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. 2023 Oct 19;24(1):825.
doi: 10.1186/s12891-023-06937-2.

An evaluation of subtalar titanium screw arthroereisis for the treatment of symptomatic paediatric flatfeet - early results

Anna Szesz  1 , Krzysztof Małecki  1 , Marcin Sibiński  2 , Kryspin R Niedzielski  1
Affiliations

An evaluation of subtalar titanium screw arthroereisis for the treatment of symptomatic paediatric flatfeet - early results

Anna Szesz et al. BMC Musculoskelet Disord. .

Abstract

Background: Idiopathic flexible flatfoot is a common condition in children which typically improves with age and remains asymptomatic. However, the condition can sometimes be more severe, and 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 flatfeet.

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: Treatment was associated with significant improvements in heel valgus angle, radiographic parameters (lateral and dorso-planar talo-first 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). Significant increases were noted for lateral loading, forefoot contact phase and double support / swing phase, and reduced medial loading (dynamic pedobarography), as well as lateral midfoot area and loading, but decreased were observed for medial forefoot loading (static pedobarography). 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 the study group.

Conclusions: Subtalar arthroereisis is a minimally-invasive and effective surgical method for treating symptomatic, idiopathic, flexible flatfeet; it has an acceptable complication rate with good early clinical results.

Level of evidence: II b.

Keywords: Extraarticular sutalar implant; Flatfeet; Footprint; Pedography; Radiological measurements; Sinus tarsi implant.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The method of measuring Staheli’s arch index (B/C ratio) and Chippaux-Smirak index (A/B*100% ratio)
Fig. 2
Fig. 2
The method of measuring Clarke’s angle during podoscopy
Fig. 3
Fig. 3
Intraoperative fluoroscopy after subtalar arthroereisis – AP view
Fig. 4
Fig. 4
Intraoperative fluoroscopy after subtalar arthroereisis – lateral view
Fig. 5
Fig. 5
Valgus deformity of the hindfoot before surgery
Fig. 6
Fig. 6
Valgus deformity after surgical correction at last follow-up
See this image and copyright information in PMC

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