Long-Term Podiatric Functional Outcomes After Evans-Mosca Correction in Adolescents With Idiopathic Flexible Flatfoot: A Case Series

Abstract

Introduction. Severe symptomatic idiopathic flexible flatfoot in adolescence may require surgical correction when conservative treatment fails. The Evans-Mosca procedure has been reported to provide satisfactory clinical and radiographic correction, but podiatric functional findings after surgery are less frequently described.

Case Presentation. This case series reports long-term podiatric findings in 14 adolescents, corresponding to 26 surgically treated feet, who had previously undergone treatment for idiopathic flexible flatfoot. The same cohort was previously described from orthopedic, clinical, and radiographic perspective.

Intervention. All patients underwent lateral column calcaneal lengthening according to the Evans-Mosca technique, associated with medial soft-tissue correction and Achilles tendon lengthening where indicated.

Outcome. At a mean follow-up of 7 years and 7 months, podiatric assessment showed no lower-limb length discrepancy, preserved ankle dorsiflexion, satisfactory subtalar mobility, physiological first-ray motion, positive Jack’s and tip-toe tests, and plantigrade support on podoscopic examination. Static baropodometry showed balanced load distribution between left and right feet and physiological rearfoot-forefoot distribution. Dynamic baropodometry showed similar plantar contact surfaces between feet and generally physiological gait-line progression. One case of functional hallux limitus was detected.

Conclusion. Evans-Mosca correction achieved satisfactory long-term functional outcomes in this series of 26 feet. Beyond the clinical and radiographic improvements already reported for this cohort, podiatric evaluation revealed preserved joint mobility, plantigrade support, balanced weight distribution, and physiological gait patterns in most patients. One case of functional hallux limitus was identified during dynamic testing.