Calcaneal lengthening osteotomy using ipsilateral fibular graft in the treatment of flexible flatfoot deformity: preliminary results

Purpose Flexible flatfoot deformity is quite common among adolescents. This study aimed to report the preliminary results of calcaneal lengthening osteotomy using a fibular bone graft. Methods This single-center, retrospective study included 28 patients (28 feet) with symptomatic flexible flatfoot deformity. The deformity was corrected with calcaneal lengthening osteotomy using an ipsilateral fibular graft. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score at the final follow-up was selected as the primary outcome measure. Radiographic outcomes included the anteroposterior talo-first metatarsal (AP talo-MT1) angle, the lateral talo-first metatarsal (LAT talo-MT1) angle, the lateral calcaneal pitch (LCP), and the Goldberg scoring system (GSS) for fibular graft incorporation. The visual analogue scale (VAS) was used to assess pain over the ipsilateral fibula donor site. Results The AOFAS ankle hindfoot score improved from a mean of 53.7 ± 22.4 to a mean of 81.1 ± 19.8, the AP talo-MT1 angle improved from a mean of 24.1° ± 15.6 to a mean of 12.9° ± 7.3, the LAT talo-MT1 angle improved from a mean of 22.3° ± 3.2 to a mean of 7.9° ± 2.3, and the LCP improved from a mean of 10.1° ± 7 to a mean of 24.4° ± 9.1. The GSS was seven points in all patients, which indicated complete radiographic union with an excellent reorganization of the fibular bone graft. The VAS for pain over the ipsilateral fibula donor site was zero at the final follow-up. Conclusion The fibular bone autograft achieved excellent incorporation when used in calcaneal lengthening osteotomy with good improvement in the clinical and radiographic outcomes in patients with symptomatic flexible flatfoot deformity. Level of evidence III, Therapeutic study.