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. 2020 Sep-Oct;28(5):212-215.
doi: 10.1590/1413-785220202805234176.

PEDIATRIC FLEXIBLE VALGUS FLATFOOT CORRECTION BY ARTHROEREISIS

CÍntia Kelly Bittar  1 , Alberto Cliquet  2 , Alexandra Mauriel Dos Reis  1 , Bruna Madeleine DA Silva SimplÍcio FlÔr  1 , DÉbora Penna Chaves Bertazzo  1 , Maria Fernanda Rosa Dezan  1
Affiliations

PEDIATRIC FLEXIBLE VALGUS FLATFOOT CORRECTION BY ARTHROEREISIS

CÍntia Kelly Bittar et al. Acta Ortop Bras. 2020 Sep-Oct.

Abstract
in English, Portuguese

Objective: This article aimed to evaluate the efficacy of arthroereisis using synthetic polyethylene implants to correct excessive valgus deformity in pediatric patients with flexible valgus flatfoot.

Methods: Retrospective study of 20 pediatric patients with flexible valgus flatfoot, totaling 23 feet, between five and 14 years old, operated between January 2009 and July 2016. Clinical evaluations were performed by the Valenti podoscopic classification and the American Orthopaedic Foot & Ankle Society criteria, based on radiographic images and podoscopic analysis. These patients underwent surgical treatment with the introduction of a synthetic implant in the sinus tarsi. Multiple linear regression analysis with Backward selection of variables, angles of pre and postoperative of radiographic images of the patients submitted to arthroereisis were performed.

Results: The arthroereisis with interposition of synthetic material was satisfactory, considering that 91% of the cases presented clinical and radiographic improvement, with correction of angles and improvement in deformity degrees. Two cases presented implant loosening. The variables of the Bordelon and Pitch angles significantly influenced (p < 0,05) the improvement of the correction of deformity degrees.

Conclusion: The arthroereisis with the interposition of synthetic polyethylene material showed to be an effective technique for flexible flatfoot in symptomatic pediatric patients. Level of Evidence II, Prognostic studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

Objetivo: Este artigo teve como objetivo avaliar a eficácia da artrorrise utilizando implantes sintéticos de polietileno para corrigir a deformidade em valgo excessivo em pacientes pediátricos com pé plano valgo flexível.

Métodos: Estudo retrospectivo de 20 pacientes pediátricos com pé plano valgo flexível, sendo 23 pés, de cinco a 14 anos de idade, operados entre 2009 e 2016. Avaliações clínicas foram realizadas pela classificação podoscópica de Valenti e os critérios da American Orthopaedic Foot & Ankle Society. Esses pacientes foram submetidos a tratamento cirúrgico com a introdução de um implante sintético no seio do tarso. Foi realizada análise de regressão linear múltipla com seleção Backward das variáveis, os ângulos do pré e pós-operatórios das imagens radiográficas dos pacientes submetidos à artrorisse.

Resultados: A artrorrise com interposição de material sintético foi satisfatória considerando que 91% dos casos apresentaram melhora clínica e radiográfica, com correção de ângulos e melhora nos graus de deformidade. Dois casos apresentaram afrouxamento do implante. As variáveis dos ângulos de Bordelon e Pitch influenciaram significativamente (p < 0,05) na melhora da correção dos graus de deformidade.

Conclusão: A artrorrise com interposição de material sintético de polietileno mostrou-se uma técnica eficaz para pé plano flexível em pacientes pediátricos sintomáticos. Nível de Evidência II, Estudos prognósticos - Investigação do efeito de característica de um paciente no desenvolvimento da doença.

Keywords: Flatfoot; Orthopedic Procedures; Prostheses and Implants.

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Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1
Figure 1. Incision in the sinus tarsi.
Figure 2
Figure 2. Insertion of the guide wire through the sinus tarsi.
Figure 3
Figure 3. Preoperative (a) and postoperative (b) radiographic image of pediatric patient with flexible valgus flatfoot submitted to arthroereisis with implant of synthetic polyethylene material. We can observe an increase in the calcaneal pitch angle.
See this image and copyright information in PMC

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