Mid‐term Results of Subtalar Arthroereisis with Talar‐Fit Implant in Pediatric Flexible Flatfoot and Identifying the Effects of Adjunctive Procedures and Risk Factors for Sinus Tarsi Pain

Abstract

Objectives To (i) report the mid‐term outcomes of subtalar arthroereisis using Talar‐Fit implant for the treatment of flexible flatfoot patients; (ii) compare clinical and radiographic outcomes between arthroereisis with and without adjunctive operative procedures to investigate the effects of adjuncts on the outcomes; and (iii) analyze the risk factors associated with sinus tarsi pain, which is the most common postoperative complication of arthroereisis. Methods Thirty‐one flexible flatfoot children and adolescents (46 feet) treated with subtalar arthroereisis using Talar‐Fit implant from June 2014 to May 2019 were retrospectively analyzed. The feet were divided into four treatment groups: (i) arthroereisis alone, (ii) arthroereisis with gastrocnemius recession, (iii) arthroereisis with Kidner procedure, and (iv) arthroereisis with gastrocnemius recession and Kidner procedure. Clinical function was evaluated based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score. The following angles were measured for radiographic evaluation: talar‐first metatarsal angle, calcaneal pitch angle, and talar declination angle on the lateral view; and talar‐first metatarsal angle, talocalcaneal angle, and anteroposterior talonavicular coverage angle on the anteroposterior (AP) view. The paired Student's t‐test was used to compare the pre‐ and postoperative angular measurements and AOFAS scores. The Wilcoxon rank‐sum test was undertaken to determine the outcome differences among four treatment groups. Multivariate logistic regression analysis was used to analyze risk factors for sinus tarsi pain. P value <0.05 is considered statistically significant. Results The mean follow‐up of the feet was 32.8 months (range, 10–71 months). The mean AOFAS score significantly improved from 55.5 ± 14.5 preoperatively to 86.3 ± 9.9 (P < 0.001). Comparison of radiographic outcomes showed that the lateral talar‐first metatarsal angle decreased by a mean of 19.1° ± 11.9° (P < 0.001), the calcaneal pitch angle increased by a mean of 5.4° ± 3.4° (P < 0.001), the talar declination angle decreased by a mean of 14.8° ± 9.9° (P < 0.001), the AP talar‐first metatarsal angle decreased by a mean of 15.6° ± 10.3° (P < 0.001), the AP talocalcaneal angle decreased by a mean of 7.2° ± 8.3° (P = 0.001), and the AP talonavicular coverage angle decreased by a mean of 20.4° ± 9.0° (P < 0.001). There were no statistically significant differences with regard to AOFAS score and all angle measurements on both the AP and lateral views among the four treatment groups. There was one dislocation case caused by a fall 6 weeks after surgery, which was treated nonoperatively. The incidence of sinus tarsi pain was 13% and logistic regression analysis indicated that patients with a longer distance from the tail end of the implant to the lateral calcaneal wall had 38.8% greater odds of developing sinus tarsi pain. Conclusions The mid‐term clinical and radiographic results were satisfactory in patients who underwent the subtalar arthroereisis procedur...

Müller-Weiss Disease: The Descriptive Factors of Failure Conservative Treatment

“…The demographic data included age, sex, body mass index (BMI) at the conservative treatment initiation time point, history of smoking of more than 20 pack-years, duration of conservative treatment, visual analog scale (VAS) scores for pain and walking disability, and Foot and Ankle Outcome Score (FAOS) for the pain, symptoms, ADL, and quality of life (QoL) subscales before treatment. The radiographic parameters reviewed were the calcaneal pitch angle, lateral Meary angle, anteroposterior (AP) Meary angle (Figure 3A and B), 2,19 talonavicular, and naviculocuneiform arthritis. The VAS scores for pain and walking disability were collected at the first visit and ranged from a minimum of 0 to a maximum of 10.…”

HyProCure for Pediatric Flexible Flatfoot: What Affects the Outcome

“…Although SA showed an overall decent mid-term result ( 29 , 33 , 34 ), a long-term effect remains unclear. So far, only one study has reported long-term follow-up results, which lack conviction.…”

“…Therefore, we worked on evaluating the HyProCure procedure for pediatric flexible flatfoot, with an effort to eliminate the impact of adjunctive operative procedures. To eliminate heterogeneity, our study included pediatric flexible flatfoot patients aged 10 to 18 years who underwent the HyProCure procedure with or without gastrocnemius recession, as gastrocnemius recession had a negligible impact on pediatric flexible flatfoot ( 34 ). Our study showed the satisfactory clinical outcomes of the HyProCure procedure for pediatric flexible flatfoot.…”

“…This effect may explicate low postoperative implant removal rates of the HyProCure device. Wang et al ( 34 ) reported that patients with a longer distance from the tail end of the implant to the lateral calcaneal wall had 38.8% greater odds of developing sinus tarsi pain via multivariate logistic regression analysis. Saxena et al ( 46 ) found that implant size was a factor for implant removal in adults (except for implant dislocation, 82.6% of implant removal was due to sinus tarsi pain).…”

Dynamic Gait Analysis in Paediatric Flatfeet: Unveiling Biomechanical Insights for Diagnosis and Treatment

“…In the context of a painful FFF, with pain arising at the medial arch, a lateral displacement of the calcaneus should be specifically looked for in order to plan a targeted correction [5]. Furthermore, there is a discussion on whether Achilles tendon lengthening is necessary as an adjunct to surgical intervention [57]. Although this clinical concern has not been extensively addressed, it holds promise for investigation through gait analysis methodologies.…”