Percutaneous Minimal Invasive Achilles Tendon Lengthening Improves Clinical and Radiographic Outcomes in Severe Flexible Flatfeet with Shortened Triceps Sureae Complex in Early Childhood: A Retrospective Study

Background: Severe flexible flatfeet with triceps surae complex shortening are prognostically unfavorable in early childhood and may compromise normal foot development.Methods: This retrospective, IRB-approved study included 20 children (38 feet) under 6 years with severe flexible flatfeet and triceps surae complex shortening. Treatment included minimally invasive percutaneous achilles tendon lengthening followed by a 4-week cast fixation and corrective orthotic therapy under talo-navicular reposition for at least 6-months. Preoperative weightbearing x-rays and at the last available follow-up included anteroposterior talus-first metatarsal angle and lateral talus pitch, Meary's and talo-calcaneal angle and were compared to reference values. ROM, surgeon-rated clinical outcomes and com-plications/re-interventions were evaluated.Results: Age at surgery was 3.7 years (1.3-5.9 y) and follow-up time was 4.3 years (1.1-8.9 y). No com-plications occurred. Clinical outcome was good (68 %) to very good (26 %). Ratio of normal angles increased significantly for three angles. Dorsiflexion ROM improved from -5.0 +/- 6.8 degrees at baseline to 15.7 +/- 7.6 degrees.Conclusions: With significant improvements in clinical and radiographic outcomes, minimal-invasive per-cutaneous Achilles tendon lengthening followed by orthotic therapy seems to be a valuable treatment option for selected preschool-aged patients with severe, flexible flatfeet with significantly shortened triceps surae.Level of Evidence: IV (c) 2022 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.