Clinical and Radiological Outcomes of Subtalar Kalix II Arthroereisis for a Symptomatic Pediatric Flexible Flatfoot

Abstract

Background. The purpose of this study is to evaluate functional and radiological outcomes of subtalar arthroereisis in the treatment of symptomatic pediatric flexible flatfeet. Methods. A total of 16 patients (26 feet) were treated with a Kalix II as subtalar motion blocker between 2009 and 2014. Calcaneal pitch (CP) and Meary’s angle (MA) were measured on radiographs preoperatively, directly postoperatively, and at follow-up 47 ± 17 (range 19-79) months. Patient satisfaction surveys were used to assess functional outcome and patient satisfaction. Results. Surgery was performed mostly for pain, walking problems, or a combination of both at a mean age of 12.5 ± 1.5 (range 10-15) years. Symptoms were relieved in 62.5% of patients in the postoperative phase and increased to 68.75% at follow-up. A statistically significant increase in CP of 2.8° and decrease in MA of 14.0° was observed directly postoperatively, which persisted during the follow-up period irrespective of Kalix removal. Revision surgery was necessary in 6 cases (23%) because of arthroereisis migration. Conclusion. Subtalar Kalix II arthroereisis significantly reduced clinical symptoms and improved the CP and MA directly postoperatively, which persisted during follow-up, irrespective of Kalix removal. Therefore, subtalar arthroereisis is a considerable intervention to reduce symptoms in children with symptomatic flexible flatfeet. Levels of Evidence: Level IV: Case series

Subtalar arthroereisis for the treatment of the symptomatic paediatric flexible pes planus: a systematic review

“…The results of the Downs and Black criteria for the 24 studies are displayed in Table 3 . Three studies scored 11 out of 15 12 , 14 , 15 , six studies scored 12 out of 15 13 , 17 , 19 , 23 , 32 , 35 , 10 studies scored 13 out of 15 18 , 20 – 22 , 24 – 26 , 28 , 29 , 33 and five studies scored 14 out of 15. 16 , 27 , 30 , 31 , 34 Five studies failed to specify any exclusion criteria.…”

“…The 24 studies consist of five prospective case series, 23 , 25 , 28 , 30 , 33 13 retrospective case series, 12 , 13 , 15 , 16 , 18 , 20 – 22 , 26 , 27 , 29 , 31 , 32 , three prospective non-randomized comparative studies 14 , 17 , 35 and three retrospective non-randomized comparative studies. 19 , 24 , 34 A total of 2550 feet of at least 1399 patients were operated on (Memeo et al did not include number of participants, only the number of feet operated on).…”

“…Failure of conservative measures was only a requirement of 13 studies. 13 , 14 , 16 , 18 , 20 , 22 – 25 , 27 , 30 , 32 , 33 Richter et al included their treatment algorithm, based on the age of the patient, evidence of tibialis posterior insufficiency and the talo-1st metatarsal index, as described by Hamel et al 39 The age of patients ranged from 5 to 17 years, with a mean of 11.62 years. Six studies did not include details of patient gender, 12 , 14 , 17 , 23 , 34 , 35 but the remaining 18 studies included 915 males and 640 females.…”

“…Fourteen patients had a concomitant spring ligament reconstruction. Ten studies routinely removed implants 16 , 20 , 21 , 23 , 25 – 30 after a minimum period of 18 months, at skeletal maturity or using the formula: planned removal/months post op = (age in years x 2) plus 6. The average follow-up period was 30.9 months.…”

Endosinotarsal device exerts a better postoperative correction in Meary’s angle than exosinotarsal screw from a meta-analysis in pediatric flatfoot

“…After writing emails to corresponding authors, there had been no response until 31 Dec., 2019. We excluded 1 study for screw inserted in talus 6 ; 7 studies for lack of calcaneal pitch angle, Meary's angle, and AOFAS 7-13 and 6 studies for lack of standard deviation or raw data [14][15][16][17][18][19] .…”