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Lewis TL, Goff TAJ, Ray R, Dhaliwal J, Carmody D, Wines AP. Clinical outcomes of subtalar arthroereisis for the treatment of stage 1 flexible progressive collapsing foot deformity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2933-2940. [PMID: 38814449 PMCID: PMC11377592 DOI: 10.1007/s00590-024-04007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The use of subtalar arthroereisis as an adjunct to the surgical treatment of stage 1 flexible progressive collapsing foot deformity (PCFD) is controversial. The aim was to investigate the clinical outcomes and report the implant removal rate of subtalar arthroereisis as an adjunct for stage 1 PCFD. METHODS A retrospective study of 212 consecutive feet undergoing operative management of stage 1 PCFD with adjunctive subtalar arthroereisis between October 2010 and April 2018. The primary outcome was the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included Foot and Ankle Disability Index (FADI), Euroqol-5D-5L Index and implant removal rate. RESULTS Post-operative clinical FAOS outcomes were collected for 153 feet (72.2%). At mean 2.5-year follow-up, the mean ± standard deviation FAOS for each domain was as follows; Pain: 81.5 ± 18.5, Symptoms: 79.5 ± 12.9, Activities of Daily Living: 82.5 ± 15.4 and Quality of Life: 64.2 ± 23.7. EQ-5D-5L Index was 0.884 ± 0.152. Pre-operative scores were available for 20 of these feet demonstrating a statistically significant improvement in all FAOS, FADI and EQ-5D-5L domains (p < 0.05). The implant removal rate for persistent sinus tarsi pain was 48.1% (n = 102). CONCLUSION Use of a subtalar arthroereisis implant as an adjunct to conventional procedures in stage 1 flexible PCFD can result in significant improvement in pain and function. Patients should be counselled as to the relatively frequent rate of subsequent implant removal. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK.
| | | | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | | - David Carmody
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
| | - Andrew P Wines
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
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Mazzotti A, Viglione V, Gerardi S, Artioli E, Rocca G, Faldini C. Subtalar arthroereisis post-operative management in children: A literature review. Foot (Edinb) 2023; 56:102037. [PMID: 37167704 DOI: 10.1016/j.foot.2023.102037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Subtalar arthroereisis is a minimally-invasive technique for the treatment of flexible flatfoot. Some issues regarding the procedure are still debated, such as post-operative management. The aim of this study is to offer a review of the pertaining literature to identify current post-operative protocols and describe possible differences among them. METHODS We searched the PubMed database for all papers related to subtalar arthroereisis in children specifying the post-operative protocols. After reviewing all studies according to excluding criteria, 50 articles were selected for analysis. RESULTS Based on the literature review, different post-operative protocols emerged in the treatment of patients undergoing subtalar arthroereisis, in particular regarding length of hospital stay, type and duration of immobilization, weight-bearing management, adopted rehabilitation scheme, sport resumption and implant removal. CONCLUSIONS The most important finding was the existence of a wide variety in post-operative management after subtalar arthroereisis in children, thus confirming that no clear consensus still exists in this field.
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Affiliation(s)
- Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy.
| | - Valentina Viglione
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Simone Gerardi
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Gino Rocca
- IRCCS Istituto Ortopedico Rizzoli, Pediatric Orthopedics and Traumatology, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
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Shi C, Li M, Zeng Q, Wen X, Tian F, Li Y. Subtalar arthroereisis combined with medial soft tissue reconstruction in treating pediatric flexible flatfoot with accessory navicular. J Orthop Surg Res 2023; 18:55. [PMID: 36658597 PMCID: PMC9850534 DOI: 10.1186/s13018-023-03542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Accessory navicular is accompanied by the deformity of valgus flexible flatfoot. The surgical treatment includes reconstruction of insertion of posterior tibial tendon following resection of the accessory navicular. However, this treatment could not correct completely the deformity of valgus flexible flatfoot. This study aimed to evaluate the efficacy of subtalar arthroereisis combined with medial soft tissue reconstruction in treating 8-14-year-old flexible flatfoot patients with accessory navicular. METHODS Clinical data of 35 pediatric flatfoot patients (with 50 feet) with accessory navicular who underwent subtalar arthroereisis and medial soft tissue reconstruction between April 2013 and September 2018 were analyzed retrospectively. Anteroposterior, lateral, and hindfoot alignment radiological images were measured in the weight-bearing position, and visual analog scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and satisfaction degree were evaluated. Also, surgical complications were recorded. RESULTS The average follow-up time of the patients was 30 ± 9.3 months. None of the patients presented wound complications, and no implant loosening was detected. The AOFAS and VAS scores improved significantly (P < 0.001). Radiological parameters, such as the talar first metatarsal angle and talonavicular coverage angle on anteroposterior foot view, Meary's angle and calcaneal pitch angle on the lateral view, and calcaneus valgus angle on hindfoot alignment view improved significantly (P < 0.001). Postoperative complications were observed in three patients. CONCLUSION Subtalar arthroereisis combined with medial soft tissue reconstruction significantly alleviated pain and improved the functions in pediatric and adolescent flexible flatfoot patients with accessory navicular; also, the radiological manifestations and functions improved.
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Affiliation(s)
- Chao Shi
- grid.43169.390000 0001 0599 1243Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, 710054 Shaanxi Province China
| | - Mingxiu Li
- grid.449637.b0000 0004 0646 966XThe Second Clinical Medical College of Shaanxi University of Chinese Medicine, Xianyang, 712046 Shaanxi Province China
| | - Qiu Zeng
- grid.43169.390000 0001 0599 1243Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, 710054 Shaanxi Province China
| | - Xiaodong Wen
- grid.43169.390000 0001 0599 1243Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, 710054 Shaanxi Province China
| | - Feng Tian
- grid.43169.390000 0001 0599 1243Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, 710054 Shaanxi Province China
| | - Yi Li
- grid.43169.390000 0001 0599 1243Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an, 710054 Shaanxi Province China
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The Effect of Customized and Silicon Insoles on Mid- and Hindfoot in Adult Flexible Pes Planovalgus. Indian J Orthop 2022; 56:1897-1905. [PMID: 35879953 PMCID: PMC9299753 DOI: 10.1007/s43465-022-00699-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Flexible flat foot or pes planovalgus is a common foot deformity, and silicone and customized insole are commonly used as a non-operative treatment modality of flexible planovalgus. However, there are inadequate data and limited evidence available regarding the immediate effects of their use in midfoot and hindfoot of adults. The aim of this study is to quantify and compare the radiological parameters immediately on weightbearing with silicon and customized insoles and without them to assess the effect on midfoot and hindfoot of the flexible planovalgus in adults. METHODS A total number of 11 (8 females and 3 males) subjects with flexible pes planovalgus deformity without any other foot deformity were included in the study. Each patient was assessed three times in a random sequence without and with use of either silicon insoles or customized insole. The radiographic parameters without insole, with silicon insole, and with customized insole conditions were calculated using online available computer software Kinovea. RESULTS One-way ANOVA analysis was performed between groups (without insole, with silicone insole and with customized insole). The hindfoot parameters depicted that calcaneal inclination angle (CIA) was significant increased (P = 0.000) and talar declination angle (TDA) was significantly decreased (P = 0.003) only with the use of customized insole compared to without insole. The midfoot parameters depicted that the first metatarsal angle (FMA) and talonavicular coverage angle (TCA) were significantly lower with customized insole (P = 0.00) as compared to other two groups and significantly lower with silicone insole (P = 0.00) as compared to without insole group. CONCLUSION The results imply that the compressibility of the insole material affects the forefoot and hindfoot biomechanics differently. This study concludes that silicone insole affects only the midfoot which bears 45% of bodyweight and customized insole affects both midfoot and more importantly the hindfoot which bears 55% of bodyweight.
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Bernasconi A, Argyropoulos M, Patel S, Ghani Y, Cullen N, Singh D, Welck M. Subtalar Arthroereisis as an Adjunct Procedure Improves Forefoot Abduction in Stage IIb Adult-Acquired Flatfoot Deformity. Foot Ankle Spec 2022; 15:209-220. [PMID: 32830576 DOI: 10.1177/1938640020951031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Our aims were (a) to determine whether subtalar arthroereisis (STA) as adjunct procedure improved radiographic correction of stage IIb adult-acquired flexible flatfoot deformity (AAFD); (b) to assess the STA-related complication rate. METHODS A retrospective analysis of 22 feet (21 patients) diagnosed with stage IIb AAFD treated by medializing calcaneal osteotomy (MCO), flexor digitorum longus (FDL) transfer, spring ligament (SL) repair with or without Cotton osteotomy and with or without STA in a single institution was carried out. Seven measurements were recorded on pre- and postoperative (minimum 24 weeks) radiographs by 2 observers and repeated twice by 1 observer. Inter- and intraobserver reliabilities were assessed. The association of demographic (gender, side, age, body mass index) and surgical variables (Cotton, STA) with radiographic change was tested with univariate analysis followed by a multivariable regression model. RESULTS Excellent inter- and intraobserver reliabilities were demonstrated for all measurements (intraclass correlation coefficient range, 0.75-0.99). Gender, side, Cotton osteotomy, and STA were included in the multivariable analysis. Regression showed that STA was the only predictor of change in talonavicular coverage angle (TNCA) (R2 = 0.31; P = .03) and in calcaneo-fifth metatarsal angle (CFMA) (R2 = 0.40; P = .02) on dorsoplantar view. STA was associated to a greater change in TNCA by 10.1° and in CFMA by 5°. Four patients out of 12 STA complained of sinus tarsi pain after STA, and removal of the implant resolved symptoms in 3 of them. CONCLUSION In this series, STA as an adjunct procedure to MCO, FDL transfer, SL repair in the treatment of stage IIb AAFD led to improvement in correction of forefoot abduction. STA-related complication and removal rates were 33%. LEVELS OF EVIDENCE Level IV: Retrospective cohort study.
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Affiliation(s)
- Alessio Bernasconi
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.,Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Shelain Patel
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Yaser Ghani
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Nicholas Cullen
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Dishan Singh
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Matthew Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
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Pavone V, Vescio A, Andreacchio A, Memeo A, Gigante C, Lucenti L, Farsetti P, Canavese F, Moretti B, Testa G, De Pellegrin M. Results of the Italian Pediatric Orthopedics Society juvenile flexible flatfoot survey: diagnosis and treatment options. J Pediatr Orthop B 2022; 31:e17-e23. [PMID: 34101678 DOI: 10.1097/bpb.0000000000000881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objectives of this study were to collect and analyze current diagnosis and treatment options of symptomatic flexible flatfoot (FFF), as well as to identify treatment expectations, among the members of the Italian Pediatric Orthopedics Society (SITOP). Diagnosis and treatment preferences were recorded according to a web-based survey. The survey was divided into six main sections: (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; (6) treatment options. One hundred and ten out of 248 SITOP members answered to the questionnaire. Age (85.5%), pain at the level of the plantar arch or fascia (61.8%), fatigue (59.1%) were the clinical parameters of crucial importance. Heel valgus (85.4%), flexibility (61.8%) and forefoot supination (47.3%) were identified as the most important foot aspects. Ninety-two responders (83.6%) identified the 'improved ability to walk longer without symptoms or discomfort' as the principal treatment expectation. Pain evaluated through the visual analog scale (VAS) was considered crucial in 31.8% of cases. All respondents confirmed they also treat patients with FFF surgically; in particular, 97.3% of SITOP affiliates declare to perform arthroereisis followed by lateral column lengthening (29.1%) and medializing calcaneal osteotomy (9.1%). Although in this survey heterogeneous findings for diagnosis and treatment of patients with symptomatic FFF within SITOP members were found, a large preference for age, heel valgus, flexibility as clinical aspects and parameters, as well as nonoperative treatment and arthroereisis, was reported.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
| | | | - Antonio Memeo
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan
| | - Cosimo Gigante
- Pediatric Orthopaedic Unit, Department of Woman and Child Health, Padua General Hospital, Padua
| | - Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
| | - Pasquale Farsetti
- Department of Orthopaedics Surgery, University of Rome "Tor Vergata", Rome
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lill
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Bari
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania
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Mattesi L, Ancelin D, Severyns MP. Is subtalar arthroereisis a good procedure in adult-acquired flatfoot? A systematic review of the literature. Orthop Traumatol Surg Res 2021; 107:103002. [PMID: 34216843 DOI: 10.1016/j.otsr.2021.103002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/29/2021] [Accepted: 04/20/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of the present systematic literature review was to determine results and complications in subtalar arthroereisis for stage-2 adult-acquired flatfoot. METHOD A search of the PubMed, Medline, CINAHL, Cochrane and Embase databases used MeSH terms "arthroereisis" AND "flatfoot" OR "adult-acquired flatfoot" OR "pes planovalgus" OR "pes planus". Two of the authors analyzed 125 articles. After reading titles and Abstracts, 105 articles were read in full text and their references were analyzed. Finally, 12 articles were selected and divided into 2 groups: isolated and associated arthroereisis. RESULTS Improvement in functional scores was greater in associated arthroereisis. Whether isolated or associated, arthroereisis achieved radiologic correction. However, the rate of complications was high, mainly concerning tarsal sinus pain. CONCLUSION Subtalar arthroereisis for stage-2 adult-acquired flatfoot is rarely performed in isolation. When it is associated to other procedures, good radiologic and clinical results can be expected. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucas Mattesi
- Department of Orthopaedic Surgery, Hôpital Pierre Zobda Quitman, 97261 Fort-de-France Cedex, France
| | - David Ancelin
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, 31059 Toulouse, France; I2R, Institut de Recherche Riquet, 31059 Toulouse, France
| | - Mathieu Pierre Severyns
- Department of Orthopaedic Surgery, Hôpital Pierre Zobda Quitman, 97261 Fort-de-France Cedex, France.
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Irgit KS, Katsarov AZ. Flexible Progressive Collapsing Foot Deformity: Is There Any Role for Arthroereisis in the Adult Patient? Foot Ankle Clin 2021; 26:539-558. [PMID: 34332734 DOI: 10.1016/j.fcl.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over the last two decades there is a growing interest in the adult literature for subtalar joint arthroereisis. Parallel to this interest, there have been improvements in the design and biomechanics of the implant, although the main indication of subtalar joint arthroereisis in adults is not clear. Most studies show significant improvement in postoperative clinical scores and visual analog scores. Sinus tarsi pain, being the most common complication, is the main determinant of clinical satisfaction. This review focuses on the role and complications of subtalar joint arthroereisis in the adult population.
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Affiliation(s)
- Kaan Suleyman Irgit
- Orthopedics and Traumatology, Marmara School of Medicine, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad No 10, PK 34899, Pendik, İstanbul, Turkey.
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Vescio A, Testa G, Amico M, Lizzio C, Sapienza M, Pavone P, Pavone V. Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years. World J Orthop 2021; 12:433-444. [PMID: 34189081 PMCID: PMC8223720 DOI: 10.5312/wjo.v12.i6.433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/21/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Flexible flatfoot (FFF) is a very common condition in children, characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot. Arthroereisis (AR) procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop (CS).
AIM We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients. We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population, young athletes, and obese people according to material device.
METHODS Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6, 2020. The research string used was (pediatric OR children OR Juvenile NOT adult) AND (flexible NOT rigid) AND (flat foot OR pes planus) AND (calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal). The risk of bias assessment was performed using the Dutch checklist form for prognosis.
RESULTS A total of 47 articles were found. Ultimately, after reading the full text and checking reference lists, we selected 17 articles that met the inclusion and exclusion criteria. A total of 1864 FFFs were identified. Eight studies concerned the subtalar AR (47.1%) and nine concerning CS (52.9%). The average age of patients at start of treatment was 11.8 years, the average follow-up of the studies was 71.9 mo (range 29.1-130). Globally, complications occurred in 153 of the 1864 FFF treated, with a rate of 8.2%.
CONCLUSION Both AR procedures are valid surgical techniques for treating FFF. Surgeon experience, implant cost, and cosmetic correction are the most common considerations included in the orthopedic device decision-making process. In obese patients, the subtalar AR is not recommended. In adolescents who need to improve sports performance, the CS screw had better results compared with other implants.
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Affiliation(s)
- Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Mirko Amico
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Claudio Lizzio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania 95123, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
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Vogt B, Toporowski G, Gosheger G, Rölfing JD, Rosenbaum D, Schiedel F, Laufer A, Kleine-Koenig MT, Theil C, Roedl R, Frommer A. Subtalar Arthroereisis for Flexible Flatfoot in Children-Clinical, Radiographic and Pedobarographic Outcome Comparing Three Different Methods. CHILDREN-BASEL 2021; 8:children8050359. [PMID: 33946168 PMCID: PMC8145324 DOI: 10.3390/children8050359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Bjoern Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (G.T.); (A.L.); (R.R.); (A.F.)
- Correspondence: ; Tel.: +49-251-83-47909
| | - Gregor Toporowski
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (G.T.); (A.L.); (R.R.); (A.F.)
| | - Georg Gosheger
- General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany; (G.G.); (C.T.)
| | - Jan Duedal Rölfing
- Orthopaedic Reconstruction, Aarhus University Hospital, 8000 Aarhus, Denmark;
| | - Dieter Rosenbaum
- Institute of Experimental Musculoskeletal Medicine, Movement Analysis Laboratory, University Hospital Muenster, 48149 Muenster, Germany;
| | - Frank Schiedel
- Pediatric Orthopedics and Neuroorthopedics, Clemenshospital Muenster, 48153 Muenster, Germany; (F.S.); (M.-T.K.-K.)
| | - Andrea Laufer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (G.T.); (A.L.); (R.R.); (A.F.)
| | - Marie-Theres Kleine-Koenig
- Pediatric Orthopedics and Neuroorthopedics, Clemenshospital Muenster, 48153 Muenster, Germany; (F.S.); (M.-T.K.-K.)
| | - Christoph Theil
- General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany; (G.G.); (C.T.)
| | - Robert Roedl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (G.T.); (A.L.); (R.R.); (A.F.)
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany; (G.T.); (A.L.); (R.R.); (A.F.)
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11
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de Bot RTAL, Stevens J, Hermus JPS, Staal HM, van Rhijn LW, Witlox AM. Clinical and Radiological Outcomes of Subtalar Kalix II Arthroereisis for a Symptomatic Pediatric Flexible Flatfoot. Foot Ankle Spec 2021; 14:9-18. [PMID: 31875408 DOI: 10.1177/1938640019892062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The purpose of this study is to evaluate functional and radiological outcomes of subtalar arthroereisis in the treatment of symptomatic pediatric flexible flatfeet. Methods. A total of 16 patients (26 feet) were treated with a Kalix II as subtalar motion blocker between 2009 and 2014. Calcaneal pitch (CP) and Meary's angle (MA) were measured on radiographs preoperatively, directly postoperatively, and at follow-up 47 ± 17 (range 19-79) months. Patient satisfaction surveys were used to assess functional outcome and patient satisfaction. Results. Surgery was performed mostly for pain, walking problems, or a combination of both at a mean age of 12.5 ± 1.5 (range 10-15) years. Symptoms were relieved in 62.5% of patients in the postoperative phase and increased to 68.75% at follow-up. A statistically significant increase in CP of 2.8° and decrease in MA of 14.0° was observed directly postoperatively, which persisted during the follow-up period irrespective of Kalix removal. Revision surgery was necessary in 6 cases (23%) because of arthroereisis migration. Conclusion. Subtalar Kalix II arthroereisis significantly reduced clinical symptoms and improved the CP and MA directly postoperatively, which persisted during follow-up, irrespective of Kalix removal. Therefore, subtalar arthroereisis is a considerable intervention to reduce symptoms in children with symptomatic flexible flatfeet.Levels of Evidence: Level IV: Case series.
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Affiliation(s)
- Robin T A L de Bot
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
| | - Jasper Stevens
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
| | - Joris P S Hermus
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
| | - Heleen M Staal
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
| | | | - Adhiambo M Witlox
- Department of Orthopaedics, Maastricht University Medical Center, Netherlands
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12
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Endosinotarsal device exerts a better postoperative correction in Meary's angle than exosinotarsal screw from a meta-analysis in pediatric flatfoot. Sci Rep 2020; 10:13532. [PMID: 32782334 PMCID: PMC7419313 DOI: 10.1038/s41598-020-70545-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/24/2020] [Indexed: 11/20/2022] Open
Abstract
For pediatric flexible flatfoot, the subtalar extra-articular screw arthroereisis (SESA) and endosinotarsal device are the most popular techniques in current practice. Nevertheless, scarce literature is available comparing the outcomes between these two techniques. Thus, we aimed to provide a meta-analysis for the radiographic and clinical outcomes, respectively. A systemic search for correction of pediatric flexible flatfoot using subtalar arthroereisis was conducted mainly in Pubmed and Scopus, and the search was completed on 31 Dec., 2019. The standardized mean differences (SMD) of postoperative versus preoperative calcaneal pitch and Meary’s angle were defined as the primary outcomes, whereas the preoperative versus posteoperative AOFAS (American Orthopaedic Foot and Ankle Society) as the secondary outcome. The meta-analysis included 12 comparative studies comprising 2063 feet in total. The quantitative analysis showed a marked improvement in Meary’s angle of endosinotarsal cone implant group (SMD: 4.298; 95% CI 2.706–5.889) than exosinotarsal screw group (SMD: 1.264; 95% CI 0.650–1.877). But no significant difference was noted between both groups in calcaneal pitch and AOFAS. The exosinotarsal screw and endosinotarsal device are both effective arthroereisis implant for pediatric flexible flatfoot. While considering the correction of Meary’s angle, the endosinotarsal device is better than exosinotarsal screw.
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13
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Walley KC, Greene G, Hallam J, Juliano PJ, Aynardi MC. Short- to Mid-Term Outcomes Following the Use of an Arthroereisis Implant as an Adjunct for Correction of Flexible, Acquired Flatfoot Deformity in Adults. Foot Ankle Spec 2019; 12:122-130. [PMID: 29644885 DOI: 10.1177/1938640018770242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The use of an arthroereisis implant for the treatment of adolescent flatfoot deformity has been described. However, data that address the outcomes of patients treated with an arthroereisis implant in adults are limited. The purpose of this study was to investigate the radiographic and clinical outcomes and complications following the use of a subtalar arthroereisis implant as an adjunct for correction acquired flatfoot deformity secondary to posterior tibial tendon dysfunction. METHODS A retrospective case-control study was performed querying all patients undergoing surgical flatfoot correction between January 1, 2010 and January 1, 2015. The experimental group included patients undergoing arthroereisis augmentation at the time of flatfoot correction. Patients undergoing the same flatfoot correction without the use of an arthroereisis implant were used as controls. Radiographic measurements were evaluated preoperatively and at final radiographic follow-up and included talonavicular (TN) coverage angle, and lateral talar-first metatarsal angle (T1MA). Patient-reported outcomes were assessed using preoperative visual analog scale (VAS) pain scores and postoperative Short Form-36, VAS, and satisfaction at final orthopedic follow-up. RESULTS A total of 15 patients underwent flatfoot correction and were augmented with an arthroereisis implant and were matched with 30 controls. Postoperative, mid-term T1MA and regional analysis was found to be improved in the experimental group versus control. Patients undergoing adjunct subtalar arthroereisis demonstrated an increased likelihood of achieving radiographically normal talonavicular coverage <7° compared with our control group at follow-up. CONCLUSIONS The adjunct use of an arthroereisis implant resulted in improved and maintained radiographic and clinical measurements in patients undergoing stage II flatfoot. CLINICAL SIGNIFICANCE These results suggest utility of a subtalar arthroereisis implant as an adjunct to flatfoot correction with little additional risk of harm to the patient. LEVELS OF EVIDENCE Level III: Case-control study.
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Affiliation(s)
- Kempland C Walley
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Gearin Greene
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jesse Hallam
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Paul J Juliano
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael C Aynardi
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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14
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Giannini S, Cadossi M, Mazzotti A, Persiani V, Tedesco G, Romagnoli M, Faldini C. Bioabsorbable Calcaneo-Stop Implant for the Treatment of Flexible Flatfoot: A Retrospective Cohort Study at a Minimum Follow-Up of 4 Years. J Foot Ankle Surg 2018. [PMID: 28633776 DOI: 10.1053/j.jfas.2017.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Arthroereisis of the subtalar joint is a common surgical technique in Europe for the management of flexible flatfoot in the pediatric population. In most cases, it is performed using a calcaneo-stop metallic screw. Despite the good clinical results, screw removal is always advised after 2 to 3 years. The use of a bioabsorbable screw might overcome the need for a second operation to remove a nonabsorbable device. We report the results of a biodegradable calcaneo-stop screw at a minimum of 4 years of follow-up. Eighty-eight procedures were performed on 44 children. All patients were clinically and radiologically evaluated preoperatively and at a minimum 4-year follow-up period. Patient satisfaction and plantar collapse using Viladot's classification were recorded. Meary's talus-first metatarsal angle and talocalcaneal angle were measured on radiographs preoperatively and at the last follow-up visit. The presence of the device at the last follow-up examination was assessed by magnetic resonance imaging. The mean follow-up duration was 56 months. Of the 44 patients, 33 (75%) reported excellent clinical outcomes, 9 (20.5%) good outcomes, and 2 (4.5%) poor. Foot print improvement was registered for all patients. The mean Meary's talus-first metatarsal angle had improved from 160.6° ± 7.7° preoperatively to 170.6° ± 6.5° at the last follow-up visit (p < .001). The talocalcaneal angle had decreased from 39.9° ± 5.2° preoperatively to 29.4° ± 4° at the last follow-up examination (p < .001). At the 4-year follow-up point, the implant could be seen to have almost completely biodegraded on magnetic resonance imaging. Two screw breakages occurred. The bioabsorbable calcaneo-stop screw seems to be an effective solution for flexible flatfoot in pediatric patients. Also, owing to its biodegradable composition, the need of a second operation for implant removal will not always be necessary.
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Affiliation(s)
- Sandro Giannini
- Professor Emeritus, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Matteo Cadossi
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Antonio Mazzotti
- Medical Doctor, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
| | - Valentina Persiani
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Giuseppe Tedesco
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Matteo Romagnoli
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Cesare Faldini
- Professor and Director, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
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15
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Faldini C, Mazzotti A, Panciera A, Perna F, Stefanini N, Giannini S. Bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot. Musculoskelet Surg 2017; 102:11-19. [PMID: 28717988 DOI: 10.1007/s12306-017-0491-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022]
Abstract
Flatfoot is a common condition in growing-age patients. Despite its common presentation, nowadays surgical indications and treatments are still debated. Arthroereisis is a widely used technique, and several implants designs have been proposed over time. Despite the good results shown in the literature, the main drawback of these techniques has always been the need for a second surgery for implant removal. Bioabsorbable devices have been introduced to overcome this necessity.Correct approach to the patient, indications and contraindications and available studies on bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot were analyzed in this narrative review. Even if only a few studies have been published in the literature, bioabsorbable implants showed good clinical results comparable to non-absorbable implants and with a rare necessity for implant removal or revision. When correct indications and proper surgical technique are followed, arthroereisis with bioabsorbable implants appears to be an effective solution for the treatment of pediatric flexible flatfoot.
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Affiliation(s)
- C Faldini
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - A Panciera
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - F Perna
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - N Stefanini
- 1st Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Giannini
- Professor Emeritus, Orthopeadics and Traumatology, University of Bologna - Alma Mater Studiorum, Bologna, Italy
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16
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Arthroereisis: physiologic blocking of the subtalar joint. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Saxena A, Via AG, Maffulli N, Chiu H. Subtalar Arthroereisis Implant Removal in Adults: A Prospective Study of 100 Patients. J Foot Ankle Surg 2016; 55:500-3. [PMID: 26874830 DOI: 10.1053/j.jfas.2015.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Indexed: 02/03/2023]
Abstract
Subtalar joint arthroereisis (STA) can be used in the management of adult acquired flatfoot deformity (AAFD), including posterior tibial tendon dysfunction. The procedure is quick and normally causes little morbidity; however, the implant used for STA often needs to be removed because of sinus tarsi pain. The present study evaluated the rate and risk factors for removal of the implant used for STA in adults treated for AAFD/posterior tibial tendon dysfunction, including patient age, implant size, and the use of endoscopic gastrocnemius recession. Patients undergoing STA for adult acquired flatfoot were prospectively studied from 1996 to 2012. The inclusion criteria were an arthroereisis procedure for AAFD/posterior tibial tendon dysfunction, age >18 years, and a follow-up period of ≥2 years. The exclusion criteria were hindfoot arthritis, age <18 years, and a follow-up period of <2 years. A total of 100 patients (average age 53 years) underwent 104 STA procedures. The mean follow-up period was 6.5 (range 2 to 17) years. The overall incidence of implant removal was 22.1%. Patient age was not a risk factor for implant removal (p = .09). However, implant size was a factor for removal, with 11-mm implants removed significantly more frequently (p = .02). Endoscopic gastrocnemius recession did not exert any influence on the rate of implant removal (p = .19). After STA for AAFD, 22% of the implants were removed. No significant difference was found in the incidence of removal according to patient age or endoscopic gastrocnemius recession. However, a significant difference was found for implant size, with 11-mm implants explanted most frequently.
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Affiliation(s)
- Amol Saxena
- Department of Sports Medicine, Palo Alto Medical Foundation Group, Palo Alto, CA.
| | - Alessio Giai Via
- Department of Orthopaedic and Traumatology, University of Rome "Tor Vergata" School of Medicine, Rome, Italy
| | - Nicola Maffulli
- Professor, Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK; Professor, Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Haywan Chiu
- Third Year Resident, Podiatric Medicine and Surgery Residency Program, Department of Veterans Affairs Healthcare System, Palo Alto, CA
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18
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Faldini C, Nanni M, Traina F, Fabbri D, Borghi R, Giannini S. Surgical treatment of hallux valgus associated with flexible flatfoot during growing age. INTERNATIONAL ORTHOPAEDICS 2015; 40:737-43. [PMID: 26508497 DOI: 10.1007/s00264-015-3019-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/11/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE During growth, hallux valgus could present associated with flatfoot. Considering the current disagreement about correction of hallux valgus during growth and the lack of reports about simultaneous correction of hallux valgus associated with flexible flatfoot, we present simultaneous treatment of both deformities during growth combining subtalar arthroeresis and SERI first metatarsal osteotomy, reporting results at an average five-year follow-up. METHODS Thirty-two children (64 feet, age range 8-12 years) affected by hallux valgus associated with flexible flatfoot underwent surgical treatment combining SERI first metatarsal osteotomy and subtalar arthroereisis with bioabsorbable endorthotic implant. Clinical evaluation was summarized with AOFAS score, and standard standing radiographs were performed. RESULTS AOFAS score ranged from 86 ± 2 to 98 ± 2 (hindfoot) and from 80 ± 4 to 98 ± 2 (forefoot). HVA ranged from 21° ± 2 to 5° ± 2, IMA from 14° ± 2 to 7° ± 2, DMAA from 18° ± 2 to 2° ± 2, and Meary's angle from 162° ± 11 to 175° ± 4. Complications included one case of delayed wound healing, inflammatory skin reaction around the outlet of the percutaneous Kirschner wire in two cases, displacement of the endorthotic implant in one case, and a second surgery to replace the implant. CONCLUSIONS SERI osteotomy and subtalar arthroereisis resulted in an effective, technically simple and easily combined approach, with a high rate of good results and low rate of complications at mid-term follow-up. These techniques performed simultaneously represent a viable option in case of hallux valgus associated with flexible flatfoot during growth. Nevertheless, considering the limitations of this study, we believe that a larger case series and a longer follow-up should be desirable.
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Affiliation(s)
- Cesare Faldini
- Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy.,Istituto Ortopedico Rizzoli, Strada Statale 113 Km 246, 90011, Bagheria, PA, Italy
| | - Matteo Nanni
- Istituto Ortopedico Rizzoli, Strada Statale 113 Km 246, 90011, Bagheria, PA, Italy.
| | - Francesco Traina
- Istituto Ortopedico Rizzoli, Strada Statale 113 Km 246, 90011, Bagheria, PA, Italy
| | - Daniele Fabbri
- Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Raffaele Borghi
- Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Sandro Giannini
- Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
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Ozan F, Doğar F, Gençer K, Koyuncu Ş, Vatansever F, Duygulu F, Altay T. Symptomatic flexible flatfoot in adults: subtalar arthroereisis. Ther Clin Risk Manag 2015; 11:1597-602. [PMID: 26527876 PMCID: PMC4621198 DOI: 10.2147/tcrm.s90649] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Flexible flatfoot is a common deformity in pediatric and adult populations. In this study, we aimed to evaluate the functional and radiographic results of subtalar arthroereisis in adult patients with symptomatic flexible flatfoot. We included 26 feet in 16 patients who underwent subtalar arthroereisis for symptomatic flexible flatfoot. Radiographic examination included calcaneal inclination angle, lateral talocalcaneal angle, Meary’s angle, anteroposterior talonavicular angle, and Kite’s angle. The clinical assessment was based on the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and a visual analog scale (VAS). The mean follow-up was 15.1±4.7 months. The mean preoperative AOFAS score was 53±6.6, while the mean AOFAS score at the last follow-up visit was 75±11.2 (P<0.05). The mean visual analog scale score was 6.9±0.6 preoperatively and 4.1±1.4 at the last follow-up visit (P<0.05). The mean preoperative and postoperative values measured were 13.4°±3.3° and 14.6°±2.7° for calcaneal inclination angles (P<0.05); 35.7°±6.9° and 33.2°±5.3° for lateral talocalcaneal angles (P>0.05); 8°±5.3° and 3.3±3 for Meary’s angles (P<0.05); 5.6°±3.5° and 2.6°±1.5° for anteroposterior talonavicular angles (P<0.05); and 23.7°±6.1° and 17.7°±5° for Kite’s angles, respectively (P<0.05). Implants were removed in three feet (11.5%). Subtalar arthroereisis is a minimally invasive procedure that can be used in the surgical treatment of adults with symptomatic flexible flatfoot. This procedure provided radiological and functional recovery in our series of patients.
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Affiliation(s)
- Fırat Ozan
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Fatih Doğar
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Kürşat Gençer
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Şemmi Koyuncu
- Department of Orthopedics and Traumatology, Bayburt State Hospital, Bayburt, Turkey
| | - Fatih Vatansever
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Fuat Duygulu
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Taşkın Altay
- Department of Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
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20
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Lui TH. Spontaneous subtalar fusion: an irreversible complication of subtalar arthroereisis. J Foot Ankle Surg 2014; 53:652-6. [PMID: 24846157 DOI: 10.1053/j.jfas.2014.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Indexed: 02/03/2023]
Abstract
Subtalar arthroereisis has been used for the treatment of symptomatic flexible flatfoot deformities in both pediatric and adult patients. Chronic sinus tarsi pain is the most common complication of this procedure and can be relieved by removal of the implant. We describe a case of spontaneous fusion of the subtalar joint after arthroereisis. This is an irreversible complication that should be described to the patient as a rare, but possible, outcome of arthroereisis of the subtalar joint.
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Affiliation(s)
- Tun Hing Lui
- Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, New Territory, Hong Kong Special Administration Region, China.
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21
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Wagner F, Hofbauer R, Matussek J. [Flexible flatfoot in children: variation within normal range or need for treatment?]. DER ORTHOPADE 2013; 42:455-68. [PMID: 23685502 DOI: 10.1007/s00132-013-2111-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Flexible flatfoot in childhood is a common cause for repetitive consultations and the diagnosis is verified by the clinical examination. In most cases the findings are age-dependent variants of the norm and if asymptomatic there is no need for treatment. In the first decade of life symptomatic flexible flatfoot should initially be treated with shoe inserts. Further diagnostic steps are required once conservative treatment is unsuccessful or a rigid structural deformity is found in the clinical examination. The underlying reasons may be neuropathic or structural anatomical in origin. Lateral column lengthening as described by Evans or minimally invasive arthroereisis are well established surgical options but for arthroereisis the number of long-term studies is low. In general the indications for surgical and conservative therapy have to be judged with caution although parents often see an urgent need for treatment.
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Affiliation(s)
- F Wagner
- Orthopädische Klinik, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Deutschland.
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