Review Question - QID 3226

A planovalgus foot deformity in patients with spina bifida may arise from distal tibia or foot deformity. In this case, the deformity is occuring through the distal tibia, and therefore is best treated with a supramalleolar osteotomy as the patient is skeletally mature.

Valgus occuring through the hindfoot can be treated with a calcaneal lengthening procedure to lengthen the lateral column of the foot and reduce the talonavicular joint. It is usually combined with a tendo-achilles lengthening, and offers further benefit in that it usually corrects the accompanying midfoot abduction deformity. Arthrodesis has been suggested for severe foot deformity, however is usually avoided because it increases the risk of skin sores and Charcot changes in the foot.

In skeletally immature patients with ankle valgus, Stevens et al performed a medial malleolar epiphysiodesis in 31 children (50 feet). They noted an average angular correction of 9.7°. With respect to patient/parent satisfaction, 22 of 31 noted improvement, eight reported no change, and one expressed disappointment.