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Flatfoot reconstruction is effective for older patients

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What is the best treatment for adult-acquired flatfoot deformity (AAFD)?

The condition is characterised by a progressive flattening of the arch of the foot that occurs as the posterior tibial tendon becomes insufficient, according to the American Orthopaedic Foot & Ankle Society. It may progress from early stages with pain along the posterior tibial tendon to advanced deformity and arthritis throughout the hindfoot and ankle, the Society explains.

When someone develops AAFD, they are offered either a reconstruction or foot fusion depending on the severity of the flatfoot and their age. Typically, reconstructions are performed in younger patients while older patients undergo fusions, even though this procedure can limit mobility.

In a study presented at last month’s annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), researchers from Hospital for Special Surgery (HSS) compared the outcomes of reconstructions on older patients to those of younger groups. They wanted to find out whether there are worse clinical outcomes or an increased number of subsequent surgical procedures following flatfoot reconstruction when compared to younger patients.

“Overall, flatfoot reconstruction provides better long-term outcomes and mobility of the foot when compared to foot fusions,” explained Dr Scott J. Ellis, foot and ankle surgeon at HSS and senior author of the study. “However, there is a chance that reconstruction could fail, and to avoid a long, arduous recovery with multiple surgeries, patients older than 65 commonly skip reconstruction and opt for a fusion.”

“My colleagues and I wanted to investigate if this was still a viable option for elderly patients in the hopes of maintaining flexibility in their foot,” Dr Ellis added.

The study measured clinical outcomes using the Foot and Ankle Outcome Score (FAOS) and compared pre-operative and post-operative scores at a minimum of two years. Findings indicated that patients in the older group did not demonstrate any differences in their outcomes compared with patients in the young and middle-aged groups, HSS reported.

Additionally, older patients were not more likely to undergo a subsequent removal of hardware or revision procedures than patients in the younger cohorts.

“Our initial hypothesis was that there would be increased complications for patients in the older group. However, we saw positive, consistent surgical outcomes across all age groups,” said Dr Ellis. “Depending on the severity of the condition, we believe a flatfoot reconstruction is a great option for patients regardless of their age. For the right patient, it can be the last surgery that they need.”