Too-long calcaneal process: Results of surgical treatment and prognostic factors

Introduction: The too-long anterior process (TLAP) can be responsible for ankle pain or repeated sprains in children or adolescents. The objective of this study was to assess the results of TLAP surgical treatmentand to analyze influencing factors in case of this surgery’s failure.Material and methods: Retrospective single-center study conducted from 2009 to 2012 including allpatients under 18 years of age for a TLAP with follow-up equal to or longer than 1 year. The results of sur-gical treatment were assessed using the AOFAS score. Failure was defined as no significant improvementin the AOFAS score at the last follow-up.Hypothesis: Predictive factors of the result of surgical treatment for TLAP can be identified.Results: At the mean follow-up of 2.5 years, 35 patients (43 feet) fulfilled the inclusion criteria. Thirteenfeet (30%) presented surgical failure. According to the AOFAS score, the results were excellent in 30 feet(70%), good in four (9%), fair in five (12%), and poor in four (9%). Surgical failure was influenced by thepatient’s age at the onset of symptoms and at the time of surgery, the degree of functional limitation, theduration of symptoms before surgery, the number of sprains, and gender (P < 0.05).Conclusion: Firstly, in this pediatric population with its high functional demand, the overall rate of failureof TLAP surgery was 30%. Secondly, the factors associated with failure demonstrated made it possible toidentify the ideal patient for this surgery: male, with symptom onset between 7 and 10 years of age, whohad experienced fewer than 15 sprains, and undergone surgery in the 3 years following the beginning ofsymptoms.Level of evidence: IV.