Acta Orthopaedica - 2026-05-08 - Journal Article
1-year results after surgery for flexible adult-acquired flatfoot deformity: a cohort study based on 190 patients from the Swedish Foot and Ankle Surgery Register.
Osbeck IKJ, Cöster M, Atroshi I
Topics
Key Takeaway
Surgical treatment of flexible AAFD (Myerson Grade II) yields a mean SEFAS improvement of 11 points at 1 year, with no significant difference between calcaneal osteotomy and hindfoot arthrodesis (adjusted mean difference 2.7, 95% CI -1.2 to 6.5).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This registry-based cohort study used Swefoot data (2017–2022) to compare SEFAS, EQ-5D, and satisfaction outcomes between calcaneal osteotomy and hindfoot arthrodesis for Myerson Grade II AAFD. Mean SEFAS improvement was 11 points in the osteotomy group and 10 points in the arthrodesis group, both exceeding the minimal important difference of 5. No statistically significant between-group difference was detected (adjusted mean difference 2.7, 95% CI -1.2 to 6.5), and satisfaction with foot appearance improved from 39% to 77% postoperatively.
Key Limitation
One-year follow-up is insufficient to capture arthrodesis-related adjacent joint degeneration or osteotomy hardware complications that typically manifest beyond 2 years and are the primary long-term differentiators between these procedures.
Original Abstract
BACKGROUND AND PURPOSE
Surgical outcomes in patients with flexible adult-acquired flatfoot deformity (AAFD) have not been evaluated in large prospective register studies. Calcaneal osteotomy and hindfoot arthrodesis are commonly used. We aimed to compare the results of these 2 procedures using preoperative and 1-year postoperative patient-reported outcome data from the Swedish Quality Register for Foot and Ankle Surgery (Swefoot).
METHODS
We analyzed data regarding feet that had primary surgery for flexible (grade II) AAFD between 2017 and 2022 in Sweden. The primary outcome was the Self-Reported Foot and Ankle Score (SEFAS), range 0-48 (minimal important difference 5). Secondary outcomes were EQ-5D and satisfaction.
RESULTS
190 feet (63% women, median age 62 years, interquartile range 54-68) were surgically treated during the study period. Mean improvement in SEFAS score was 12 (95% confidence interval [CI] 10-13) in grade IIa and 10 (CI 8-12) in grade IIb, and in the EQ-5D index 0.27 (CI 0.20-0.34) and 0.23 (CI 0.15-0.31), respectively. Compared with preoperatively a higher percentage of patients were satisfied with postoperative foot appearance (77% vs 39%) and foot strength (66% vs 23%). The mean SEFAS score improvement was 11 (CI 10-13) in the osteotomy group and 10 (CI 5-15) in the arthrodesis group; adjusted mean difference was 2.7 (CI -1.2 to 6.5).
CONCLUSION
Surgical treatment of flexible AAFD significantly improves function and quality of life at 1 year postoperatively. No differences in postoperative patient-reported outcomes were observed between patients who underwent calcaneal osteotomy compared with hindfoot arthrodesis.