo Young Jang
  • Jung Heum Baek
  • Hyun Jae Sung
  • Gi Won ChoiEmail author
Review Article



This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and arthroereisis (AR) for treating symptomatic flatfoot in children.


We conducted a comprehensive search on MEDLINE, EMBASE, and Cochrane Library databases. Literature search, data extraction, and quality assessment were conducted by two independent reviewers. The outcomes analyzed included radiographic parameters, clinical scores, satisfaction, complications, and re-operations.


Twenty-one and 13 studies were included in the LCL and AR groups, respectively. The change in anteroposterior talo-first metatarsal angle was greater in the LCL (9.5° to 21.7°) than in the AR group (10.6° to 12.8°). The change in calcaneal pitch was greater in the LCL (2.1° to 26.53°) than in the AR group (− 1.3° to 3.23°). Improvements in the American Orthopedic Foot and Ankle Society (AOFAS) ankle–hindfoot score were greater in the LCL (27.7 to 39.1) than in the AR group (17 to 22). The percentage of satisfaction was similar between the LCL (68% to 89%) and AR (78.5% to 96.4%) groups. The complication rate was higher in the LCL (0% to 86.9%) than in the AR group (3.5% to 45%). The most common complications were calcaneocuboid subluxation and persistent pain in the LCL and AR groups, respectively. The re-operation rate was similar between the LCL (0% to 27.3%) and AR (0% to 36.4%) groups.


The LCL group has achieved more radiographic corrections and more improvements in the AOFAS score than the AR group. Complications were more common in the LCL group than in the AR group, and the re-operation rates were similar between the two groups.


Flatfoot Subtalar arthroereisis Lateral column lengthening Calcaneal lengthening Children Systematic review 



  1. 1.
    Bouchard M, Mosca VS (2014) Flatfoot deformity in children and adolescents: surgical indications and management. J Am Acad Orthop Surg 22:623–632. CrossRefPubMedGoogle Scholar
  2. 2.
    Fernandez de Retana P, Alvarez F, Viladot R (2010) Subtalar arthroereisis in pediatric flatfoot reconstruction. Foot Ankle Clin 15:323–335. CrossRefPubMedGoogle Scholar
  3. 3.
    Mourkus H, Prem H (2018) Double calcaneal osteotomy with minimally invasive surgery for the treatment of severe flexible flatfeet. Int Orthop 42:2123–2129. CrossRefPubMedGoogle Scholar
  4. 4.
    Chong DY, Macwilliams BA, Hennessey TA, Teske N, Stevens PM (2015) Prospective comparison of subtalar arthroereisis with lateral column lengthening for painful flatfeet. J Pediatr Orthop B 24:345–353. CrossRefPubMedGoogle Scholar
  5. 5.
    Andreacchio A, Orellana CA, Miller F, Bowen TR (2000) Lateral column lengthening as treatment for planovalgus foot deformity in ambulatory children with spastic cerebral palsy. J Pediatr Orthop 20:501–505PubMedGoogle Scholar
  6. 6.
    Evans D (1975) Calcaneo-valgus deformity. J Bone Joint Surg Br 57:270–278CrossRefPubMedGoogle Scholar
  7. 7.
    Mosca VS (1995) Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot. J Bone Joint Surg Am 77:500–512CrossRefPubMedGoogle Scholar
  8. 8.
    Moraleda L, Salcedo M, Bastrom TP, Wenger DR, Albinana J, Mubarak SJ (2012) Comparison of the calcaneo-cuboid-cuneiform osteotomies and the calcaneal lengthening osteotomy in the surgical treatment of symptomatic flexible flatfoot. J Pediatr Orthop 32:821–829. CrossRefPubMedGoogle Scholar
  9. 9.
    Zeifang F, Breusch SJ, Doderlein L (2006) Evans calcaneal lengthening procedure for spastic flexible flatfoot in 32 patients (46 feet) with a followup of 3 to 9 years. Foot Ankle Int 27:500–507CrossRefPubMedGoogle Scholar
  10. 10.
    Martinelli N, Bianchi A, Martinkevich P, Sartorelli E, Romeo G, Bonifacini C, Malerba F (2017) Return to sport activities after subtalar arthroereisis for correction of pediatric flexible flatfoot. J Pediatr Orthop B 27:82–87. CrossRefGoogle Scholar
  11. 11.
    Mosca VS (2010) Flexible flatfoot in children and adolescents. J Child Orthop 4:107–121. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Schon LC (2007) Subtalar arthroereisis: a new exploration of an old concept. Foot Ankle Clin 12:329–339CrossRefPubMedGoogle Scholar
  13. 13.
    Needleman RL (2006) A surgical approach for flexible flatfeet in adults including a subtalar arthroereisis with the MBA sinus tarsi implant. Foot Ankle Int 27:9–18CrossRefPubMedGoogle Scholar
  14. 14.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Martinkevich P, Rahbek O, Stilling M, Pedersen LK, Gottliebsen M, Soballe K, Moller-Madsen B (2016) Is structural hydroxyapatite tricalcium-phosphate graft or tricortical iliac crest autograft better for calcaneal lengthening osteotomy in childhood? Interim results from a randomised, controlled non-inferiority study. Bone Joint J 98-B:1554–1562CrossRefPubMedGoogle Scholar
  16. 16.
    Westberry DE, Davids JR, Anderson JP, Pugh LI, Davis RB, Hardin JW (2013) The operative correction of symptomatic flat foot deformities in children: the relationship between static alignment and dynamic loading. Bone Joint J 95-B:706–713. CrossRefPubMedGoogle Scholar
  17. 17.
    Viegas GV (2003) Reconstruction of the pediatric flexible planovalgus foot by using an Evans calcaneal osteotomy and augmentative medial split tibialis anterior tendon transfer. J Foot Ankle Surg 42:199–207CrossRefPubMedGoogle Scholar
  18. 18.
    Rhodes J, Mansour A, Frickman A, Pritchard B, Flynn K, Pan Z, Chang F, Miller N (2017) Comparison of allograft and bovine xenograft in calcaneal lengthening osteotomy for flatfoot deformity in cerebral palsy. J Pediatr Orthop B 37:e202–e208. CrossRefGoogle Scholar
  19. 19.
    Marengo L, Canavese F, Mansour M, Dimeglio A, Bonnel F (2017) Clinical and radiological outcome of calcaneal lengthening osteotomy for flatfoot deformity in skeletally immature patients. Eur J Orthop Surg Traumatol 27:989–996. CrossRefPubMedGoogle Scholar
  20. 20.
    Kim JR, Shin SJ, Wang SI, Kang SM (2013) Comparison of lateral opening wedge calcaneal osteotomy and medial calcaneal sliding-opening wedge cuboid-closing wedge cuneiform osteotomy for correction of planovalgus foot deformity in children. J Foot Ankle Surg 52:162–166. CrossRefPubMedGoogle Scholar
  21. 21.
    Noritake K, Yoshihashi Y, Miyata T (2005) Calcaneal lengthening for planovalgus foot deformity in children with spastic cerebral palsy. J Pediatr Orthop B 14:274–279CrossRefPubMedGoogle Scholar
  22. 22.
    Oeffinger DJ, Pectol RW Jr, Tylkowski CM (2000) Foot pressure and radiographic outcome measures of lateral column lengthening for pes planovalgus deformity. Gait Posture 12:189–195CrossRefPubMedGoogle Scholar
  23. 23.
    Luo CA, Kao HK, Lee WC, Yang WE, Chang CH (2017) Limits of calcaneal lengthening for treating planovalgus foot deformity in children with cerebral palsy. Foot Ankle Int 38:863–869. CrossRefPubMedGoogle Scholar
  24. 24.
    Lee IH, Chung CY, Lee KM, Kwon SS, Moon SY, Jung KJ, Chung MK, Park MS (2015) Incidence and risk factors of allograft bone failure after calcaneal lengthening. Clin Orthop Relat Res 473:1765–1774. CrossRefPubMedGoogle Scholar
  25. 25.
    Kadhim M, Holmes L Jr, Miller F (2013) Long-term outcome of planovalgus foot surgical correction in children with cerebral palsy. J Foot Ankle Surg 52:697–703. CrossRefPubMedGoogle Scholar
  26. 26.
    Dogan A, Zorer G, Mumcuoglu EI, Akman EY (2009) A comparison of two different techniques in the surgical treatment of flexible pes planovalgus: calcaneal lengthening and extra-articular subtalar arthrodesis. J Pediatr Orthop B 18:167–175. CrossRefPubMedGoogle Scholar
  27. 27.
    Ettl V, Wollmerstedt N, Kirschner S, Morrison R, Pasold E, Raab P (2009) Calcaneal lengthening for planovalgus deformity in children with cerebral palsy. Foot Ankle Int 30:398–404. CrossRefPubMedGoogle Scholar
  28. 28.
    Adams SB Jr, Simpson AW, Pugh LI, Stasikelis PJ (2009) Calcaneocuboid joint subluxation after calcaneal lengthening for planovalgus foot deformity in children with cerebral palsy. J Pediatr Orthop 29:170–174. CrossRefPubMedGoogle Scholar
  29. 29.
    Kwak YH, Park KB, Park HW, Kim HW (2008) Use of allograft in skeletally immature patients for calcaneal neck lengthening osteotomy. Yonsei Med J 49:79–83. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Yoo WJ, Chung CY, Choi IH, Cho TJ, Kim DH (2005) Calcaneal lengthening for the planovalgus foot deformity in children with cerebral palsy. J Pediatr Orthop 25:781–785CrossRefPubMedGoogle Scholar
  31. 31.
    Danko AM, Allen B Jr, Pugh L, Stasikelis P (2004) Early graft failure in lateral column lengthening. J Pediatr Orthop 24:716–720CrossRefPubMedGoogle Scholar
  32. 32.
    Jay RM, Din N (2013) Correcting pediatric flatfoot with subtalar arthroereisis and gastrocnemius recession: a retrospective study. Foot ankle Spec 6:101–107. CrossRefPubMedGoogle Scholar
  33. 33.
    Scharer BM, Black BE, Sockrider N (2010) Treatment of painful pediatric flatfoot with Maxwell-Brancheau subtalar arthroereisis implant a retrospective radiographic review. Foot Ankle Spec 3:67–72. CrossRefPubMedGoogle Scholar
  34. 34.
    Cao L, Miao XD, Wu YP, Zhang XF, Zhang Q (2017) Therapeutic outcomes of Kalix II in treating juvenile flexible flatfoot. Orthop Surg 9:20–27. CrossRefPubMedGoogle Scholar
  35. 35.
    Smith RD, Rappaport MJ (1983) Subtalar arthroereisis. A four-year follow-up study. J Am Podiatry Assoc 73:356–361CrossRefPubMedGoogle Scholar
  36. 36.
    Wen J, Liu H, Xiao S, Li X, Fang K, Zeng M, Tang Z, Cao S, Li F (2017) Comparison of mid-term efficacy of spastic flatfoot in ambulant children with cerebral palsy by 2 different methods. Medicine (Baltimore) 96:e7044. CrossRefGoogle Scholar
  37. 37.
    Molayem I, Persiani P, Marcovici LL, Rosi S, Calistri A, Villani C (2009) Complications following correction of the planovalgus foot in cerebral palsy by arthroereisis. Acta Orthop Belg 75:374–379PubMedGoogle Scholar
  38. 38.
    Viladot A (1992) Surgical treatment of the child’s flatfoot. Clin Orthop Relat Res:34–38Google Scholar
  39. 39.
    Black PR, Betts RP, Duckworth T, Smith TW (2000) The Viladot implant in flatfooted children. Foot Ankle Int 21:478–481CrossRefPubMedGoogle Scholar
  40. 40.
    Vedantam R, Capelli AM, Schoenecker PL (1998) Subtalar arthroereisis for the correction of planovalgus foot in children with neuromuscular disorders. J Pediatr Orthop 18:294–298PubMedGoogle Scholar
  41. 41.
    Carranza-Bencano A, Zamora-Navas P, Fernandez-Velazquez JR (1997) Viladot's operation in the treatment of the child’s flatfoot. Foot Ankle Int 18:544–549CrossRefPubMedGoogle Scholar
  42. 42.
    Crawford AH, Kucharzyk D, Roy DR, Bilbo J (1990) Subtalar stabilization of the planovalgus foot by staple arthroereisis in young children who have neuromuscular problems. J Bone Joint Surg Am A 72:840–845CrossRefGoogle Scholar
  43. 43.
    Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353CrossRefGoogle Scholar
  44. 44.
    Morris C, Liabo K, Wright P, Fitzpatrick R (2007) Development of the Oxford ankle foot questionnaire: finding out how children are affected by foot and ankle problems. Child Care Health Dev 33:559–568CrossRefPubMedGoogle Scholar
  45. 45.
    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefGoogle Scholar
  46. 46.
    Ahn JY, Lee HS, Kim CH, Yang JP, Park SS (2014) Calcaneocuboid joint subluxation after the calcaneal lengthening procedure in children. Foot Ankle Int 35:677–682. CrossRefPubMedGoogle Scholar
  47. 47.
    Martinelli N, Romeo G, Bonifacini C, Vigano M, Bianchi A, Malerba F (2016) Validation of the Italian version of the Oxford Ankle Foot Questionnaire for children. Qual Life Res 25:117–123. CrossRefPubMedGoogle Scholar
  48. 48.
    Stein BE, Schon LC (2015) Posterior tibial tendon dysfunction in the adult: current concepts. Instr Course Lect 64:441–450PubMedGoogle Scholar
  49. 49.
    Metcalfe SA, Bowling FL, Reeves ND (2011) Subtalar joint arthroereisis in the management of pediatric flexible flatfoot: a critical review of the literature. Foot Ankle Int 32:1127–1139. CrossRefPubMedGoogle Scholar
  50. 50.
    Yasui Y, Tonogai I, Rosenbaum AJ, Moore DM, Takao M, Kawano H, Kennedy JG (2017) Use of the arthroereisis screw with tendoscopic delivered platelet-rich plasma for early stage adult acquired flatfoot deformity. Int Orthop 41:315–321. CrossRefPubMedGoogle Scholar
  51. 51.
    Needleman RL (2005) Current topic review: subtalar arthroereisis for the correction of flexible flatfoot. Foot Ankle Int 26:336–346CrossRefPubMedGoogle Scholar
  52. 52.
    Bourlez J, Joly-Monrigal P, Alkar F, Laborde A, Cottalorda J, Louahem D, Delpont M (2018) Does arthroscopic resection of a too-long anterior process improve static disorders of the foot in children and adolescents? Int Orthop 42:1307–1312. CrossRefPubMedGoogle Scholar
  53. 53.
    Soomekh DJ, Baravarian B (2006) Pediatric and adult flatfoot reconstruction: subtalar arthroereisis versus realignment osteotomy surgical options. Clin Podiatr Med Surg 23:695–708CrossRefPubMedGoogle Scholar
  54. 54.
    Bernasconi A, Lintz F, Sadile F (2017) The role of arthroereisis of the subtalar joint for flatfoot in children and adults. EFORT Open Rev 2:438–446. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryKorea University Ansan HospitalAnsan-siSouth Korea
  2. 2.Department of Orthopaedic SurgeryKorea University Anam HospitalSeoulSouth Korea
  3. 3.Department of Orthopaedic SurgeryKorea University Guro HospitalSeoulSouth Korea

Personalised recommendations