Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years

Abstract

BACKGROUND Flexible flatfoot (FFF) is a very common condition in children, characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot. Arthroereisis (AR) procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop (CS). AIM We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients. We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population, young athletes, and obese people according to material device. METHODS Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6, 2020. The research string used was (pediatric OR children OR Juvenile NOT adult) AND (flexible NOT rigid) AND (flat foot OR pes planus) AND (calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal). The risk of bias assessment was performed using the Dutch checklist form for prognosis. RESULTS A total of 47 articles were found. Ultimately, after reading the full text and checking reference lists, we selected 17 articles that met the inclusion and exclusion criteria. A total of 1864 FFFs were identified. Eight studies concerned the subtalar AR (47.1%) and nine concerning CS (52.9%). The average age of patients at start of treatment was 11.8 years, the average follow-up of the studies was 71.9 mo (range 29.1-130). Globally, complications occurred in 153 of the 1864 FFF treated, with a rate of 8.2%. CONCLUSION Both AR procedures are valid surgical techniques for treating FFF. Surgeon experience, implant cost, and cosmetic correction are the most common considerations included in the orthopedic device decision-making process. In obese patients, the subtalar AR is not recommended. In adolescents who need to improve sports performance, the CS screw had better results compared with other implants.

An evaluation of subtalar titanium screw arthroereisis for the treatment of symptomatic paediatric flatfeet - early results

“…Our findings are similar to those of previous studies, indicating that arthroeresis yields improved gait pattern and less pain [ 13 – 15 ]. Indino et al found that subtalar arthroereisis with endorthesis was effective for treating paediatric flexible flatfoot, reflected in improved radiographic parameters at skeletal maturity [ 20 ].…”

HyProCure for Pediatric Flexible Flatfoot: What Affects the Outcome

“…They found no significant differences in radiographic or clinical parameters between the two groups in the short and medium term. A recent systematic review ( 41 ) showed that both impact blocking and self-locking devices were proven to be valid and effective for treating pediatric flexible flatfeet. Nonetheless, for those with obesity or those demanding high performance in sports, the calcaneo-stop procedure may be better and more recommended ( 41 ).…”

“…A recent systematic review ( 41 ) showed that both impact blocking and self-locking devices were proven to be valid and effective for treating pediatric flexible flatfeet. Nonetheless, for those with obesity or those demanding high performance in sports, the calcaneo-stop procedure may be better and more recommended ( 41 ). The calcaneo-stop procedure, a cheap, simple, and effective technique, has shown satisfactory clinical and radiographic outcomes and low rates of complications ( 42 ).…”

Really Asymptomatic? Health-Related Quality of Life and Objective Clinical Foot Characteristics among 5–10-Year-Old Children with a Flexible FlatFoot

“…At this point, for the clinical practitioner, in the decision-making process, it is essential to distinguish between the different forms of flatfoot-asymptomatic or symptomatic flexible flatfoot. If the child expresses pain in the feet, and the parents also have concerns about the shape of the child's feet, this commonly used combination opens up the possibility of using an understandable and approved treatment algorithm for flexible symptomatic flatfoot [1,4,[18][19][20][21][22][23]. On the other hand, if the child does not express or note pain in the feet, but only the parents are worried about the child's flat feet, then clinicians should alleviate their parents' worry and explain that children are born with flexible flatfoot which naturally develops the normal arch in the first decade of life or remains asymptomatic [24].…”