Calcaneo-stop: A simple screw with a big impact

Objectives: This study evaluated the functional and radiographic outcomes and the adverse events of calcaneal stop surgery in adolescents with symptomatic flexible flatfoot refractory to conservative treatment. Methods: This single-center retrospective cohort included 320 feet in 180 adolescents (90 female; mean age, 14.5 years; range, 12–17). Outcomes were the American Orthopedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot score, the visual analog scale (VAS) for pain, and five radiographic angles (calcaneal pitch, Kite’s talocalcaneal, talar declination, Meary’s, and talonavicular coverage), assessed preoperatively, early postoperatively, and at final follow-up (mean, 30 months; range, 24–36). Because 140 patients were treated bilaterally, all outcomes were analyzed with linear mixed-effects models including random intercepts for patient and for foot, with Holm-adjusted pairwise comparisons. Results: All radiographic and functional outcomes improved significantly over time (all p < 0.001). Hindfoot valgus decreased by 8.07° and calcaneal pitch increased by 6.51°. The AOFAS score rose from 67.16 ± 6.03 to 87.08 ± 5.51 (mean change, 19.92; 95% confidence interval [CI], 19.15–20.69), and VAS pain fell from 7.03 ± 2.69 to 1.03 ± 1.52 (mean change, −6.00; 95% CI, −6.30–−5.70); pain did not change further thereafter. Adverse events affected 48 feet (15.0%): Sinus tarsi irritation (6.25%), superficial infection (3.75%), deformity recurrence (2.50%), transient edema (1.56%), and asymptomatic screw loosening (0.94%); all were managed non-operatively. Conclusion: In adolescents with conservative-refractory symptomatic flexible flatfoot, calcaneal stop surgery was associated with significant functional and radiographic improvement at a mean follow-up of 30 months, with minor adverse events. Longer-term comparative studies are needed.