Subtalar Arthroereisis for Flexible Flatfoot in Children—Clinical, Radiographic and Pedobarographic Outcome Comparing Three Different Methods

Abstract

Subtalar arthroereises (STA) is a minimally invasive and reversible surgery to correct symptomatic flexible flatfoot (FFF) in children. Various techniques were described either applying expandable sinus tarsi implants or lateral calcaneus stop screws. Studies comparing the outcome of STA with different devices are rare. This retrospective single-center cohort study analyzes the results of STA using three different implants. 113 STA were performed in 73 consecutive patients (28 females). Mean age at surgery was 10.8 years (range 5–16). Mean follow-up was 29.0 months (range 1–111). In 21 feet the non-absorbable Kalix® endorthesis and in 56 feet the absorbable Giannini endorthesis were applied. Subtalar extraarticular screw arthroereises (SESA) was conducted in 36 feet. Clinical, radiographic and pedobarographic parameters were analyzed. No intraoperative complications were observed. All three procedures achieved comparable improvements of the clinical, radiographic and pedobarographic parameters. The mean foot function index (FFI) improved from 36.4 (range 12–63) to 22.8 (range 2–55). The mean preoperative calcaneal inclination angle and the lateral talocalcaneal angle improved from 9.5° (range 0–22) and 42.3° (range 21–62) to 12.8° (range 0–26) and 37.6° (range 15–56), respectively. Pedobarographically determined values of the arch index, the medial midfoot contact area and the medial forefoot peak pressure decreased. In contrast to SESA (1/36, 3%), a higher incidence of implant-related complications was observed using Kalix® (6/21, 29%) and Giannini (10/56, 8%) sinus tarsi implants. Peroneal muscle contractures only occurred in the SESA group (4/36, 11%). Premature removal due to treatment-related complications was necessary in 6/21 Kalix® implants (29%), 4/56 Giannini implants (7%) and 4/36 SESA implants (11%). Implant choice for treatment of painful FFF in children with STA seems to play a subordinate role. Clinical, radiographic and pedobarographic outcomes are comparable between the applied implants. Surgeons and patients should be aware of the different spectrum of implant-related complications. Treatment can be reliably monitored by radiation-free pedobarography providing dynamic information about the deformity.

Subtalar titanium screw arthroereisis for the treatment of the symptomatic pediatric flatfoot

“…Similar results have already been published, and arthroeresis has been found to yield improved gait pattern and less pain [13][14][15][16]. In addition, the frequency of complications described in the present study is similar to that reported previously on subtalar titanium implants [14,17].…”

Subtalar Joint Arthroerisis in Management of Pediatric Flexible Flatfoot

“…As well, De Pellegrin et al [11] reported that there was significant improvement of pain at 3 months postoperatively compared to preoperative pain score.…”

“…As well, De Pellegrin et al [11] reported that the Costa-Bartani angle was measured at 146° ± 7° and 129° ± 5°, respectively, while the talar inclination angle was measured at 43° ± 8°, and 25° ± 6°, respectively [p 0.001]. The calcaneal pitch was measured at 11° ± 6°, and 14° ± 5°, respectively.…”

“…In line with the present study El Gazzar et al [7] sought to determine whether the subtalar extra-articular screw arthroereisis technique was helpful at treating children with FFF. The study enrolled 12 feet of eight children with FFF, the mean age was 10.5 years [5][6][7][8][9][10][11][12][13][14][15][16], five boys and three girls. Also, Elmarghany et al [8] sought to assess the subtalar extra-articular screw arthroereisis Regarding the Operative Data, we found that all surgeries were conducted uneventfully within a mean operative time for correction of the affected side of 16 ± 4.5 minutes [range, 13 -26 minutes].…”

An evaluation of subtalar titanium screw arthroereisis for the treatment of symptomatic paediatric flatfeet - early results

“…Almost all authors concentrate on objectives aspects of the procedure [ 1 , 13 – 16 ]. The study itself is based on a wide spectrum of objective clinical, radiological, podoscopic and pedobarographic measurements, together with subjective observations based on a specifically-designed foot health survey completed by the patients.…”