Outcomes of Mosca Calcaneal Osteotomy Versus Subtalar Arthroereisis in Correction of Painful Flexible Flatfoot: A Comparative Study

Background: Painful flat foot is a common pediatric disorder. Heel valgus, dropped medial arch and forefoot abduction are common presenting features. several treatment options are available including conservative and different surgical procedures. Methods: Thirty cases of painful flexible flat foot were divided into group A(15 cases) treated with Mosca calcaneal osteotomy technique and group B(15 cases) treated with subtalar arthroereisis. Visual analogue scale for pain (VAS) and American orthopedic foot and ankle score (AOFAS) were used for clinical evaluation. Calcaneal valgus, Talo-calcaneal, Calcaneal pitch and Meary’s angels were used for radiological evaluation. Results: In group A; the VAS was reduced from pre-operative 4.01± 2.33 to be 0.52 ± 0.22 in the post-operative final follow up period while AOFAS was improved from 69.47 ± 1.34 to be 95.2 ± 4.01 post-operatively, also the meary`s and talo-navicular angles were improved to be 3.9 ± 4.1 and 4.9 ± 5.0 respectively in the post-operative period. In group B; the VAS was reduced from 3.37 ± 2.89 to be 1.99 ± 1.23 in the post-operative final follow up period while AOFAS was improved from 70.32 ± 3.45 to be 90.02 ± 1.01 post-operatively, also the meary`s and talo-navicular angles were improved to be 5 ± 4.1 and 7.2 ± 8.1 respectively in the post-operative period. Conclusion: Mosca technique and subtalar arthroereisis are effective surgical procedures in the management of painful flexible flat foot with adequate restoration of foot arch.