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Midterm assessment of subtalar arthroereisis for correction of flexible flatfeet in children.
Orthop Traumatol Surg Res. 2020 Feb; 106(1):185-191.OT

Abstract

BACKGROUND

The role of subtalar arthroereisis (STA) for treating flexible flatfoot (FFF) in children is controversial. We hypothesized that (1) STA provided significant radiographic correction of low longitudinal arch and forefoot abduction in paediatric FFF and that (2) mid-term clinical outcomes were satisfactory and comparable to a normal population.

METHODS

A retrospective comparative study was performed of paediatric patients with symptomatic FFF who underwent STA between 2012 and 2015. Multiple measurements on preoperative and latest follow-up radiographs were recorded by two observers and compared to assess for correction of the FFF. Intra- and inter-observer reliability was also assessed. Ankle and hindfoot range of motion (ROM), AOFAS hindfoot score and VAS-FA score were compared with controls without foot symptoms or deformity. From 70 consecutive feet, 62 (31 patients) treated at 10.5 years of age were identified and compared to 48 controls (24 patients). Mean follow-up was 62 months.

RESULTS

Intra- and inter-observer reliability was excellent for all angles (range, 0.81-0.97). Radiographic measurements demonstrated significant improvement after surgery (p<0.001) but significance was not reached in talonavicular coverage angle (p=0.49) and calcaneo-fifth metatarsal angle (p=0.53) on dorsoplantar view. At latest follow-up, patients had less hindfoot inversion than controls (15.1̊ vs. 19.3̊, p=0.03), lower AOFAS scores (94.1 vs. 99.6 points, p=0.01), due to pain (p=0.01) and alignment (p=0.006) subscores. Using the VAS-FA score, patients were found to demonstrate higher pain at rest (prange, 0.02-0.03) and during activity (p=0.009), and felt limited when standing on one leg (p range, 0.01-0.03) and running (p=0.04). No loss of correction was found after removal of the implant.

CONCLUSION

This study showed that STA corrected the low longitudinal arch in symptomatic paediatric FFF, but did not correct forefoot abduction in relation to the hindfoot. Mid-term assessment revealed STA provided satisfactory ankle and hindfoot ROM, pain and function levels, but limitations are witnessed compared to unaffected individuals. This aspect should be considered when counselling patients and their parents or caregivers to allow for realistic expectations.

LEVEL OF EVIDENCE

III, retrospective comparative study.

Authors+Show Affiliations

Foot and Ankle Unit, Royal National Orthopaedic Hospital, HA7 4LP, Brockley Hill, Stanmore, United Kingdom; Orthopaedic Division, Department of Public Health, University of Naples Federico II, Via Pansini 80131, Napoli, Italy. Electronic address: alebernas@gmail.com.Orthopaedic Division, Department of Public Health, University of Naples Federico II, Via Pansini 80131, Napoli, Italy.Orthopaedic Division, Department of Public Health, University of Naples Federico II, Via Pansini 80131, Napoli, Italy.Ankle and Foot Surgery Centre, Clinique de l'Union, Boulevard de Ratalens, 31240 Saint-Jean, France.Foot and Ankle Unit, Royal National Orthopaedic Hospital, HA7 4LP, Brockley Hill, Stanmore, United Kingdom.Orthopaedic Division, Department of Public Health, University of Naples Federico II, Via Pansini 80131, Napoli, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31848065

Citation

Bernasconi, Alessio, et al. "Midterm Assessment of Subtalar Arthroereisis for Correction of Flexible Flatfeet in Children." Orthopaedics & Traumatology, Surgery & Research : OTSR, vol. 106, no. 1, 2020, pp. 185-191.
Bernasconi A, Iervolino C, D'Alterio R, et al. Midterm assessment of subtalar arthroereisis for correction of flexible flatfeet in children. Orthop Traumatol Surg Res. 2020;106(1):185-191.
Bernasconi, A., Iervolino, C., D'Alterio, R., Lintz, F., Patel, S., & Sadile, F. (2020). Midterm assessment of subtalar arthroereisis for correction of flexible flatfeet in children. Orthopaedics & Traumatology, Surgery & Research : OTSR, 106(1), 185-191. https://doi.org/10.1016/j.otsr.2019.10.012
Bernasconi A, et al. Midterm Assessment of Subtalar Arthroereisis for Correction of Flexible Flatfeet in Children. Orthop Traumatol Surg Res. 2020;106(1):185-191. PubMed PMID: 31848065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Midterm assessment of subtalar arthroereisis for correction of flexible flatfeet in children. AU - Bernasconi,Alessio, AU - Iervolino,Cecilia, AU - D'Alterio,Rosa, AU - Lintz,François, AU - Patel,Shelain, AU - Sadile,Francesco, Y1 - 2019/12/14/ PY - 2019/06/28/received PY - 2019/10/20/revised PY - 2019/10/30/accepted PY - 2019/12/19/pubmed PY - 2019/12/19/medline PY - 2019/12/19/entrez KW - Arthroereisis KW - Children KW - Flatfoot KW - Self-locking KW - Subtalar SP - 185 EP - 191 JF - Orthopaedics & traumatology, surgery & research : OTSR JO - Orthop Traumatol Surg Res VL - 106 IS - 1 N2 - BACKGROUND: The role of subtalar arthroereisis (STA) for treating flexible flatfoot (FFF) in children is controversial. We hypothesized that (1) STA provided significant radiographic correction of low longitudinal arch and forefoot abduction in paediatric FFF and that (2) mid-term clinical outcomes were satisfactory and comparable to a normal population. METHODS: A retrospective comparative study was performed of paediatric patients with symptomatic FFF who underwent STA between 2012 and 2015. Multiple measurements on preoperative and latest follow-up radiographs were recorded by two observers and compared to assess for correction of the FFF. Intra- and inter-observer reliability was also assessed. Ankle and hindfoot range of motion (ROM), AOFAS hindfoot score and VAS-FA score were compared with controls without foot symptoms or deformity. From 70 consecutive feet, 62 (31 patients) treated at 10.5 years of age were identified and compared to 48 controls (24 patients). Mean follow-up was 62 months. RESULTS: Intra- and inter-observer reliability was excellent for all angles (range, 0.81-0.97). Radiographic measurements demonstrated significant improvement after surgery (p<0.001) but significance was not reached in talonavicular coverage angle (p=0.49) and calcaneo-fifth metatarsal angle (p=0.53) on dorsoplantar view. At latest follow-up, patients had less hindfoot inversion than controls (15.1̊ vs. 19.3̊, p=0.03), lower AOFAS scores (94.1 vs. 99.6 points, p=0.01), due to pain (p=0.01) and alignment (p=0.006) subscores. Using the VAS-FA score, patients were found to demonstrate higher pain at rest (prange, 0.02-0.03) and during activity (p=0.009), and felt limited when standing on one leg (p range, 0.01-0.03) and running (p=0.04). No loss of correction was found after removal of the implant. CONCLUSION: This study showed that STA corrected the low longitudinal arch in symptomatic paediatric FFF, but did not correct forefoot abduction in relation to the hindfoot. Mid-term assessment revealed STA provided satisfactory ankle and hindfoot ROM, pain and function levels, but limitations are witnessed compared to unaffected individuals. This aspect should be considered when counselling patients and their parents or caregivers to allow for realistic expectations. LEVEL OF EVIDENCE: III, retrospective comparative study. SN - 1877-0568 UR - https://www.unboundmedicine.com/medline/citation/31848065/Midterm_assessment_of_subtalar_arthroereisis_for_correction_of_flexible_flatfeet_in_children L2 - https://linkinghub.elsevier.com/retrieve/pii/S1877-0568(19)30376-7 DB - PRIME DP - Unbound Medicine ER -
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