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Abstract
Purpose
The purpose of this study was to evaluate the radiographic and clinical outcomes of subtalar arthroereisis as a method of treatment for pediatric flexible flatfoot.
Materials and Methods
We retrospectively investigated 14 feet among 10 patients with flexible flatfoot, who were treated with a subtalar arthroereisis using a sinus tarsi implant between March 2007 and June 2012. Radiographically, the talo-1st metatarsal angle, talar declination, and calcaneal pitch angle have all been measured on lateral radiographs. The talo-navicular coverage angle and talo-1st metatarsal angle was measured on anteroposterior (AP) radiographs and tibio-calcaneal angle was assessed by hindfoot alignment view. Visual analogue scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used for clinical evaluation.
Results
The mean follow-up was 48.7 months (16–98 months), and the mean age was 11.6 years (6–19 years). Radiographically, the mean pre-operative and postoperative values measured by the lateral foot radiograph were −25.1° and −7.5° for talo-1st metatarsal angle, 37.4° and 23.2° for talar declination, and 8.3° and 15.0° for calcaneal pitch angle, respectively. The mean preoperative and postoperative values measured by foot AP radiograph were 23.0° and 11.9° for talo-navicular coverage angle and 17.2° and 9.0° for talo-1st metatarsal angle, respectively. Moreover, tibio-calcaneal angle improved from valgus 17.4° on average to 4.5° on average. Clinically, the VAS score and AOFAS score was improved from 5.8 to 1.5 and from 61.8 to 90.4, respectively. Complication was sinus tarsi pain that occurred in 5 cases (35.7%).
Conclusion
We achieved a satisfactory correction of pediatric flexible flatfoot deformities via subtalar arthroereisis, using a sinus tarsi implant with favorable radiographic and clinical measures. However, high potential complication rate of postoperative sinus tarsi pain on weight-bearing should carefully be considered.
Figures and Tables
Figure 1
A 9-year-old male patient with flexible flatfoot complained of foot pain during walking and sports activity. Subtalar arthroereisis with Kalix implant was performed, resulting in significant flatfoot correction. (A) Preoperative weight-bearing lateral radiograph shows −35.0° for talo-1st metatarsal angle, 41.0° for talar declination and 12.0° for calcaneal pitch angle. (B) At 5 years postoperation, radiograph shows −1° for talo-1st metatarsal angle, 12.0° for talar declination, and 17.7° for calcaneal pitch angle.
Figure 2
Weight-bearing anteroposterior radiographs. (A) Preoperative radiograph shows 34.0° for talo-navicular coverage angle and 34.8° for talo-1st metatarsal angle. (B) At 5 years postoperation, radiograph shows 15.0° for talo-navicular coverage angle and 0.2° for talo-1st metatarsal angle.
Figure 3
Hindfoot alignment view. (A) Preoperative radiograph shows 22.0° for tibio-calcaneal angle. (B) At 5 years postoperation, radiograph shows 1.0° for tibio-calcaneal angle.
Figure 4
A 9-year-old female patient underwent implant removal at postoperative 42 months due to sinus tarsi pain. (A) Preoperative radiograph shows flatfoot deformity. (B) At postoperative 3 years, lateral radiograph shows satisfactory correction of flatfoot. (C) At 7 years postoperation and 42 months after implant removal, lateral radiograph shows that the correction of deformity is well maintained.
Figure 5
At 7 years postoperation, lateral radiograph shows mild degenerative changes with subchondral sclerosis and bony spur in the subtalar joint.
Table 2
Radiographic Outcomes of Patients with Flatfoot Treated with Subtalar Arthroereisis
Values are presented as mean±standard deviation or percent only. F/U, follow-up; LT1MTA, lateral talo-1st metatarsal angle; TDA, talar declination angle; CPA, calcaneal pitch angle; AP, anteroposterior; TNCA, talo-navicular coverage angle; AT1MTA, AP talo-1st metatarsal angle; TCA, tibio-calcaneal angle.
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