Arthroereisis for Symptomatic Flexible Flatfoot Deformity in Young Children: Radiological Assessment and Short-Term Follow-Up.J Foot Ankle Surg. 2019 Sep; 58(5):904-915.JF
The purpose of this study is to recognize those young patients with symptomatic flexible flatfoot deformity who need treatment and to provide radiological evidence that arthroereisis is capable of relocating the talus properly over the calcaneus. We included 28 feet in 14 children who underwent subtalar arthroereisis in association with percutaneous triple-hemisection Achilles tendon lengthening. Selected for arthroereisis were children with symptomatic flexible flatfoot deformity who complained of foot and leg pain, had decreased endurance in sports activities and long walks, who did not respond to conservative treatment modalities for at least 6 months, and in whom at radiological assessment on stance position with the medial arch support orthosis the talonavicular joint lateral subluxation still remained, with Meary's angle in anteroposterior (A/P) and lateral view remaining increased. The mean age at surgery was 10.71 ± 1.58 (range 8 to 14) years. The minimum follow-up duration was 19 months, with mean follow-up duration of 35.14 ± 9.82 (range 19 to 60) months. For estimation of the efficacy of the surgical procedure, the American Orthopaedic Foot and Ankle Society (AFOAS) rating scale was used preoperatively and postoperatively in all patients. The mean preoperative AFOAS ankle-hind foot rating score was 65.14 ± 7.16 (range 58 to 75) points. The mean postoperative AFOAS score was 88.851 ± 5.61 (range 83 to 97) points and the 2-tailed p value <.0001. After arthroereisis surgical treatment, all AOFAS scores and all foot angles improved significantly, except the calcaneal inclination angle which improved slightly.