Radiographic and Functional Results following Subtalar Arthroereisis in Pediatric Flexible Flatfoot

Abstract

Introduction. Flexible flatfoot (FFF) is one of the most common skeletal disorders in children. In symptomatic patients who do not respond to conservative measures, surgery may be an option. Subtalar arthroereisis consists of limiting excessive eversion of the subtalar joint through different types of implants. Materials and Methods. We carried out a retrospective study of 16 patients (32 feet) intervened for FFF with a subtalar device (arthroereisis), across the period of 2008-2015 with a minimum follow-up period of one year. Pre- and postoperative measures of the Moreau-Costa-Bartani angle, dorsoplantar (DP) and lateral (L) talocalcaneal angle, talonavicular coverage angle, and naviculocuboid overlap were used to evaluate correction of the deformity. Two expert surgeons from the Pediatric Orthopedics Unit took separate measurements of these angles for subsequent analysis purposes and to obtain the interobserver correlation coefficient for quantitative variables. Pre- and postoperative differences in the measurement of angles were ascertained using Student’s t-test for paired samples; and a functional evaluation of the patients intervened was carried out pre- and postoperatively by administering the parent version of the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) during a clinical interview. All statistical analyses were performed using the SPSS v. 19.0 program (SPSS, Chicago, IL), with values being deemed statistically significant at p<0.05. Results. A breakdown of the study population showed 81.25% (13 patients) males and 18.75% (3 patients) females, with mean age of 9 years (7-11). The interobserver coefficient for quantitative variables displayed a very high degree of concordance (0.7-0.9), indicating that the validity of the measures was adequate. Pre- and postoperative analysis of differences in the measurement of angles was statistically significant (p<0.005). In terms of functional evaluation, the postoperative results were positive, with statistical significance for the “school and play”, “emotional”, and “footwear” domains of the OxAFQ-C scale and no differences in the “physical” domain. Conclusion. Subtalar arthroereisis is a valid option for the treatment of symptomatic pediatric flatfoot, with good postoperative functional and radiographic results.

Subtalar arthroereisis for the treatment of the symptomatic paediatric flexible pes planus: a systematic review

“…Fourteen patients had a concomitant spring ligament reconstruction. Ten studies routinely removed implants 16 , 20 , 21 , 23 , 25 – 30 after a minimum period of 18 months, at skeletal maturity or using the formula: planned removal/months post op = (age in years x 2) plus 6. The average follow-up period was 30.9 months.…”

“… 15 , 33 , 35 Only ten studies measured any form of kinematics 12 , 14 , 15 , 23 – 26 , 30 , 33 , 35 and only eight studies utilized patient-reported outcomes. 14 – 16 , 21 – 23 , 28 , 30 …”

Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years

“…In 1992, Viladot[ 7 ] reported the success rate achieved by the first non-osseous sinus tarsi implant. The aim of implants is to correct the FFF deformity with preservation of foot function and limitation of excessive anterior displacement of the talus upon the calcaneus[ 8 ]. Moreover, some authors[ 9 , 10 ] have hypothesized that CS could play a role in the activation of mechanoreceptors in the sinus tarsi, although it has not yet been supported by experimental evidence.…”

Endosinotarsal device exerts a better postoperative correction in Meary’s angle than exosinotarsal screw from a meta-analysis in pediatric flatfoot

“…After writing emails to corresponding authors, there had been no response until 31 Dec., 2019. We excluded 1 study for screw inserted in talus 6 ; 7 studies for lack of calcaneal pitch angle, Meary’s angle, and AOFAS 7 – 13 and 6 studies for lack of standard deviation or raw data 14 – 19 .…”