Arthroereisis of the subtalar joint in the management of pediatric flexible flatfoot: A retrospective clinical study

Abstract

Background/Aim: Management of flatfoot is still a challenge for orthopedic surgeons because it is a common and physiological process that usually requires observation and follow-up due to its asymptomatic nature in the pediatric population. The aim of this study was to investigate the radiological and pedobarographic results of symptomatic flexible flatfoot in pediatric patients who were treated by simultaneous gastrocnemius lengthening and arthroereisis of the subtalar joint. Methods: This retrospective cohort study included 20 feet of 10 children (5 males, 5 females; mean age: 11.4 years; age range 9-14 years) who underwent simultaneous gastrocnemius lengthening and subtalar joint arthroereisis procedure for bilateral symptomatic flatfoot. The mean follow-up period was 24 months (range 11-32). All arthroereisis procedures were performed using a cannulated arthroereisis titanium implant. To assess the radiological results, calcaneal pitch angle and Meary’s talus-first metatarsal angle on radiographs were measured preoperatively and at the final follow-up. Pedobarographic assessment was based on plantar heel and forefoot pressures preoperatively and at the final follow-up. Results: The mean calcaneal pitch angle increased from 8° (0.93°) preoperatively to 16.5° (1.14°) postoperatively (p<0.001), while the mean Meary’s talus-first metatarsal angle decreased from 7.5° (1.14°) preoperatively to 0.5° (0.51)° postoperatively (p<0.001). The mean heel peak pressure and forefoot peak pressure increased from 11.5 (1.14) N/cm2 and 10.5 (1.14) N/cm2 preoperatively to 17.5 (1.14) N/cm2 and 15.5 (1.14) N/cm2 postoperatively, respectively (p<0.001 for both variables). In addition, the pedobarographic assessment revealed that medially increased center of pressure moved to laterally increased center of pressure in all feet with an improvement in terms of forefoot and heel pressures. None of the patients experienced major intraoperative or postoperative complications. Conclusion: Simultaneous gastrocnemius lengthening and arthroereisis of the subtalar joint seems an effective and safe surgical option for symptomatic flexible flatfoot in pediatric patients.