Arthroereisis: Treatment of Pes Planus.

Abdullah Ghali,Ahmed Thabet-Hagag,David Momtaz,Amr Abdelgawad,Aum Mhapankar,Brandon Driggs

doi:10.7759/cureus.21003

Abstract

Arthroereisis is a surgical procedure primarily used to treat flexible pes planus (flatfoot) in pediatric and young adult patients. The principal goal of subtalar arthroereisis is to relieve pain and restore function. This is primarily done by restoring the medial foot arch without fusing the subtalar joint and without requiring a long recovery period needed after osteotomies. Although the procedure can be performed in isolation to treat flexible flatfoot, it can also be performed as an ancillary in the treatment of tarsal coalition, posterior tibial tendon dysfunction, and accessory navicular syndrome. Various implants and multiple surgical techniques exist for arthroereisis, such as the sinus tarsi implant and calcaneo-stop. The type of device and the surgical approach to proceed with are based on the surgeon’s discretion rather than an evidence-based protocol. Multiple complications can arise from subtalar arthroereisis, most commonly sinus tarsi pain. Currently, there is a dearth of quality clinical data and evidence on the long-term outcomes and complications of arthroereisis. This lack of literature for a commonly performed procedure validates the need for future studies to better guide a standard protocol, reach consensus on well-defined indications and contraindications, provide expected complications, and improve the practice of evidence-based medicine.

Highlights

BackgroundAnatomy of the subtalar jointThe subtalar joint articulates the talus, calcaneus, and navicular bones of the foot (Figure 1)
The procedure can be performed in isolation to treat flexible flatfoot, it can be performed as an ancillary in the treatment of tarsal coalition, posterior tibial tendon dysfunction, and accessory navicular syndrome
We reviewed three recent systematic reviews on the outcomes of subtalar arthroereisis by Tan et al [24], Metcalfe et al [23], and Smith et al [3]

Summary

Introduction

The subtalar joint articulates the talus, calcaneus, and navicular bones of the foot (Figure 1). The final surgical option is a type of arthroereisis procedure referred to as the calcaneo-stop screw, which is the focus of this review This involves inserting a screw that acts as an obstacle to prevent hypermobilization of the subtalar joint. The initial discourse on surgical alteration of the tarsi and the subtalar joint arose in 1946 when Chambers suggested correcting flatfoot by placing a wedge upon the superior surface of the calcaneus to restrict the anterior displacement of the talus from the calcaneus [7]. The first surgeon to insert a cortical bone wedge graft into the sinus tarsi was Stefán Haraldsson in 1962 In doing so, he limited subtalar eversion to treat his patients with pes planus. Since arthroereisis first rose onto the podiatric and orthopedic surgery landscape, a myriad of improvements have been suggested to alter the implant’s shape to create a block, screw, or cap, and material to construct it out of polyethylene, titanium, or silastic [8]

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Disclosures