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.
Highlights
Flexible flatfoot (FFF) in children and adults is a common reason for orthopedic consultation [1]
The operative techniques and ingrowing growing patients, especially in European countries the the applied implants have constantly evolvedevolved since thesince first description of lateral arthroerand applied implants have constantly the first description of lateral eises in 1970 [27]
This study provides new insights in diagnostical approaches by using pedobarography which helps to dynamically assess foot alignment
Summary
Flexible flatfoot (FFF) in children and adults is a common reason for orthopedic consultation [1]. The distinction between physiological and pathological FFF remains challenging, especially in growing patients [2]. Standard assessment includes clinical and radiological examination. Modern technology such as digital pedobarography has helped to improve understanding and treatment of the deformity [3,4,5]. When FFF becomes symptomatic, affecting gait and limiting quality of life, different treatment options are available. If conservative treatment such as weight reduction, physiotherapy or insoles fail, operative treatment can be considered [2,6,7,8]. Surgical approaches include soft-tissue procedures and bony corrections such as subtalar arthroereises (STA), correction osteotomies and arthrodeses [7,9,10,11,12,13]
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