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

Abstract

Subtalar arthroereisis has a controversial history and has previously been associated with high failure rates and excessive complications. A database search for outcomes of arthroereisis for the treatment of symptomatic paediatric flexible pes planus provided 24 articles which were included in this review, with a total of 2550 feet operated on. Post-operative patient-reported outcome measures recorded marked improvement. Patient satisfaction was reported as excellent in 79.9%, and poor in 5.3%. All radiological measurements demonstrated improvement towards the normal range following arthroereisis, as did hindfoot valgus, supination, dorsiflexion and Viladot grade. Complications were reported in 7.1% of cases, with a reoperation rate of 3.1%. Arthroereisis as a treatment for symptomatic paediatric flexible pes planus produces favourable outcomes and high patient satisfaction rates with a reasonable risk profile. There is still a great deal of negativity and literature highlighting the complications and failures of arthroereisis, especially for older implants. The biggest flaws in the collective literature are the lack of high-quality prospective studies, a paucity of long-term data and the heterogeneity of utilized outcome measures between studies. Cite this article: EFORT Open Rev 2021;6:118-129. DOI: 10.1302/2058-5241.6.200076

Arthroereisis: Treatment of Pes Planus

“…The anteroposterior (AP) talar first metatarsal, AP talar calcaneal, and lateral talar first metatarsal angles, as well as the calcaneal incidence, normalized after arthroereisis. Kinematic measurements also showed progression toward anatomical normality, with a mean reduction in hindfoot valgus of 8.1 degrees [3]. Pedobarographic analysis comparing postoperative feet after arthroereisis with a control group of normal feet showed normalized contact area between medial and lateral midfoot in the arthroereisis group compared to the control group.…”

“…Pes planus, the primary condition for which arthroereisis is performed, occurs due to the abduction of the forefoot, excess subtalar eversion, and resultant loss of the medial longitudinal arch of the foot [3]. Pediatric flatfoot may be categorized into rigid and flexible flatfoot.…”

“…Conservative measures include rest, anti-inflammatory medications, physiotherapy, and orthotics. However, if pain persists and there are functional ambulatory difficulties affecting daily life, operative treatment may be indicated [3]. Numerous surgical options are commonly adopted.…”

“…The subtalar arthroereisis was widely adopted during the 1970s but has since fallen in and out of practice [3]. Despite losing some degree of pervasiveness, a large proportion of providers perform arthroereisis according to a 2013 survey of the American Orthopedic Foot & Ankle Society (AOFAS).…”

“…Subtalar arthroereisis has mainly been used to correct flexible flatfoot. In fact, rigid pes planus may contraindicate the use of arthroereisis as the primary surgical procedure [3]. Other contraindications include active infection, prior sinus tarsi surgery or trauma, and advanced arthrosis of the subtalar joint [12].…”