Skip to main content

Advertisement

SpringerLink
Log in

Comparison between Malerba osteotomy and combined Evans/medial displacement calcaneal osteotomies for the management of flexible pes planus in young adults: a prospective randomised control trial, three years follow-up

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The aim of the current study is to evaluate the functional and radiological outcomes of Malerba osteotomy in comparison to the standardized combined Evans/Medial Displacement Calcaneal Osteotomy (MDCO) in the management of symptomatic flexible pes planus in young adults.

Methods

Prospective randomized control trial included 34 feet (33 patients), 17 cases in each group. Functionally, patients were assessed by AOFAS and FADI scores. Radiographic evaluation included calcaneal pitch, lateral talo-1st metatarsal, AP talo-first metatarsal, AP talo-calcaneal angles, and the talar coverage percentage.

Results

Pre-operative and three years follow-up scores and angles were compared between both groups. No statistically significant difference could be detected between both groups (P value 0.87). However, the data showed statistically significant difference in each group when comparing (pre-operative and third year follow-up scores and angles) (P value < 0.001). The mean union rate was eight weeks in Malerba group and nine weeks in Evans/MDCO group. No incidence of nonunion. Complications like calcaneocuboid subluxation, calcaneal anterior process fracture, and lateral column pain were exclusively reported in Evans/MDCO group.

Conclusion

Malerba osteotomy is a strong valid option for the operative management of flexible pes planus in young adults. Authors recommend Malerba osteotomy in all mild and moderate deformities due to lower complication rate while the combined Evans/MDCO is preferred in severe deformity due to relatively higher corrective power with consideration of possible complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data Availability

Yes.

Code availability

Not applicable.

References

  1. Hentges MJ, Moore KR, Catanzariti AR, Derner R (2014) Procedure selection for the flexible adult acquired flatfoot deformity. Clin Podiatr Med Surg 31:363–379. https://doi.org/10.1016/j.cpm.2014.03.003

    Article  PubMed  Google Scholar 

  2. Weil LS, Roukis TS (2001) The calcaneal scarf osteotomy: operative technique. J Foot Ankle Surg 40:178–182. https://doi.org/10.1016/S1067-2516(01)80085-5

    Article  PubMed  Google Scholar 

  3. Kitaoka HB, Alexander IJ, Adelaar RS et al (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353. https://doi.org/10.1177/107110079401500701

    Article  CAS  PubMed  Google Scholar 

  4. Martin RL, Burdett RG, Irrgang JJ (1999) The Foot and Ankle Disability Index (FADI) Score and Sports Module. J Orthop Sports Phys Ther J Athl Train 29:35–40

    Article  Google Scholar 

  5. Chan YH (2003) Biostatistics 102: quantitative data - parametric & non-parametric tests. Singapore Med J 44:391–396. https://doi.org/10.1081/E-EBS

    Article  CAS  PubMed  Google Scholar 

  6. Yontar NS, Ogut T, Guven MF et al (2016) Surgical treatment results for flexible flatfoot in adolescents. Acta Orthop Traumatol Turc 50:655–659. https://doi.org/10.1016/j.aott.2016.02.002

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chan YH (2003) Biostatistics 103: qualitative data - tests of independence. Singapore Med J 44:498–503

    CAS  PubMed  Google Scholar 

  8. Chan YH (2003) Biostatistics 104: correlational analysis. Singapore Med J 44(12):614–619

  9. Walczak M, Napiontek M (2003) Flexible flatfoot in children–a controversial subject. Chir Narzadow Ruchu Ortop Pol 68:261–267

    PubMed  Google Scholar 

  10. Vora AM, Tien TR, Parks BG, Schon LC (2006) Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer. J Bone Joint Surg - Series A 88:1726–1734. https://doi.org/10.2106/JBJS.E.00045

    Article  Google Scholar 

  11. Ellis SJ, Yu JC, Johnson AH et al (2010) Plantar pressures in patients with and without lateral foot pain after lateral column lengthening. J Bone Joint Surg - Series A 92:81–91. https://doi.org/10.2106/JBJS.H.01057

    Article  Google Scholar 

  12. Demetracopoulos CA, Nair P, Malzberg A, Deland JT (2015) Outcomes of a stepcut lengthening calcaneal osteotomy for adult-acquired flatfoot deformity. Foot Ankle Int 36:749–755. https://doi.org/10.1177/1071100715574933

    Article  PubMed  Google Scholar 

  13. 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(4):500–512

  14. Foster JR, McAlister JE, Peterson KS, Hyer CF (2017) Union rates and complications of lateral column lengthening using the interposition plating technique: a radiographic and medical record review. J Foot Ankle Surg 56:247–251. https://doi.org/10.1053/j.jfas.2016.11.014

    Article  PubMed  Google Scholar 

  15. Ozan F, Doğar F, Gençer K et al (2015) Symptomatic flexible flatfoot in adults: subtalar arthroereisis. Ther Clin Risk Manag 11:1597–1602. https://doi.org/10.2147/TCRM.S90649

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Department, Faculty of Medicine, Cairo University Kasr Alainy Hospitals, Cairo, Egypt

    Mohamed Nagy, Ahmed Kholeif, Ali M. Reda Mansour, Yasser A. Radwan, Ahmed Khedr, Ahmed S. Elhalawany, Ahmed Samir & Abo Bakr Zein

  2. Orthopaedic Surgery Department, University Hospitals of Derby and Burton, Derby, UK

    Mohamed Nagy

  3. Burton NHS Foundation Trust, Burton, UK

    Mohamed Nagy

  4. Diagnostic and Intervention Radiology Department, Faculty of Medicine, Cairo University Kasr Alainy Hospitals, Cairo, Egypt

    Samar Abdelhameed

  5. Orthopaedic Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Islam Sarhan

Authors
  1. Mohamed Nagy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed Kholeif
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali M. Reda Mansour
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Samar Abdelhameed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasser A. Radwan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmed Khedr
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ahmed S. Elhalawany
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ahmed Samir
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Islam Sarhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Abo Bakr Zein
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Setting the research plan and the operative procedures that will be involved in the study:

Ahmed Kholeif, M.Sc., M.D.

The operating surgeons:

Mohamed Nagy M.Sc., MRCS, M.D.

Abo Bakr Zein M.Sc., M.D.

The radiological measures on the PACS system:

Ahmed Khedr M.Sc., USMLE, M.D.

Samar Abdelhameed M.Sc., M.D.

Writing the introduction, patients, and method:

Islam Sarhan M.Sc., MRCS, M.D.

Ahmed S. Elhalawany M.Sc., MRCS.

Statistical analysis and writing the results:

Yasser A. Radwan M.Sc., M.D.

Writing the discussion and the abstract:

Ali M. Reda Mansour M.Sc., M.D.

Ahmed Samir M.Sc.

Corresponding author

Correspondence to Mohamed Nagy.

Ethics declarations

Ethics approval

The research has been approved by the clinical committee at the Orthopaedic Department and by the Ethical committee of the Faculty of Medicine, Cairo University.

Consent to participate

All the patients signed a consent to be participating in this randomized control trial.

Consent for publication

Authors consented to proceed for publication of the uploaded scientific material.

Conflict of interest

The authors declare no competing interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level I evidence: RCT

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nagy, M., Kholeif, A., Mansour, A.M.R. et al. Comparison between Malerba osteotomy and combined Evans/medial displacement calcaneal osteotomies for the management of flexible pes planus in young adults: a prospective randomised control trial, three years follow-up. International Orthopaedics (SICOT) 45, 2579–2588 (2021). https://doi.org/10.1007/s00264-021-05172-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-021-05172-5

Keywords

Search

Navigation