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Talonavicular Arthrodesis for the Treatment of Neurological Flat Foot Deformity in Pediatric Patients: Clinical and Radiographic Evaluation of 29 Feet

de Coulon, Geraldo MD; Turcot, Katia PhD; Canavese, Federico MD,PhD; Dayer, Romain MD; Kaelin, Andre MD; Ceroni, Dimitri MD

Journal of Pediatric Orthopaedics: July/August 2011 - Volume 31 - Issue 5 - p 557–563
doi: 10.1097/BPO.0b013e31821fffa0

Background Patients with cerebral palsy, syndromes, myopathies, and other forms of neurological impairment can develop planovalgus foot deformity of variable degrees of severity. Several techniques have already been described to resolve the deformity with variable results. Talonavicular arthrodesis is a well-known technique in adult patients, but to our knowledge, it has not been described in children with neurological impairment.

Methods We performed a retrospective chart and radiographic review of 18 neurological patients (10 boys, 8 girls) with a mean age of 11.3±2.6 years (range, 7 to 19 y) who underwent talonavicular arthrodesis for flat foot deformity between 1998 and 2009, at our center.

Results Of a total of 29 feet, talonavicular arthrodesis was judged satisfactory in 28 feet, whereas 1 had unsatisfactory results according to the Yoo clinical outcome scoring scale. Subjective observations reported that 3 feet from 2 patients were painful preoperatively and none after last follow-up. Functionally, 2 of 13 patients were able to stop using braces after surgery. The significant improvement achieved postoperatively in radiographic measurement angles was maintained at last follow-up without any loss of angle correction.

Conclusions Talonavicular arthrodesis seems to achieve a reliable hind foot fixation in flat foot in patients with neurological impairment.

Level of Evidence IV Case series.

*Department of Child and Adolescent, Pediatric Orthopaedic Service

Willy Taillard Laboratory of Kinesiology, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

None of the authors received financial support for this study.

Reprints: Geraldo de Coulon, MD, Department of Child and Adolescent, Pediatric Orthopaedic Service, University of Geneva Hospitals, 6 Rue Willy Donzé, 1211 Geneva 14/Switzerland. e-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.