Pediatric Flexible Pes Valgus Deformity

Abstract

The pediatric pes valgus deformity cannot be considered the same as the adult deformity. In the pediatric deformity, it is important to evaluate the child with respect to the developmental stage. Often, children may be asymptomatic, and the foot shape will be more of a concern to parents, possibly as a result of family history or deformity. The clinician’s challenge is to distinguish between a benign condition that is part of normal development and a condition that can cause disability if left untreated. Fortunately, only a small percentage of patients with a clinically visible low arch require surgery. Severe pain and deformity and lack of response to conservative treatment may indicate the need for surgical intervention. A short tendoachillis is often a deforming force in the pes valgus deformity that may need to be addressed surgically as well. For those patients who do require surgery, improved techniques have resulted in better surgical results. There are many procedures available to the surgeon that can aid in correcting the pes valgus deformity. The medial calcaneal slide is a useful technique, particularly as an alternative in patients with compensated metatarsus adductus. The Evans calcaneal osteotomy provides predictable radiographic correction in multiple planes and is generally well tolerated. Forefoot supinatus can be addressed effectively with the Cotton medial cuneiform osteotomy, and navicular cuneiform instability can be addressed with the Youngs/medial arch tenosuspension or a navicular cuneiform arthrodesis. Arthroereisis is an extra-articular procedure that may be useful in patients with a frontal plane dominant deformity. Pediatric flexible flatfoot has been the subject of extensive study, writings, and discussion. The most common question is determining which of these patients require surgical intervention and when. Although guidance can be given, certainty is not possible. This chapter will give the reader a better understanding of some of the issues and concerns that relate to the flexime of the issues and concerns that relate to the flexible flatfoot deformity in children and adolescents including the biomechanics, stabilizing anatomic features, evaluation techniques, indications for intervention, conservative care, surgical procedures, ongoing evaluation, and complications.