Mosca reports outcomes of a modified Evans calcaneal lengthening osteotomy in 20 children (31 feet) with severe, symptomatic hindfoot valgus — flatfoot and skewfoot — refractory to at least one year of nonoperative care. The central question: can this joint-preserving osteotomy reliably correct severe deformity across a wide range of etiologies, including neuromuscular conditions Evans himself had excluded?
Long-term follow-up data on subtalar and triple arthrodesis — cited directly in this paper. Showed 64% and 75% unsatisfactory results respectively, with adjacent joint degeneration in up to 58% of ankles. Yet arthrodesis remained the standard for severe pediatric hindfoot valgus because the Evans osteotomy was so briefly described in 1975 that it had stayed relatively obscure.
This paper changed that. When you see a child with severe symptomatic flatfoot or skewfoot who has failed a year of bracing, calcaneal lengthening is the operation. Not subtalar or triple arthrodesis. The procedure works across etiologies: cerebral palsy, myelomeningocele, idiopathic, and post-coalition all responded equally well.
In practice, address the whole foot: lengthen the Achilles if dorsiflexion is less than 10° after graft placement, add a medial cuneiform opening-wedge osteotomy for skewfoot forefoot adduction, and watch for calcaneocuboid dorsal subluxation during distraction (use a Steinmann pin if it occurs).
Mosca's paper is why lateral column lengthening is now a cornerstone of pediatric flatfoot surgery. It preserved subtalar motion in every eligible foot while matching normal radiographic alignment, buying time before any future arthrodesis would be needed.
Mosca reports outcomes of a modified Evans calcaneal lengthening osteotomy in 20 children (31 feet) with severe, symptomatic hindfoot valgus — flatfoot and skewfoot — refractory to at least one year of nonoperative care. The central question: can this joint-preserving osteotomy reliably correct severe deformity across a wide range of etiologies, including neuromuscular conditions Evans himself had excluded?
Long-term follow-up data on subtalar and triple arthrodesis — cited directly in this paper. Showed 64% and 75% unsatisfactory results respectively, with adjacent joint degeneration in up to 58% of ankles. Yet arthrodesis remained the standard for severe pediatric hindfoot valgus because the Evans osteotomy was so briefly described in 1975 that it had stayed relatively obscure.
This paper changed that. When you see a child with severe symptomatic flatfoot or skewfoot who has failed a year of bracing, calcaneal lengthening is the operation. Not subtalar or triple arthrodesis. The procedure works across etiologies: cerebral palsy, myelomeningocele, idiopathic, and post-coalition all responded equally well.
In practice, address the whole foot: lengthen the Achilles if dorsiflexion is less than 10° after graft placement, add a medial cuneiform opening-wedge osteotomy for skewfoot forefoot adduction, and watch for calcaneocuboid dorsal subluxation during distraction (use a Steinmann pin if it occurs).
Mosca's paper is why lateral column lengthening is now a cornerstone of pediatric flatfoot surgery. It preserved subtalar motion in every eligible foot while matching normal radiographic alignment, buying time before any future arthrodesis would be needed.