Surgical Treatment of Severe Idiopathic Flexible Flatfoot By Mosca Technique in child Patients

Abstract

Introduction: Extra-articular osteotomies, also known as functional surgery, are the treatment of choice for this painful Severe Idiopathic Flexible Flatfoot (SIFFF), which cause functional discomfort that can compromise sporting activities and the wearing of street shoes. The aim is to refine the surgical procedure, make it more effective and improve the final result, both aesthetically and functionally. We propose a less aggressive surgical strategy for immature bones that are still growing. Methods: We conducted a prospective study, from 2013 to 2017, of 21 patients (36 feet) withsevere idiopathic flexible flatfoot (SIFFF)and symptoms, operated on using the Mosca technique. Clinical evaluation was made according to the American Orthopedic Foot and Ankle Society (AOFAS). Radiographic evaluation was made using anteroposterior and lateral weight-bearing radiographs of the feet to evaluate: talonavicular coverage, talocalcaneal angle, calcaneal pitch, talohorizontal angle, and lateral talo-first MTT angle, Results: The short-term results of our series treated using the MC1 procedures were good and excellent both radiographically and functionally. The complete disappearance of pain, the deepening of the medial arch, the correction of the valgus of the hindfoot, the disappearance of the medial and plantar prominence of the head of the talus and the ease with which the foot can be put on testify to the reliability of this surgical procedure. Residual calcaneocuboid subluxation remains frequent but has no functional repercussions. Conclusion: The new therapeutic approach for idiopathic, symptomatic SIFFF in children and adolescents respects the growth and joint mobility of the foot. Corrective extra-articular osteotomies associated with soft tissue procedures are used in order to preserve joint growth and mobility.

Keywords: severe idiopathic flexible flatfoot, Mosca technique, soft tissue procedures, calcaneocuboid subluxation