Zafer ATBASİ

Functional evaluation of bilateral arthroereisis of subtalar joint and simultaneousgastrocnemius lengthening in symptomatic flexible flatfoot in children

The aim of this study was to report the radiological and pedobarographic results of 10 children’s 20 feet with symptomatic flexible flat foot, who were treated with gas-trocnemius lengthening with arthroereisis of subtalar joint. A total of 10 children’s 20 feet (5 boys and 5 girls between 9-14-year-old) with painful feet due to the flatfoot were treated in our clinic between August 2016 and December 2018. Bilateral gastrocnemius lengthening and arthroereisis of subtalar joint was performed simultaneously. Radiological evaluation was performed by measuring calcaneal pitch angle and Meary’s talusfirst metatarsal angles, pedobarographic evaluation by static and dynamic plantar heel and forefoot pressure data. The mean calcaneal pitch angle increased from 8° ± 0.93° preoperatively to 16.5° ± 1.14° postoperatively, and the mean Meary’s talus-first metatarsal angle decreased from 7.5° ± 1.14°preoperatively to 0.5° ± 0.51° postoperatively. The mean heel peak pressure and the forefoot peak pressure ascend-ed 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. Clinical evaluation revealed that 9 patient had painful feet, while 1 patient had discomfort since the implant had been inserted.Arthroereisis of subtalar joint with simultaneous gastrocnemius lengthening provides painful feet and seems to be an effective, simple and safe solution for symptomatic flexible flatfoot in pediatric patients.

PDF

___

1. Caravaggi P, Lullini G, Berti L, et al. Functional evaluation of bilateralsubtalar arthroereisis for the correction of flexible flatfoot in children: 1-year follow-up. Gait Posture. 2018;64:152-8.

2. Herring JA. Tachdjian’s Pediatric Orthopaedics. 5th Edn. Elsevier, Philadelphia 2013.

3. Roth S, Sestan B, Tudor A, Ostojic Z, Sasso A, Durbesic A. Minimal invasive calcaneostop method for idiopathic flexible per planovalgus in children. Foot Ankle Int. 2007;28:991–5.

4. Mosca VS. Flexible flatfoot in children and adolescents. J Child Orthop. 2010;4:107-21.

5. Faldini C, Mazzotti A, Panciera A, et al. Bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot. Musculoskelet Surg. 2018;102:11-9.

6. Viladot Voegeli A, Fontecilla Cornejo N, Serrá Sandoval JA, et al. Results of subtalar arthroereisis for posterior tibial tendon dysfunction stage IIA1. Based on 35 patients. Foot Ankle Surg. 2018;24:28-33.

7. Arangio GA, Salathe EP. A biomechanical analysis of posterior tibial tendon dysfunction, medial displacement calcaneal osteotomy and flexor digitorum longus transfer in adult acquired flat foot. Clin Biomech (Bristol, Avon). 2009;24:385-90.

8. Fernández de Retana P, Alvarez F, Viladot R. Subtalar arthroereisis in pediatric flatfoot reconstruction. Foot Ankle Clin. 2010;15:323-35.

9. Schon LC. Subtalar arthroereisis: a new exploration of an old concept. Foot Ankle Clin. 2007;12:329-39.

10. Jerosch J, Schunck J, Abdel-Aziz H. The stop screw technique-a simple and reliable method in treating flexible flatfoot in children. Foot Ankle Surg. 2009;15:174-8.

11. Sullivan JA. Pediatric flatfoot: evaluation and management. J Am Acad Orthop Surg. 1999;7:44-53.

12. Lin CJ, Lai KA, Kuan TS, Chou YL. Correlating factors and clinical significance of flexible flatfoot in preschool children. J Pediatr Orthop. 2001;21:378-82.

13. Ledoux WR, Hillstrom HJ. The distributed plantar vertical force of neutrally aligned and pes planus feet. Gait Posture 2010;15:1-9.

14. Dziuba A, Szpala A. Foot kinematics in gait of children with cerebral palsy (CP). Acta Bioeng Biomech. 2008;10:3-6.

15. Alvarez C, De Vera M, Chhina H, Black A. Normative data for the dynamic pedobarographic profiles of children. Gait Posture. 2008;28:309-15.

16. Liu XC, Thometz JG, Tassone C, Barker B, Lyon R. Dynamic plantar pressure measurement for the normal subject: Free-mapping model for the analysis of pediatric foot deformities. J Pediatr Orthop. 2005;25:103-6.

17. Ford SE, Scannell BP. Pediatric flatfoot: pearls and pitfalls. Foot Ankle Clin. 2017;22:643-56.

18. Matheis EA, Spratley EM, Hayes CW, Adelaar RS, Wayne JS. Plantar measurements to determine success of surgical correction of Stage IIb adult acquired flatfoot deformity. J Foot Ankle Surg. 2014;53:562-6.

19. MacMahon A, Hillstrom HJ, Do HT, Chan JY, Deland JT, Ellis SJ. In Vivo Plantar Pressures in Adult-Acquired Flatfoot Compared to Control Using an Intraoperative Pedobarographic Device. HSS J. 2017;13:136-45.

20. Ortiz CA, Wagner E, Wagner P. Arthroereisis: what have we learned? Foot Ankle Clin. 2018;23:415-34.

21. 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.