Effectiveness of subtalar arthroereisis with endorthesis for pediatric flexible flat foot

a retrospective cross-sectional study with final follow up at skeletal maturity

Cristian Indino, Jorge Hugo Villafañe, Riccardo D'Ambrosi, Luigi Manzi, Camilla Maccario, Pedro Berjano, Federico Giuseppe Usuelli

Research output: Contribution to journalArticle

Abstract

Background: Pediatric flexible flatfoot is sometimes asymptomatic but it can rarely cause physical impairment, pain, and difficulty walking. We evaluated the radiographic effectiveness of intervention of subtalar arthroereisis with endorthesis for pediatric flexible flatfoot with final follow-up at skeletal maturity. Methods: This is a retrospective cross-sectional study. 56 consecutive patients (112 feet) who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot (mean age at final follow-up 15.5 ± 1.2 years, 39.3% female) were enrolled. All the radiographic studies were performed in the hospital. Radiographs (standard weight-bearing radiographs of the foot with anteroposterior and lateral view) were used to measure lateral talocalcaneal angle (LTC), calcaneal pitch angle (CP), Meary's angle (MA), anteroposterior talonavicular angle (APTN), talonavicular uncoverage percent (TNU). Minimum follow-up was 18 months. Measures were assessed pre-operatively and at the final follow-up. Clinical and functional parameters were assessed at the final follow-up. Results: Children who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot exhibited a statistically significant improvement in all radiographic measurement parameters at the last follow-up at skeletal maturity (all, p < 0.004). Mean follow-up was 40.1 ± 23.6 months. Clinical parameters were not correlated with the foot radiographic parameters at follow up period. Conclusions: Our results suggest that endorthesis in pediatric flexible flatfoot was effective for improving radiographic parameters at skeletal maturity. The amount of the morphologic correction at the end of the skeletal growth should be expected mainly for lateral tarso-metatarsal alignment and talo-navicular congruency (MA, APTN, TNU). Level of evidence: Level III, retrospective study.

Original languageEnglish
JournalFoot and Ankle Surgery
Early online dateDec 2018
DOIs
Publication statusE-pub ahead of print - Dec 2018

Fingerprint

Flatfoot
Cross-Sectional Studies
Pediatrics
Foot
Mobility Limitation
Metatarsal Bones
Weight-Bearing
Retrospective Studies
Pain
Therapeutics
Growth

Keywords

  • Arthroereisis
  • Endorthesis
  • Foot
  • Pediatric

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

@article{618dab3329b04119b553a389d6dc9c6b,
title = "Effectiveness of subtalar arthroereisis with endorthesis for pediatric flexible flat foot: a retrospective cross-sectional study with final follow up at skeletal maturity",
abstract = "Background: Pediatric flexible flatfoot is sometimes asymptomatic but it can rarely cause physical impairment, pain, and difficulty walking. We evaluated the radiographic effectiveness of intervention of subtalar arthroereisis with endorthesis for pediatric flexible flatfoot with final follow-up at skeletal maturity. Methods: This is a retrospective cross-sectional study. 56 consecutive patients (112 feet) who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot (mean age at final follow-up 15.5 ± 1.2 years, 39.3{\%} female) were enrolled. All the radiographic studies were performed in the hospital. Radiographs (standard weight-bearing radiographs of the foot with anteroposterior and lateral view) were used to measure lateral talocalcaneal angle (LTC), calcaneal pitch angle (CP), Meary's angle (MA), anteroposterior talonavicular angle (APTN), talonavicular uncoverage percent (TNU). Minimum follow-up was 18 months. Measures were assessed pre-operatively and at the final follow-up. Clinical and functional parameters were assessed at the final follow-up. Results: Children who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot exhibited a statistically significant improvement in all radiographic measurement parameters at the last follow-up at skeletal maturity (all, p < 0.004). Mean follow-up was 40.1 ± 23.6 months. Clinical parameters were not correlated with the foot radiographic parameters at follow up period. Conclusions: Our results suggest that endorthesis in pediatric flexible flatfoot was effective for improving radiographic parameters at skeletal maturity. The amount of the morphologic correction at the end of the skeletal growth should be expected mainly for lateral tarso-metatarsal alignment and talo-navicular congruency (MA, APTN, TNU). Level of evidence: Level III, retrospective study.",
keywords = "Arthroereisis, Endorthesis, Foot, Pediatric",
author = "Cristian Indino and Villafa{\~n}e, {Jorge Hugo} and Riccardo D'Ambrosi and Luigi Manzi and Camilla Maccario and Pedro Berjano and Usuelli, {Federico Giuseppe}",
year = "2018",
month = "12",
doi = "10.1016/j.fas.2018.12.002",
language = "English",
journal = "Foot and Ankle Surgery",
issn = "1268-7731",
publisher = "Elsevier Limited",

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TY - JOUR

T1 - Effectiveness of subtalar arthroereisis with endorthesis for pediatric flexible flat foot

T2 - a retrospective cross-sectional study with final follow up at skeletal maturity

AU - Indino, Cristian

AU - Villafañe, Jorge Hugo

AU - D'Ambrosi, Riccardo

AU - Manzi, Luigi

AU - Maccario, Camilla

AU - Berjano, Pedro

AU - Usuelli, Federico Giuseppe

PY - 2018/12

Y1 - 2018/12

N2 - Background: Pediatric flexible flatfoot is sometimes asymptomatic but it can rarely cause physical impairment, pain, and difficulty walking. We evaluated the radiographic effectiveness of intervention of subtalar arthroereisis with endorthesis for pediatric flexible flatfoot with final follow-up at skeletal maturity. Methods: This is a retrospective cross-sectional study. 56 consecutive patients (112 feet) who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot (mean age at final follow-up 15.5 ± 1.2 years, 39.3% female) were enrolled. All the radiographic studies were performed in the hospital. Radiographs (standard weight-bearing radiographs of the foot with anteroposterior and lateral view) were used to measure lateral talocalcaneal angle (LTC), calcaneal pitch angle (CP), Meary's angle (MA), anteroposterior talonavicular angle (APTN), talonavicular uncoverage percent (TNU). Minimum follow-up was 18 months. Measures were assessed pre-operatively and at the final follow-up. Clinical and functional parameters were assessed at the final follow-up. Results: Children who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot exhibited a statistically significant improvement in all radiographic measurement parameters at the last follow-up at skeletal maturity (all, p < 0.004). Mean follow-up was 40.1 ± 23.6 months. Clinical parameters were not correlated with the foot radiographic parameters at follow up period. Conclusions: Our results suggest that endorthesis in pediatric flexible flatfoot was effective for improving radiographic parameters at skeletal maturity. The amount of the morphologic correction at the end of the skeletal growth should be expected mainly for lateral tarso-metatarsal alignment and talo-navicular congruency (MA, APTN, TNU). Level of evidence: Level III, retrospective study.

AB - Background: Pediatric flexible flatfoot is sometimes asymptomatic but it can rarely cause physical impairment, pain, and difficulty walking. We evaluated the radiographic effectiveness of intervention of subtalar arthroereisis with endorthesis for pediatric flexible flatfoot with final follow-up at skeletal maturity. Methods: This is a retrospective cross-sectional study. 56 consecutive patients (112 feet) who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot (mean age at final follow-up 15.5 ± 1.2 years, 39.3% female) were enrolled. All the radiographic studies were performed in the hospital. Radiographs (standard weight-bearing radiographs of the foot with anteroposterior and lateral view) were used to measure lateral talocalcaneal angle (LTC), calcaneal pitch angle (CP), Meary's angle (MA), anteroposterior talonavicular angle (APTN), talonavicular uncoverage percent (TNU). Minimum follow-up was 18 months. Measures were assessed pre-operatively and at the final follow-up. Clinical and functional parameters were assessed at the final follow-up. Results: Children who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot exhibited a statistically significant improvement in all radiographic measurement parameters at the last follow-up at skeletal maturity (all, p < 0.004). Mean follow-up was 40.1 ± 23.6 months. Clinical parameters were not correlated with the foot radiographic parameters at follow up period. Conclusions: Our results suggest that endorthesis in pediatric flexible flatfoot was effective for improving radiographic parameters at skeletal maturity. The amount of the morphologic correction at the end of the skeletal growth should be expected mainly for lateral tarso-metatarsal alignment and talo-navicular congruency (MA, APTN, TNU). Level of evidence: Level III, retrospective study.

KW - Arthroereisis

KW - Endorthesis

KW - Foot

KW - Pediatric

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