Assessment of ankle angle after medializing calcaneal osteotomy and lengthening of the gastrocnemius-soleus complex in the surgical treatment of flexible pes planovalgus

Abstract

Objective: To evaluate the variation of ankle joint range of motionafter medial calcaneal sliding osteotomy and lengthening ofthe gastrocnemius-soleus complex in the surgical treatment offlexible pes planovalgus. Methods: Between March 2016 andJanuary 2017, 36 feet of 22 patients presenting with flexible pesplanovalgus, with ages ranging from 11 to 22 years, underwent theKoutsogiannis procedure, in combination or not with other boneand soft tissue procedures and gastrocnemius-soleus complexzone IV (Vulpius) lengthening. The variation of ankle extensionwas measured in degrees using a goniometer and the Silfverskioldtest in knee extension and flexion, both preoperatively and afterthe medializing calcaneal osteotomy and after lengthening, thustotaling 3 measurements. Results: There was a reduction in ankleextension after the medializing calcaneal osteotomy, with apreoperative mean of 93º with an extended knee and 104.7º with aflexed knee, while a mean of 90.7º (loss of 2.3º) was obtained afterthe osteotomy in extension and 98.9º (loss of 5.8º) in flexion. Aftergastrocnemius lengthening, we achieved a significant gain of rangeof motion, averaging 107.2º (gain of 14.2º) with the knee extendedand 117.6º (gain of 12.9º) with the knee flexed. Conclusion: Vulpiuslengthening of the gastrocnemius-soleus complex resulted in a significant increase in ankle extension, a fact that may prevent futureproblems resulting from the shortening of this complex.