Lateral column lengthening for adolescent idiopathic pes planovalgus deformity - Systematic review.

Abstract

Pes planovalgus is the commonest foot deformity in children and presents with wide range of severity and symptoms. Surgery is mostly indicated for significant malalignment, resistant to non-surgical management. Lateral column lengthening is considered an appealing option as does not involve arthrodesis and allows for further growth and foot development. We conducted a systematic review on lateral column lengthening for pes planovalgus deformity in line with PRISMA-P Checklist. We carried out detailed literature search on PubMed, Cochrane, EMBASE, CINAHL, Google Scholar and Bibliographies. We analysed selected studies for patient demographics, radiological, clinical outcome and complications. We identified seven studies with 103 patients involving 156 feet. The mean age was 13.3 years (Range 5.7-42) and mean follow up was 70.2 Months (Range 24.9-156). There was statistical significant improvement in Calcaneal pitch, Lateral Talo-metatarsal and AP Talo-navicular angles (p-value 0.001). The mean preoperative AOFAS Score (71 Feet) was 58.85 (Range 34-78) and mean postoperative AOFAS Score (91 Feet) was 92.25 (Range 73-100). Two studies (32 Feet) used author specified criteria has reported Good/Excellent result in 72% (23/32 feet) and Fair/Poor result in 18% (9/32) feet. Complications were reported in 17.5% (18/103) included nerve related, pseudo arthrosis, non-union and metal related complications. Surgical intervention with lateral column lengthening has good radiological and clinical outcome with high patient satisfaction and acceptable complications. The literature is mostly retrospective and there is need for prospective, multi-centre studies using patient centred validated outcome measure.