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Modified balloon vaginoplasty allows further distention of the distal vagina or thinning of the septum, which may decrease the risk of stenosis, is a beneficial choice for patients with distal vaginal atresia ≥ 3 cm. Previous studies evaluating hindfoot and knee alignment have suggested compensation between the knee and the hindfoot deformities. However, these studies did not investigate the influence of the orientation of the subtalar axis on the results. Using computed tomography data of patients without osteoarthritis, digital twins, a