Treatment of Pediatric Flexible Flatfoot with Subtalar Arthroereisis: Functional and Radiographic Results

Abstract

Introduction: Flexible flatfoot (FFF) is one of the most frequent conditions that pediatric orthopedists face on a daily basis, with an incidence ranging from 15 to 45%. Subtalar arthroereisis has been described as a valid treatment option, which allows, through a simple and easy technique, to restore the internal plantar arch with few complications. The aim of this work is to retrospectively analyze a series of patients treated with this technique and to evaluate the clinical-functional and radiological results of this technique. Materials and Methods: We evaluated 41 patients between 9 and 15 years old, with a diagnosis of idiopathic flexible flatfoot treated by two surgeons of our institution, between January 2013 and December 2019, who underwent subtalar arthroereisis. A clinical functional and radiological evaluation was performed before and after the surgery. For the functional assessment, the Oxford ankle foot Oxford score for children in parent version (OxAFQ-C) was used. Radiologically the following angles were evaluated: Talonavicular coverage, talocalcaneal angle on the frontal radiograph, talocalcaneal angle on the profile radiograph, and Moreau Costa Bartani angle. Results: Radiographic improvement in foot alignment after surgery was observed in all the patients studied. The functional outcome evaluated by means of the Oxford score for children revealed that all the patients analyzed showed a wide improvement in their school participation, physical activities, emotional state and problems caused by the use of their footwear. Discussion: While there is no doubt about the initial orthopedic treatment when this pathology is asymptomatic, surgical treatment continues to be a matter of discussion; especially in terms of when to indicate it, patient symptoms, appropriate age, choice of surgical technique and the performance of complementary procedures. Conclusions: This study showed that subtalar arthroereisis is a valid treatment option for children with symptomatic flexible flat feet with very good results and few postoperative complications.