Clinical and Radiological Outcomes of Subtalar Arthroereisis for Management of Planovalgus Foot in Children With Cerebral Palsy: 3-Year Follow-up

Abstract

Background Planovalgus deformity of the foot is common among cerebral palsy (CP) patients. It is an upcoming topic with debate and controversy that require further studies. Many clinical studies involving arthroereisis have shown acceptable results in short- and mid-term follow-up. The aim of this work was to evaluate the outcome of arthroereisis using a conventional screw placed percutaneously across the talocalcaneal articulation for the treatment of moderate planovalgus deformity in children with CP. Methods Between 2015 and 2018, a prospective study was conducted including 23 CP patients with bilateral flexible planovalgus deformity with follow-up period ranging from 24 to 40 months (mean of 36.7 months). The radiological and clinical outcomes were assessed. The patient/parent outcome was evaluated using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). Results The results showed statistically significant improvement in both radiological and clinical data as well as patient’s symptoms and parent’s satisfaction. Conclusion Results obtained from literature from the past decades after arthroereisis for the correction of moderate planovalgus deformity in CP patients are promising. The few studies reported on that procedure shared the same harmony with our study giving a chance to be a good alternative to joint destructive procedures. Our technique is simple, effective, economical, and minimally invasive if used in selected pediatric CP patients. Levels of Evidence Therapeutic, Level IV

Arthroereisis with a Talar Screw in Symptomatic Flexible Flatfoot in Children

“…Thirty-seven percent of our study group underwent simultaneous Achilles tendon lengthening. Other authors also reported performing additional procedures in 17-100% of patients undergoing arthroereisis [1,3,7,[9][10][11][12][13][14][16][17][18]. Those additional procedures had no effect on either clinical or radiological outcomes [10,14].…”

“…Arthroereisis, which is used in the treatment of symptomatic pes planovalgus, is minimally invasive, inexpensive, produces few complications, and ensures high rates of patient satisfaction [1,2,[4][5][6][7][8][9]15,17,19]. The implants used for arthroereisis mechanically limit foot pronation and improve proprioception, which helps achieve the correction of pes planovalgus deformity [1][2][3]5].…”

“…Since it is a minimally invasive, inexpensive, and time-efficient procedure with few complications, arthroereisis is an accepted method of treatment for symptomatic pes planovalgus, yielding high rates of patient satisfaction with treatment [1][2][3][5][6][7][8][9]19,22]. Nonetheless, there is no consensus on the technique of arthroereisis in the treatment of symptomatic pes planovalgus [1,2,4,5,7,8,10,12,13,20].…”

“…Nonetheless, there is no consensus on the technique of arthroereisis in the treatment of symptomatic pes planovalgus [1,2,4,5,7,8,10,12,13,20]. Some authors suggest the use of free-floating sinus tarsi implants [6,7,9], some advocate for inserting screws into the calcaneus [3,8,13,15,16,19], still others report comparable outcomes irrespective of the type of implant used [1,2,12,18]. The goals of arthroereisis procedure includes reduction of pain and deformity, improvement of gait, and increase in physical activity and sport activity [5,7,8,10,12].…”

Symptomatic flatfoot in cerebral palsy

“…]. Arthroereisis has had a recent resurgence in the literature [41][42][43][44][45]. However, most neuromuscular pediatric orthopedic surgeons have tended to avoid this technique due to high complication rates and less correction capacity than other techniques [46].…”