Preliminary Results of Subtalar Arthroereisis with Vulpius Procedure for Symptomatic Flatfoot in Patients with Type I Osteogenesis Imperfecta

Abstract

In this retrospective study, we aim to assess the safety and feasibility of adapting subtalar arthroereisis (SA) for type I osteogenesis imperfecta (OI) patients with symptomatic flatfoot. From December 2013 to January 2018, six type I OI patients (five girls and one boy, 12 feet) with symptomatic flexible flatfoot were treated with SA and the Vulpius procedure. All the patients were ambulatory and skeletally immature with failed conservative treatment and unsatisfactory life quality. The median age at the time of surgery was 10 years (range 5–11), and the median follow-up period was 55 months (range 33–83). All functional and radiographic parameters improved (p < 0.05) after the procedure at the latest follow-up. The median American Orthopaedic Foot and Ankle Society ankle-hindfoot scale improved from 68 (range 38–80) to 95 (range 71–97). All of the patients ambulated well without significant complications. The weight-bearing radiographs showed maintained correction of the tarsal bone alignment with intact bony surfaces adjacent to implants during the post-operative follow-up period. This is the very first study on symptomatic flatfoot in pediatric patients with type I OI. Our data suggest that SA is a potentially viable approach, as functional improvements and maintained radiographic correction without significant complication were observed.

Developmental Foot Deformities in Patients with Connective Tissue Disorders

“…Surgical correction involving the osseous and soft tissue may be warranted in severe cases or patients who fail conservative management 60 . Performing a bilateral subtalar arthroereisis in patients with OI-related pes planus deformity has demonstrated significant improvements in the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale during successive follow-up appointments 59 . Although there are no clear guidelines on surgical management of skew foot deformity in patients with OI, the realignment of the tarsal bone with hindfoot bone stabili-zation must be taken into consideration while considering surgical correction 58 .…”

“…OI is a connective tissue disorder that is known to cause both quantitative and qualitative errors in collagen synthesis 58,59 . OI has a prevalence of 3 to 7 per 100,000 live births and can occur in multiple variations and clinical manifestations 59,60 .…”

“…OI is a connective tissue disorder that is known to cause both quantitative and qualitative errors in collagen synthesis 58,59 . OI has a prevalence of 3 to 7 per 100,000 live births and can occur in multiple variations and clinical manifestations 59,60 . Type 1 OI follows an autosomal dominant mode of inheritance and is widely regarded as the mildest form of the disorder, whereas type 2 OI is inherited in an autosomal recessive pattern and is considered the most severe variant, typically resulting in fetal death in utero 60 .…”