الفهرس 
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Abstract
Flexible flat feet is a very common among children. Surgical treatment is only indicated in children when there is pain and tightness in the tendo-Achilles as recommended by most authors(13,40). The calcaneostop screw method and anterior calcaneal lengthening are very popular in treating flexible flat feet. Children presented with idiopathic painful flexible flatfeet not responding to conservative management are the scope of this study.
The aim of the work is to assess the value and compare the results of the calcaneostop technique and the anterior calcaneal lengthening osteotomy in the treatment of flexible flat feet in children.
In the period between March 2009 and December 2012 a prospective study was carried out on 30 feet with painful idiopathic flexible flat feet. All of them were selected from the pediatric orthopaedic outpatient clinic of Mansoura University. All of them were idiopathic, flexible, and painful after exclusion of other known etiology.
We have used two operative techniques for the selected cases; anterior calcaneal lengthening osteotomy and calcaneostop screw. The method of treatment have been selected by systematic random sampling every other case so that the patients with odd numbers were treated with calcaneostop screw and those with even numbers by anterior calcaneal lengthening osteotomy.
In this study the range of was between 6 and 13 years with the mean age of 11.51 years. The mean age in the Calcaneostop group was 11.56 years and of the anterior calcaneal lengthening was 11.85 years. The mean follow up for both groups was 27.48 months and the range 24- 34 months.
Analysis of the pre-operative data proved that both groups were comparable concerning all the pre-operative clinical and radiological parameters.
Both techniques were able to improve the clinical, radiological and podographic parameters at the last follow up which was proved statistically when the pre-operative and post-operative data were compared in each group.
No statistically significant difference was found between the anterior calcaneal lengthening osteotomy group and the calcaneostop screw group concerning the clinical scoring at the last follow up. The anterior calcaneal lengthening improved the podograhic measurement more than the calcaneostop screw method and this was statistically significant. There was a statistically significant improvement in all radiological angles in the anterior calcaneal lengthening group at the last follow-up. On the other hand in the calcaneostop group the statistically significant improvement was at the lateral talo-calcaneal angle and the AP talo-calcaneal angle. There was no statistically significant improvement at the AP talo-first metatrasl angleAccordingly the anterior calcaneal osteotomy could correct the deformity in three planes while the calcaneostop screw could correct the deformity in two planes only.
Conclusion: Both anterior calcaneal lengthening osteotomy and calcaneostop methods were successful in treating idiopathic painful flexible flat feet. No significant difference was found in the clinical scoring between the anterior calcaneal lengthening osteotomy and the calcaneostop. Podographic measurement improvement was more in the clacaneal osteotomy group.