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

Abstract

Background. Idiopathic flexible flatfoot in children is a common condition which most frequently improves with age and remains asymptomatic. In some cases, the condition is more severe, and may cause mechanical impairment or pain. The aim of the study was to perform a prospective clinical, radiological, podoscopic and pedobarographic assessment (static and dynamic) of subtalar titanium screw arthroereisis for the treatment of symptomatic, idiopathic, flexible flatfoot. Methods. A prospective, consecutive, non-controlled, cohort, clinical follow-up study was performed. In total, 30 patients (41 feet), mean age 10 (6 to 16 years), were evaluated. Clinical and standing radiological assessments, static and dynamic pedobarography, as well as podoscopy, were performed before surgery and at final follow-up. Results. Significant improvements were found for heel valgus angle, radiographic parameters (lateral and dorso-planar talo-1st metatarsal angle, calcaneal inclination angle, talar declination angle, longitudinal arch angle) and podoscopic parameters (Clark’s angle, Staheli’s arch index and Chippaux-Smirak index). The dynamic pedobarography identified significant increases in lateral loading, forefoot contact phase and double support / swing phase, together with reduced medial loading. Static pedobarography identified significant increases in lateral midfoot area and loading, and a decrease in medial forefoot loading. Four patients reported persistent pain in the sinus tarsi region (six feet) and in one case the implant was replaced for a larger one due to undercorrection. No overcorrections or infection complications were noted in our study group. Conclusions. Subtalar arthroereisis is a minimally-invasive and effective method of surgical treatment of symptomatic, idiopathic, flexible flatfoot with low complication rate with good clinical results.