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Monestier L, Riva G, Latiff M, Marciandi L, Bozzi E, Pelozzi A, Pautasso A, Pilato G, Surace MF, D'Angelo F. Pediatric flexible flatfoot: Does obesity influence the outcomes of arthroereisis? World J Orthop 2024; 15:850-857. [PMID: 39318489 PMCID: PMC11417632 DOI: 10.5312/wjo.v15.i9.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide. Although relationships between obesity and flatfoot have been shown, no studies have investigated the influence of obesity on arthroereisis outcomes.
AIM To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants.
METHODS This retrospective study included one hundred and sixty-nine pediatric patients (10-14 years old) who underwent subtalar arthroereisis (PEEK PitStop® device) for severe flexible flatfoot. Exclusion criteria were additional procedures, revision of previous corrective surgeries, rigid flatfoot with severe deformity, and neurological or post-traumatic flatfoot. Preoperative/postoperative European Foot and Ankle Society (EFAS) and visual analogue scale (VAS) scores were determined; radiographic assessment was conducted on weight-bearing foot X-rays: Kite angle, first metatarsal-talus angle, Meary angle, calcaneal pitch angle and lateral talo-calcaneal angle were analyzed.
RESULTS EFAS and VAS scores improved post-operatively in the whole population. Only seven cases with complications were reported. Radiographic assessment revealed an improvement in all angles. Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes: Relationships were reported between BMI and postoperative EFAS/VAS scores, postoperative calcaneal pitch angle, Kite angle, Meary angle and talo-first metatarsal angle.
CONCLUSION Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children, obesity significantly influences clinical and radiographic outcomes of arthroereisis, and obese children tend to perceive more pain and discomfort.
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Affiliation(s)
- Luca Monestier
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Giacomo Riva
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Mahfuz Latiff
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Luca Marciandi
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Elisa Bozzi
- Residency Program in Orthopedics and Trauma, Department of Biotechnologies and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
| | - Alessandra Pelozzi
- Residency Program in Orthopedics and Trauma, Department of Biotechnologies and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
| | - Andrea Pautasso
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Giorgio Pilato
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
| | - Michele Francesco Surace
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
- Division of Orthopedics and Traumatology, Ospedale di Cittiglio, ASST Sette Laghi, Varese 21100, Lombardy, Italy
| | - Fabio D'Angelo
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
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Alkhatatba M, Essa SB, Khatatbeh M, Radaideh A, Audat HZ, Younes AB, Alrawashdeh M, Abualadas J, Obeidat N, Al-Omari J, Anaqreh Y. Subtalar Arthroereisis for Symptomatic Flexible Flatfoot in Adolescents: A Prospective Study of 26 Feet. Mater Sociomed 2024; 36:131-136. [PMID: 39712326 PMCID: PMC11663004 DOI: 10.5455/msm.2024.36.131-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 10/25/2024] [Indexed: 12/24/2024] Open
Abstract
Background Flexible flatfoot is a normal finding in infants and the arch is shaped spontaneously in most children before the age of 10 years. Flexible flatfoot is a common deformity in both adolescent and adult populations. Objective This prospective study aims to assess the functional and radiological outcomes of subtalar arthroereisis in adolescent patients with symptomatic flexible flatfoot. Methods This is a prospective study and included 26 feet in 19 patients who underwent subtalar arthroereisis for symptomatic flexible flatfeet deformity. Preoperative and postoperative functional assessment based on the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale. Radiographic parameters included preoperative and postoperative Kite`s angle, talonavicular coverage angle, Anterior-Posterior talo-1st metatarsal angle, Meary`s angle, talar declination angle, calcaneal inclination angle and lateral talocalcaneal angle. Results The mean follow-up period was 22.5±9.4 months and the mean preoperative AOFAS score was 54.6±6.0, while the mean AOFAS score at the last follow-up visit was 86.3±3.9 (P<0.001).The mean preoperative and postoperative radiological measurements were 19.0°±8.2° and 7.4°±3.9° for the AP Talo-1st metatarsal angle (P<0.001); 23.6°±9.1° and 8.0°±4.0° for talonavicular coverage angle (P<0.001); 35.4°±3.7° and 24.1°±3.4° for Kite`s angle (P<0.003); 22.4°±6.1° and 7.5°±3.7° for Meary`s angle (P<0.001); 41.0°±4.4° and 25.2°±7.1° for talar declination angle (P<0.001); 13.5°±3.7° and 21.3°±3.6° for calcaneal inclination angle (P<0.001) and 52.4°±7.2° and 42.9°±4.8° for lateral talocalcaneal angle (P<0.041) respectively. Conclusion Subtalar arthroereisis is an effective and minimally invasive procedure that showed clinical and radiological improvement for symptomatic flexible flatfoot in our study group.
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Affiliation(s)
- Mohammad Alkhatatba
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Suhaib Bani Essa
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Moawiah Khatatbeh
- Department of Public Health, Faculty of Medicine, Yarmouk University Irbid, Jordan
| | - Ahmad Radaideh
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamzeh Ziad Audat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Bani Younes
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mutaz Alrawashdeh
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jehad Abualadas
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Naser Obeidat
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jamal Al-Omari
- Department of Special Surgery, Faculty of Medicine, Al-Balqa Applied University, Balqa, Jordan
| | - Yazan Anaqreh
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Xie HG, Chen L, Geng X, Wang C, Zhang C, Wang X, Huang J, Ma X. Mid-term assessment of subtalar arthroereisis with Talar-Fit implant in pediatric patients with flexible flatfoot and comparing the difference between different sizes and exploring the position of the inserted implant. Front Pediatr 2023; 11:1258835. [PMID: 37849498 PMCID: PMC10577167 DOI: 10.3389/fped.2023.1258835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Background Subtalar arthroereisis (STA) has gained growing acceptance as a viable approach solution for the management of pediatric flexible flatfoot. However, STA still remains controversial. The purpose of this study is to assess the effect of STA using the Talar-Fit implant for treating pediatric flexible flatfoot. Specifically, the aims of the study are as follows: first, to present the mid-term outcomes of STA using the Talar-Fit implant; second, to compare the radiographic and clinical outcomes associated with varying sizes of Talar-Fit implant; and third, to analyze the optimal position of the inserted implants. Methods A retrospective analysis was conducted on a cohort of 57 pediatric patients diagnosed with flexible flatfoot (77 feet) who underwent STA utilizing Talar-Fit between January 2014 and December 2021. The participants were categorized into five groups according to the size of the implant: Group 8, Group 9, Group 10, Group 11, and Group 12. The evaluation included the assessment of clinical function using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, as well as the assessment of radiographic data such as the calcaneal pitch angle (CPA), lateral Meary angle (LMA), talar declination angle (TDA), and medial longitudinal arch angle (MLAA) were evaluated. Furthermore, the position of the inserted implants was also recorded, including angle, depth, and distance. The comparison of pre- and postoperation was conducted using the paired Student's t-test, whereas the analysis of differences among subgroups was performed using the Wilcoxon rank-sum test. A P-value < 0.05 is considered statistically significant. Results In total, 57 pediatric patients (77 feet) were successfully followed-up for an average period of 26.8 months. The overall AOFAS score significantly improved from 58.6 ± 10.9 to 85.2 ± 8.6 (P < 0.001). Furthermore, the LMA decreased from 20.3° ± 3.6° to 4.5° ± 1.3°, the CPA increased from 14.8° ± 1.6° to 23.6° ± 2.7°(P < 0.05), the TDA decreased from 40.2° ± 2.3° to 25.5° ± 3.2°(P < 0.05), and the MLAA decreased from 140.1° ± 2.8° to 121.4° ± 3.9°(P < 0.05). No statistically significant differences were observed among subgroups regarding the final outcomes. The improvements of CPA, TDA, and MLAA among different groups were significantly different; however, the adjusted P-values were all greater than 0.05. The implant were inserted at a mean angle of 89.5° ± 2.4°, a mean depth of 0.9 mm ± 2.1 mm, and a mean distance of 9.9 mm ± 0.9 mm. Eight patients experienced complications, including six cases of pain occurrence and two cases of implant dislocation. Conclusion STA with Talar-Fit has demonstrated satisfactory mid-term outcomes. A Talar-Fit with a larger size may demonstrate a superior effect when compared with that of a smaller size. The implants were inserted in a similar position, indicating that the medial edge of the implant may be possible to transcend the midline of the talus neck.
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Affiliation(s)
| | | | | | | | | | | | | | - Xin Ma
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Abstract
Various surgical techniques are known for the treatment of flexible flatfoot in children after failure of nonsurgical attempts. Data collected in a review of the last 10-year period (2010-2020) show that among the 691 feet undergoing subtalar arthroereisis with endorthesis, average age at surgery was 11.40 years and in the 1856 feet that underwent subtalar arthroereisis with calcaneo-stop 11.69 years, while the complications rate was 9.00% and 6.38%, respectively. These data confirm that subtalar arthroereisis with calcaneo-stop may have an advantage over subtalar arthroereisis with endorthesis as the screw is not placed across the subtalar joint but instead into the calcaneus.
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Affiliation(s)
- Maurizio De Pellegrin
- Pediatric Orthopedic and Traumatology Unit, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy
| | - Désirée Moharamzadeh
- Orthopedic and Traumatology Unit, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy.
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Wang S, Yu J, Helili M, Zhang C, Huang J, Wang X, Chen L, Ma X. Biomechanical assessment of two types and two different locations of subtalar arthroereisis implants for flexible flatfoot: A cadaveric study. Clin Biomech (Bristol, Avon) 2021; 89:105475. [PMID: 34525448 DOI: 10.1016/j.clinbiomech.2021.105475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 07/30/2021] [Accepted: 08/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Subtalar arthroereisis refers to the implantation of a sinus tarsi implant for the treatment of flexible flatfoot. The purpose of this study was to compare the ability to correct the flatfoot deformity and contact pressure of the posterior subtalar joint between two types of self-locking wedge implants and between two different positions for the same device in a cadaveric flatfoot model. METHODS The flatfoot model was created in ten cadaver feet through ligament sectioning and cyclic loading. Three kinds of arthroereisis procedures were evaluated: Talar-Fit (type I self-locking wedge implant) anchored in the sinus portion of the tarsal sinus (T-sinus group), Talar-Fit in the canalis portion (T-canalis group), and HyProCure (type II) in the canalis portion (H group). Corrective ability in the sagittal and transverse planes were measured with clinometers. Contact pressure was measured with pressure-sensitive films. FINDINGS T-canalis group provided more sagittal (mean difference for size 10 mm: 1.9°, P = 0.014; mean difference for size 11 mm: 3.1°, P = 0.037) and transverse (mean difference for size 8 mm: 1.8°, P = 0.049; mean difference for size 11 mm: 2.2°, P = 0.049) corrections than T-sinus group. The flattening process shifted the peak pressure of the posterior subtalar joint to the posteromedial side (P < 0.05) and arthroereisis helped the distribution of contact pressure restore uniformity (all P > 0.05). INTERPRETATION A self-locking wedge implant inserted in the canalis portion of the tarsal sinus achieved better correction than an implant inserted in the sinus portion.
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Affiliation(s)
- Sen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Jian Yu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Maimaitirexiati Helili
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Li Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Department of Orthopedics, Huashan Hospital North, Fudan University, 108 Luxiang Road, Shanghai 200040, China.
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China.
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Irgit KS, Katsarov AZ. Flexible Progressive Collapsing Foot Deformity: Is There Any Role for Arthroereisis in the Adult Patient? Foot Ankle Clin 2021; 26:539-558. [PMID: 34332734 DOI: 10.1016/j.fcl.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over the last two decades there is a growing interest in the adult literature for subtalar joint arthroereisis. Parallel to this interest, there have been improvements in the design and biomechanics of the implant, although the main indication of subtalar joint arthroereisis in adults is not clear. Most studies show significant improvement in postoperative clinical scores and visual analog scores. Sinus tarsi pain, being the most common complication, is the main determinant of clinical satisfaction. This review focuses on the role and complications of subtalar joint arthroereisis in the adult population.
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Affiliation(s)
- Kaan Suleyman Irgit
- Orthopedics and Traumatology, Marmara School of Medicine, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad No 10, PK 34899, Pendik, İstanbul, Turkey.
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Li B, He W, Yu G, Zhou H, Xia J, Zhao Y, Zhu H, Yu T, Yang Y. Treatment for Flexible Flatfoot in Children With Subtalar Arthroereisis and Soft Tissue Procedures. Front Pediatr 2021; 9:656178. [PMID: 34095026 PMCID: PMC8175848 DOI: 10.3389/fped.2021.656178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Children with flexible flatfoot is common in clinics and there is no unified conclusion on surgical treatment. And for some patients with severe deformities, the correction of the subtalar joint arthroereisis combine the release of the Achilles tendon or gastrocnemius muscle release is still not satisfactory. The main aim of the present study was to investigate the therapeutic outcomes of subtalar arthroereisis combined with Achilles tendon or gastrocnemius recession and medial soft tissue (spring ligament, talonavicular joint capsule, tibionavicular ligaments and tibiospring ligaments) tightening for treating flexible flatfoot with severe deformities. Methods: Thirty patients (32 feet) with pediatric flexible flatfoot who underwent subtalar arthroereisis and soft tissue procedures during January 2016 to January 2018. There were 18 males (20 feet) and 12 females (12 feet) with an average age of 9.5 years (range, 8-12 years). We used the AOFAS scores and VAS scores combined with angles measure to evaluate the pre-operative and post-operative status. Results: Thirty patients (32 feet) were followed up for 25.3 months on average (range, 18-36 months). There was no infection. Post-operative foot pain, arch collapse, and other symptoms improved. At last follow-up, the Meary angle was decreased from 17.5° ± 4.4° to 4.1° ± 1.2° (P < 0.05), the talar-first metatarsal (AP) was decreased from 15.3° ± 3.1° to 4.8° ± 1.3°(P < 0.05), The mean AOFAS score was rose from 66.6 ± 5.8 to 88.6 ± 7.9 (P < 0.05), the mean VAS score was decreased from 6.6 ± 0.6 to 1.7 ± 0.3 (P < 0.05). Conclusion: The subtalar arthroereisis combined with soft tissue procedures can effectively correct flexible flatfoot in children and it is a significant method for severe forefoot abduction reconstruction. Level of Evidence: IV.
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Affiliation(s)
- Bing Li
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenbao He
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guangrong Yu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haichao Zhou
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiang Xia
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Youguang Zhao
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Zhu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Yu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunfeng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Papamerkouriou YM, Rajan R, Chaudhry S, Kodumuri P, Evans H, Kerr M. Prospective Early Clinical, Radiological, and Kinematic Pedobarographic Analysis Following Subtalar Arthroereises for Paediatric Pes Planovalgus. Cureus 2019; 11:e6309. [PMID: 31938601 PMCID: PMC6944146 DOI: 10.7759/cureus.6309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/06/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Arthroereises implants mechanically block eversion and limit subtalar motion. They are used in children with pes planovalgus in order to correct the valgus deformity. In this study, we aimed to objectively assess children with flatfoot before and after the insertion of the Kalix II implant, clinically, radiologically and by kinematic pedobarographic analysis. Materials and methods Six children (12 feet) were treated by the insertion of the Kalix II implant (Integra LifeSciences, Plainsboro, NJ). Patients completed the Manchester Oxford Foot Questionnaire (MOXFQ) preoperatively and at six months post operatively. Radiological outcome was assessed by lateral (L) and anterior posterior (AP) foot weight-bearing radiographs taken pre operatively and post operatively. Pedobarographic data was obtained pre operatively and at six months post operatively using a 1 meter RS Scan Footscan (RSscan International, Olen, Belgium) pedobarograph. In addition, patients underwent gait analysis pre and post operatively. Results Mean age was 11.05 +/-3.24 years (range 6.2 to 15.5 years). In all cases, screw removal was carried out at between 15 to 18 months post insertion. The mean pre op MOXFQ score was 55.3 +/-9.68 which reduced to 34.3 +/-15.66 post operatively with a p value < 0.00001 which was statistically significant. Mean Meary's angle preop was -15.21+/-5.51 degrees which corrected to -7.57+/-4.62 post op with a p value=0.00001. The mean calcaneal pitch before surgery was 11.96+/-3.8 which increased to 14.98+/-3.85 with a p value =0.00067. The first MTH: fifth MTH peak pressure ratio pre operatively was 4.53+/-2.78 which was found to reduce significantly post operatively to 1.35+/-0.97 (p=0.04), indicating a lateral shift of the foot pressures. Conclusion There were statistically significant improvements in the patient-reported MOXFQ, radiological improvements, and pedobarographic changes, indicating a lateral shift of the foot pressures. There were no complications.
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Affiliation(s)
| | - Rohan Rajan
- Orthopaedics, Royal Derby Hospital, Derby, GBR
| | | | | | - Helen Evans
- Physiotherapy, Royal Derby Hospital, Derby, GBR
| | - Martin Kerr
- Physiotherapy, Royal Derby Hospital, Derby, GBR
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Memeo A, Verdoni F, Rossi L, Ferrari E, Panuccio E, Pedretti L. Flexible Juvenile Flat Foot Surgical Correction: A Comparison Between Two Techniques After Ten Years' Experience. J Foot Ankle Surg 2019; 58:203-207. [PMID: 30658957 DOI: 10.1053/j.jfas.2018.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Indexed: 02/03/2023]
Abstract
The aim of our study is a retrospective analysis of the 2 most common surgical treatments of symptomatic juvenile flat foot: different arthroereisis techniques. Exosinotarsal arthroereisis with metallic screw and endosinotarsal with bioabsorbable devices were compared. In total, 402 feet were examined for a median follow-up of 130 months. Only symptomatic (plantar or calcaneus pain), flexible, and idiopathic flat feet were included in our study. Congenital (fibrous/bone tarsal coalitions), neurologic, and posttraumatic flat feet were excluded. During clinical examination, the feet were categorized according to the Viladot classification, which took into consideration the plantar impression: only grades 3 and 4 were included (complete medial longitudinal arch collapse). Evaluation was determined by taking into consideration 3 parameters: clinical evaluation, pain, and variation of the radiologic angles. No statistical differences were found between the 2 techniques; the choice can be determined mostly by the surgeon's preference.
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Affiliation(s)
- Antonio Memeo
- Surgeon, Unity Operative Complex, Pediatric Orthopedics and Traumatology, G. Pini Institute, Milan, Italy
| | - Fabio Verdoni
- Surgeon, Unity Operative Complex, Pediatric Orthopedics and Traumatology, G. Pini Institute, Milan, Italy
| | - Laura Rossi
- Surgeon, Unity Operative Complex, Pediatric Orthopedics and Traumatology, G. Pini Institute, Milan, Italy
| | - Elisa Ferrari
- Surgeon, Unity Operative Complex, Pediatric Orthopedics and Traumatology, G. Pini Institute, Milan, Italy
| | - Elena Panuccio
- Surgeon, Unity Operative Complex, Pediatric Orthopedics and Traumatology, G. Pini Institute, Milan, Italy
| | - Leopoldo Pedretti
- Surgeon, Unity Operative Complex, Pediatric Orthopedics and Traumatology, G. Pini Institute, Milan, Italy.
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Ceccarini P, Rinonapoli G, Gambaracci G, Bisaccia M, Ceccarini A, Caraffa A. The arthroereisis procedure in adult flexible flatfoot grade IIA due to insufficiency of posterior tibial tendon. Foot Ankle Surg 2018; 24:359-364. [PMID: 29409235 DOI: 10.1016/j.fas.2017.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND To report on the functional, biomechanical, and radiographic results of patients who had undergone arthroereisis plus tensioning of the posterior tibial tendon for flexible flatfoot. The hypothesis is that arthroereisis associated to a tensioning of the posterior tibial tendon give a good correction with great satisfaction in patients with flexible flatfoot in grade IIA. METHODS We evaluated 29 patients (31 feet), mean age of 46.4 years, who had been surgically treated for adult flatfoot grade IIA according to Myerson. Mean follow-up was 34.15 months. For clinical evaluation, the AOFAS hindfoot and VAS-FA scores were used. RESULTS Postoperative results showed significant increases in both AOFAS and VAS-FA scores: 54.2-81.9 and 61.5-83.2 points, respectively. For the X-ray parameters, we observed a significant variation in the talo-first metatarsal angle, from 13.8° in pre-op to 7.4° in post-op. In lateral view, Djian Annonier angle was improved from 146.6° to 134.1°. The Meary's angle, compared to an average of 8.8° in pre-operative stage improved to 4.3° in the post-operative stage. Postoperative satisfaction was excellent-good according to 23 patients (79.4%). Pain in the tarsal sinus was reported in 5 out of 31 feet (16.1%) for the first three months after surgery. CONCLUSIONS Arthroereisis and tensioning of the posterior tibial tendon provided good functional outcomes for patients under 60 years of age having stage IIA flexible flatfoot without arthritic manifestations.
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Affiliation(s)
- P Ceccarini
- Department of Orthopedics and Traumatology, SM Misericordia Hospital, University of Perugia, Italy.
| | - G Rinonapoli
- Department of Orthopedics and Traumatology, SM Misericordia Hospital, University of Perugia, Italy.
| | - G Gambaracci
- Department of Radiodiagnostic, University of Perugia, Italy.
| | - M Bisaccia
- Department of Orthopedics and Traumatology, SM Misericordia Hospital, University of Perugia, Italy.
| | - A Ceccarini
- Department of Orthopedics and Traumatology, SM Misericordia Hospital, University of Perugia, Italy.
| | - A Caraffa
- Department of Orthopedics and Traumatology, SM Misericordia Hospital, University of Perugia, Italy.
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Caravaggi P, Lullini G, Berti L, Giannini S, Leardini A. Functional evaluation of bilateral subtalar arthroereisis for the correction of flexible flatfoot in children: 1-year follow-up. Gait Posture 2018; 64:152-158. [PMID: 29909229 DOI: 10.1016/j.gaitpost.2018.06.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/21/2018] [Accepted: 06/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Flexible flatfoot (FFF) is a common alteration of the foot diagnosed in the pediatric population causing pain and decreased quality of life. Surgical treatment via arthroereisis of the subtalar joint can be recommended when non-invasive options do not result in sufficient pain relief. While clinical outcome of subtalar joint arthroereisis is generally positive, no functional evaluation has thus far been reported following surgery. RESEARCH QUESTION The aim of this study was to assess the effects of two arthroereisis implants for the correction of bilateral FFF on foot and lower limb biomechanics during gait. METHODS This is a prospective study following 13 children affected by bilateral symptomatic FFF. The patients underwent bilateral subtalar arthroereisis during the same surgery using two types of poly-L-lactide bioabsorbable implants: an expanding endo-orthotic implant, and a calcaneo-stop screw. Radiological parameters and gait analysis were performed preoperatively and at 1 year follow-up and compared to those from an age-matched normal-arched control population. Lower limb and multisegment foot kinematic analysis, along with EMG of the main ankle flexor/extensor muscles, were performed during level walking at comfortable speed. Paired non-parametric Wilcoxon signed-rank test was used to assess differences in radiological and kinematic parameters between pre-op and post-op assessments. RESULTS All radiological parameters, and frontal-plane orientation of the rearfoot in double-leg standing were improved at 1-year follow-up in both implant groups (e.g calcaneo-stop: pre-op = 15 ± 7 deg; post-op = 6 ± 9 deg; p < 0.01). The endo-orthotic implant group showed significantly lower pronation/supination at the ankle and midtarsal joint. Activation of the tibialis anterior muscle was more physiological after surgery in both groups. SIGNIFICANCE According to the present analysis, both implants appear effective in restoring physiological alignment of the rearfoot, however the endo-orthotic implant appeared more effective in restoring a more correct frontal-plane mobility of foot joints.
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Affiliation(s)
- Paolo Caravaggi
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Giada Lullini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Lisa Berti
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Sandro Giannini
- First Orthopaedics and Traumatology Clinic, Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
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Giannini S, Cadossi M, Mazzotti A, Persiani V, Tedesco G, Romagnoli M, Faldini C. Bioabsorbable Calcaneo-Stop Implant for the Treatment of Flexible Flatfoot: A Retrospective Cohort Study at a Minimum Follow-Up of 4 Years. J Foot Ankle Surg 2018. [PMID: 28633776 DOI: 10.1053/j.jfas.2017.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Arthroereisis of the subtalar joint is a common surgical technique in Europe for the management of flexible flatfoot in the pediatric population. In most cases, it is performed using a calcaneo-stop metallic screw. Despite the good clinical results, screw removal is always advised after 2 to 3 years. The use of a bioabsorbable screw might overcome the need for a second operation to remove a nonabsorbable device. We report the results of a biodegradable calcaneo-stop screw at a minimum of 4 years of follow-up. Eighty-eight procedures were performed on 44 children. All patients were clinically and radiologically evaluated preoperatively and at a minimum 4-year follow-up period. Patient satisfaction and plantar collapse using Viladot's classification were recorded. Meary's talus-first metatarsal angle and talocalcaneal angle were measured on radiographs preoperatively and at the last follow-up visit. The presence of the device at the last follow-up examination was assessed by magnetic resonance imaging. The mean follow-up duration was 56 months. Of the 44 patients, 33 (75%) reported excellent clinical outcomes, 9 (20.5%) good outcomes, and 2 (4.5%) poor. Foot print improvement was registered for all patients. The mean Meary's talus-first metatarsal angle had improved from 160.6° ± 7.7° preoperatively to 170.6° ± 6.5° at the last follow-up visit (p < .001). The talocalcaneal angle had decreased from 39.9° ± 5.2° preoperatively to 29.4° ± 4° at the last follow-up examination (p < .001). At the 4-year follow-up point, the implant could be seen to have almost completely biodegraded on magnetic resonance imaging. Two screw breakages occurred. The bioabsorbable calcaneo-stop screw seems to be an effective solution for flexible flatfoot in pediatric patients. Also, owing to its biodegradable composition, the need of a second operation for implant removal will not always be necessary.
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Affiliation(s)
- Sandro Giannini
- Professor Emeritus, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Matteo Cadossi
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Antonio Mazzotti
- Medical Doctor, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
| | - Valentina Persiani
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Giuseppe Tedesco
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Matteo Romagnoli
- Orthopaedic Surgeon, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Cesare Faldini
- Professor and Director, II Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
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Arthroereisis: physiologic blocking of the subtalar joint. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ozan F, Doğar F, Gençer K, Koyuncu Ş, Vatansever F, Duygulu F, Altay T. Symptomatic flexible flatfoot in adults: subtalar arthroereisis. Ther Clin Risk Manag 2015; 11:1597-602. [PMID: 26527876 PMCID: PMC4621198 DOI: 10.2147/tcrm.s90649] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Flexible flatfoot is a common deformity in pediatric and adult populations. In this study, we aimed to evaluate the functional and radiographic results of subtalar arthroereisis in adult patients with symptomatic flexible flatfoot. We included 26 feet in 16 patients who underwent subtalar arthroereisis for symptomatic flexible flatfoot. Radiographic examination included calcaneal inclination angle, lateral talocalcaneal angle, Meary’s angle, anteroposterior talonavicular angle, and Kite’s angle. The clinical assessment was based on the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and a visual analog scale (VAS). The mean follow-up was 15.1±4.7 months. The mean preoperative AOFAS score was 53±6.6, while the mean AOFAS score at the last follow-up visit was 75±11.2 (P<0.05). The mean visual analog scale score was 6.9±0.6 preoperatively and 4.1±1.4 at the last follow-up visit (P<0.05). The mean preoperative and postoperative values measured were 13.4°±3.3° and 14.6°±2.7° for calcaneal inclination angles (P<0.05); 35.7°±6.9° and 33.2°±5.3° for lateral talocalcaneal angles (P>0.05); 8°±5.3° and 3.3±3 for Meary’s angles (P<0.05); 5.6°±3.5° and 2.6°±1.5° for anteroposterior talonavicular angles (P<0.05); and 23.7°±6.1° and 17.7°±5° for Kite’s angles, respectively (P<0.05). Implants were removed in three feet (11.5%). Subtalar arthroereisis is a minimally invasive procedure that can be used in the surgical treatment of adults with symptomatic flexible flatfoot. This procedure provided radiological and functional recovery in our series of patients.
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Affiliation(s)
- Fırat Ozan
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Fatih Doğar
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Kürşat Gençer
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Şemmi Koyuncu
- Department of Orthopedics and Traumatology, Bayburt State Hospital, Bayburt, Turkey
| | - Fatih Vatansever
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Fuat Duygulu
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Taşkın Altay
- Department of Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
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Tarissi N, Vallée A, Dujardin F, Duparc F, Roussignol X. Reducible valgus flat-foot: assessment of posterior subtalar joint surface displacement by posterior arthroscopy during sinus tarsi expansion screwing. Orthop Traumatol Surg Res 2014; 100:S395-9. [PMID: 25454334 DOI: 10.1016/j.otsr.2014.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Subtalar arthroereisis corrects childhood and adult reducible valgus flat-foot in certain indications. Inserting an expansion screw in the sinus tarsi simultaneously corrects the calcaneal valgus of the talocalcaneal divergence and first-ray pronation if these are reducible. The displacement induced in the posterior subtalar joint (decoaptation, translation, rotation) is, however, poorly known. The present study involved arthroscopic assessment of posterior subtalar joint surface displacement during insertion of a talocalcaneal arthroereisis screw, with the hypothesis that displacement varies in three dimensions according to screw size. MATERIAL AND METHOD Eight specimens were used for the study. All ankles were supple, taken from adult subjects. A 4.5-mm arthroscope was used and measurements were taken with a graduated palpator in the posterior subtalar joint. Three sinus tarsi expansion screws of incremental diameter were assessed. Before and after insertion measurements were made of posterolateral and posteromedial talar exposure on the calcaneus, anteroposterior and lateromedial translation, and talocalcaneal joint-line opening. RESULTS Medial rotation, varization and anterior translation of the calcaneus were comparable in all cases. Mean lateral opening of the posterior subtalar joint was 0.88 mm with 8-mm screws and 1.25 mm with 16-mm screws. Significant differences between 8 and 16 mm screws were found for lateral subtalar joint opening (P=0.028) and for lateromedial translation (P=0.004). CONCLUSION Sinus tarsi expansion screwing corrects hindfoot valgus and talocalcaneal divergence by inducing medial translation of the calcaneus under the talus and talar medial rotation and varization, proportional to screw size (medial translation and lateral opening of the subtalar joint). LEVEL OF EVIDENCE III.
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Affiliation(s)
- N Tarissi
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - A Vallée
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - F Dujardin
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - F Duparc
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - X Roussignol
- Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France.
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Fitzgerald RH, Vedpathak A. Plantar pressure distribution in a hyperpronated foot before and after intervention with an extraosseous talotarsal stabilization device-a retrospective study. J Foot Ankle Surg 2013; 52:432-43. [PMID: 23632067 DOI: 10.1053/j.jfas.2013.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Indexed: 02/03/2023]
Abstract
Plantar pressure measurements have long been used by clinicians to provide information regarding potential impairments and disorders of the foot and ankle. Elevations in peak plantar pressures or a poor distribution of these pressures can be an indication of pathomechanics in the foot. Lower extremity deficits such as sensory impairment, foot deformities, limited joint mobility, and reduced plantar tissue thickness have been associated with high plantar pressures. The total pressures, pressure distribution, and peak pressures provide useful information to evaluate the abnormal functioning of the talotarsal joint. Instability of the talotarsal joint can result in excessive forces exerted on the joints and surrounding tissues in the foot that can then lead to dysfunction of the proximal musculoskeletal kinetic chain. In the present study, we performed a retrograde analysis of the pre- and postoperative measurements of the peak plantar pressures, peak forces, and area of contact between the foot and the ground during each phase of the gait cycle for 6 patients (12 feet) who had undergone a bilateral extraosseous talotarsal stabilization procedure using a type II extraosseous talotarsal stabilization device. After the procedure, a significant reduction was seen in the peak pressures (42%) over the entire foot and a significant increase in the contact area (19.7%) between the foot and the floor. This could imply that the extraosseous talotarsal stabilization procedure was effective in stabilizing the talotarsal joint complex, thus eliminating abnormal hindfoot motion and restoring the normal biomechanics of the foot and ankle complex, as indicated by a reduction and realignment of the peak plantar pressures and forces.
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Affiliation(s)
- Ryan H Fitzgerald
- University of South Carolina School of Medicine, Greenville, SC 29605, USA.
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Pavone V, Costarella L, Testa G, Conte G, Riccioli M, Sessa G. Calcaneo-stop procedure in the treatment of the juvenile symptomatic flatfoot. J Foot Ankle Surg 2013; 52:444-7. [PMID: 23623303 DOI: 10.1053/j.jfas.2013.03.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Indexed: 02/03/2023]
Abstract
Flexible flatfoot is the most prevalent condition seen in pediatric orthopedic clinics. It is characterized by an absence of the medial arch and a valgus position of the calcaneus. The purpose of the present study was to report on the results obtained in children treated using the calcaneo-stop procedure. A total of 410 flatfeet in 242 consecutive patients were treated using the calcaneo-stop procedure from January 1999 to March 2010 (10 years, 3 months) and were followed up to February 2012. The mean age at surgery was 11 (range 7 to 14) years, and the mean follow-up duration was 88 (range 14 to 157) months. A clinical evaluation, podoscopic examination, and radiologic assessment were performed in the participating patients preoperatively and at 6 months postoperatively. Of the 242 patients, 168 (69.42%) underwent bilateral foot surgery and 74 (30.58%) unilateral intervention, involving 33 right (44.6%) and 41 left (55.4%) feet. At follow-up, the outcome was satisfactory in 397 feet (96.83%); heel valgus was observed in only 12 feet (2.92%), and the footprint was normalized in 328 feet (80%). The calcaneo-stop procedure is a simple, reliable, and minimally invasive procedure for the treatment of pediatric flexible flatfoot. It allows alignment of the talus and calcaneus, restoring a proper foot arch.
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Affiliation(s)
- Vito Pavone
- Orthopaedic Clinic, University of Catania, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy.
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Bourdet C, Seringe R, Adamsbaum C, Glorion C, Wicart P. Flatfoot in children and adolescents. Analysis of imaging findings and therapeutic implications. Orthop Traumatol Surg Res 2013; 99:80-7. [PMID: 23260367 DOI: 10.1016/j.otsr.2012.10.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 09/16/2012] [Accepted: 10/05/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pes planovalgus (PPV) is a complex three-dimensional deformity of which routine radiographs provide only a two-dimensional analysis. HYPOTHESIS Angles and other radiographic parameters of the foot in children and adolescents, when studied on both the dorsoplantar and the lateral view, can be used to establish a radiographic classification system for PPV that provides useful therapeutic guidance in clinical practice. MATERIALS AND METHODS A retrospective single-centre study was conducted on 65 feet in 35 patients aged 7 to 18 years and having adequate ossification. All patients had a clinical diagnosis of idiopathic or neurologic PPV and available weight-bearing dorsoplantar and strict lateral radiographs. We excluded pes planus due to tarsal coalition, congenital bone deformities, or overcorrection of talipes equinovarus (n=25). All possible axes were drawn and angles measured after an evaluation of interindividual agreement. RESULTS We identified four patterns of PPV: subtalar pes planus (n=16) with marked subtalar valgus and longitudinal sag predominating at the talonavicular joint, midtarsal pes planus (n=12) without subtalar valgus but with marked midtarsal abduction and sag predominating at the cuneonavicular joint, mixed pes planus (n=28) with subtalar valgus, midtarsal abduction, and sag at both the talonavicular and cuneonavicular joints, and pes planocavus (n=9) with sag of the medial arch and cavus deformity of the lateral arch. CONCLUSION This original classification system provides therapeutic guidance by helping to match the surgical procedure to the nature and location of the deformities. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- C Bourdet
- Department of pediatric radiology, Paris Descartes University, Cochin - Saint-Vincent-de-Paul Hospital, AP-HP, 27, rue du Faubourg-Saint-Jacques, Paris, France
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Baker JR, Klein EE, Weil L, Weil LS, Knight JM. Retrospective analysis of the survivability of absorbable versus nonabsorbable subtalar joint arthroereisis implants. Foot Ankle Spec 2013; 6:36-44. [PMID: 23263677 DOI: 10.1177/1938640012470712] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Subtalar joint arthroereisis is a surgical modality that has been shown to be an effective procedure for flexible flatfoot in both pediatric and adult populations. Despite advances in understanding its mechanics and function, complication and implant removal rates remain as high as 30% to 40%. Analysis was performed to determine the survivability of 2 subtalar joint arthroereisis implants, absorbable and nonabsorbable, used alone and in combination with other procedures in both the adult and pediatric populations. The 95 total arthroereisis procedures were analyzed in several major categories: absorbable implants versus nonabsorbable implants and adult versus pediatric patients. Each major group was then further subdivided to create further subgroups: absorbable isolated procedures, absorbable combined procedures, nonabsorbable isolated procedures, and nonabsorbable combined procedures. The overall survival rates were 83% for absorbable implants and 81% for nonabsorbable implants. A total of 11 (17%) absorbable implants and 6 (19%) nonabsorbable implants were removed, respectively, at an average of 9 months and 23 months postoperatively. When used alone and in combination with other procedures, 36% and 13% of absorbable implants and 18% and 19% of nonabsorbable implants, respectively, were removed. When comparing adult versus pediatric populations, the overall survival rates of the absorbable and nonabsorbable implants were 81% for absorbable implants and 79% for nonabsorbable implants in the adult population and 85% for absorbable implants and 100% for nonabsorbable implants in the pediatric population.
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Affiliation(s)
- Jeffrey R Baker
- Weil Foot & Ankle Institute, Des Plaines, Illinois 60016, USA
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Yen-Douangmala D, Vartivarian M, Choung JD. Subtalar arthroereisis and its role in pediatric and adult population. Clin Podiatr Med Surg 2012; 29:383-90. [PMID: 22727379 DOI: 10.1016/j.cpm.2012.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Subtalar joint arthroereisis is a surgical procedure that addresses symptomatic flexible flatfoot deformities using an extraarticular implant within the sinus tarsi. Three groups of implants have been developed for this procedure: self-locking wedges, axis-altering devices, and impact-blocking devices. The self-locking wedge implants are the focus of this article, relative to its use, limitations, and controversies in the pediatric and adult population.
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Affiliation(s)
- Daphne Yen-Douangmala
- Department of Podiatric Surgery, Kaiser Foundation Hospital, 99 Montecillo Road, San Rafael, CA 94903, USA
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Graham ME, Parikh R, Goel V, Mhatre D, Matyas A. Stabilization of joint forces of the subtalar complex via HyProCure sinus tarsi stent. J Am Podiatr Med Assoc 2012; 101:390-9. [PMID: 21957270 DOI: 10.7547/1010390] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The foot is the foundation of the body. The stability of the osseous hindfoot structure is crucial in bipedal locomotion. The subtalar joint is responsible for conversion of the rotatory forces of the lower extremities and dictates the movements of the midtarsal joints and the forefoot. In a hyperpronated foot, excessive abnormal pronation results in partial to full obliteration of the sinus tarsi. The hypothesis is that the HyProCure device will prevent obliteration of the sinus tarsi, thereby stabilizing the subtalar joint complex and eliminating the excessive forces to the proximal and distal musculoskeletal system that occur with every step. METHODS Five fresh-frozen human foot cadaver specimens that represented pathologic hindfoot and midfoot instability and partial to full obliteration of the sinus tarsi were axially compressed to 2,000 N and internally rotated by 15° to produce maximum pronation of the subtalar joint using a biaxial materials testing machine. The forces were measured across the posterior and anterior talocalcaneal joint facets before and after placement of the HyProCure stent. RESULTS The subtalar joint stabilized after placement of the HyProCure sinus tarsi stent. The mean ± 1 SD forces in the posterior talocalcaneal joint increased from 795.88 ± 106 N to 1,004.86 ± 72.41 N (P < 0.05, two-tailed paired t test). The mean ± SD forces at the anterior talocalcaneal joint decreased from 520.15 ± 127.18 N to 394.56 ± 73.83 N (P < 0.05), shifting the contact area posteriorly. CONCLUSIONS Placement of the HyProCure subtalar stabilization stent in a hyperpronated foot prevents excessive talar subluxation and assists in proper distribution of the axial loads on the subtalar facet joints.
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Metcalfe SA, Bowling FL, Reeves ND. Subtalar joint arthroereisis in the management of pediatric flexible flatfoot: a critical review of the literature. Foot Ankle Int 2011; 32:1127-39. [PMID: 22381197 DOI: 10.3113/fai.2011.1127] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pediatric flexible flatfoot is a common deformity for which a small, but significant number undergo corrective surgery. Arthroereisis is a technique for treating flexible flatfoot by means of inserting a prosthesis into the sinus tarsi. The procedure divides opinion in respect of both its effectiveness and safety. METHODS A database search up until 2010 was used to find articles regarding arthroereisis in pediatric patients. We summarized the findings of this study. RESULTS Seventy-six studies were identified. Eight of the nine radiographic parameters reported show significant improvement following arthroereisis reflecting both increased static arch height and joint congruency. Calcaneal inclination angle demonstrated the least change with only small increases following arthroereisis. Arthroereisis remains associated with a number of complications including sinus tarsi pain, device extrusion, and under-correction. Complication rates range between 4.8% and 18.6% with unplanned removal rates between 7.1% and 19.3% across all device types. CONCLUSION Current evidence is limited to consecutive case series or ad hoc case reports. Limited evidence exists to suggest that devices may have a more complex mode of action than simple motion blocking or axis altering effects. The interplay between osseous alignment and dynamic stability within the foot may contribute to the effectiveness of this procedure. Although literature suggests patient satisfaction rates of between 79% to 100%, qualitative outcome data based on disease specific, validated outcome tools may improve current evidence and permit comparison of future study data.
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Affiliation(s)
- Stuart A Metcalfe
- Manchester Metropolitan University, Institute for Biomedical Research into Human Movement and Health, Manchester, M1 5GD, UK.
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Graham ME, Jawrani NT, Goel VK. Effect of extra-osseous talotarsal stabilization on posterior tibial nerve strain in hyperpronating feet: a cadaveric evaluation. J Foot Ankle Surg 2011; 50:672-5. [PMID: 21907596 DOI: 10.1053/j.jfas.2011.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Indexed: 02/03/2023]
Abstract
Excessive abnormal strain or tension on the posterior tibial nerve in feet exhibiting talotarsal instability has been considered one of the possible etiologic factors of tarsal tunnel syndrome. The suggested treatment options in such cases include stabilization of the talotarsal joint complex in a corrected position, which might help minimize the abnormal forces placed on the posterior tibial nerve due to over stretching. The primary goal of this study was to quantify strain on the posterior tibial nerve in feet exhibiting hyperpronation caused by talotarsal instability, before and after an extra-osseous talotarsal stabilization (EOTTS) procedure. We hypothesized that the excessive strain placed on the posterior tibial nerve in hyperpronating cadaveric feet would be reduced significantly after intervention using the HyProCure(®) EOTTS device. Posterior tibial nerve strain was quantified in 9 fresh-frozen cadaver specimens. A miniature differential variable reluctance transducer was used to measure nerve elongation as the foot was moved from its neutral to a maximally pronated position, before and after intervention. The mean elongation of the posterior tibial nerve (with respect to a fixed reference point) decreased by 43% after the EOTTS procedure (i.e., from 5.91 ± 0.91 mm to 3.38 ± 1.20 mm; N = 27). The reduction was statistically significant at p < .001. HyProCure(®) was effective in stabilizing the talotarsal joint complex, thus reducing the excessive amount of strain placed on the posterior tibial nerve. Clinical implications of this study suggest the use of EOTTS devices in the treatment of tarsal tunnel syndrome.
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Abstract
Arthroereisis has gained popularity over the years because it eliminates excessive pronation while conserving preoperative inversion and preserves forefoot to rearfoot adaptation to uneven terain. Technically simple, some of the advantages of subtalar arthroereisis are that it is joint sparing and preserves ligaments. In addition, the implant does not interfere with osseous growth and does not compromise future operative intervention if more invasive procedures are required. Arthroereisis, however, can have associated complications along with the need for surgical removal in some patient populations.
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Cook EA, Cook JJ, Basile P. Identifying risk factors in subtalar arthroereisis explantation: a propensity-matched analysis. J Foot Ankle Surg 2011; 50:395-401. [PMID: 21708340 DOI: 10.1053/j.jfas.2011.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Indexed: 02/03/2023]
Abstract
A case-control study was undertaken to identify differences in patients with flexible flatfoot deformity who required explantation of subtalar arthroereisis compared with those who did not. All patients who required removal of a self-locking wedge-type subtalar arthroereisis were identified between 2002 and 2008. Propensity scores matched 22 explanted subtalar arthroereises to 44 controls (nonexplanted arthroereises), resulting in a total of 66 implants that met all inclusion and exclusion criteria. Multivariate logistic regression found that patients who required explantation had a greater odds of radiographic undercorrection, determined from radiographic anteroposterior talar-first metatarsal angles postoperatively, P = .0012, odds ratio (OR) = 1.175 (95% confidence interval [CI] 1.066 to 1.295), or residual transverse plane-dominant deformities, as determined from radiographic calcaneocuboid abduction angles postoperatively, P = .05, OR = 1.096 (95% CI 1.06 to 1.203). Patients with smaller postoperative anteroposterior talocalcaneal angles had a 16.7% reduction in odds for arthroereisis explantation (P = .0019) (95% CI 6.5% to 25.8%). Age, gender, implant size, shape, duration, implant position, surgeon experience, and concomitant procedures were not statistically different between the 2 groups. This study helps identify key factors that may result in subtalar arthroereisis explantation.
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Affiliation(s)
- Emily A Cook
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Podiatric Surgery, Department of Surgery, Boston, MA 02215, USA
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Graham ME, Jawrani NT, Goel VK. The effect of HyProCure(®) sinus tarsi stent on tarsal tunnel compartment pressures in hyperpronating feet. J Foot Ankle Surg 2010; 50:44-9. [PMID: 21106413 DOI: 10.1053/j.jfas.2010.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Indexed: 02/03/2023]
Abstract
Tarsal tunnel syndrome is characterized by increased pressure in the tarsal tunnel. In hyperpronation, there is excessive abnormal pronation resulting from partial displacement of the talus on the calcaneus. In this study, we hypothesized that hyperpronation caused by talotarsal instability will lead to increased pressure in the tarsal tunnel and porta pedis. We also hypothesized that the pressure in these compartments will decrease following an extra-osseous talotarsal stabilization procedure using HyProCure(®). Pressures in the tarsal tunnel and porta pedis were measured in 9 fresh-frozen cadaver specimens using an intracompartmental pressure monitor system. Pressures were measured with the foot in neutral and hyperpronated position, before and after stabilization using HyProCure. For the tarsal tunnel, pressure in the neutral position with and without HyProCure was 3 ± 3 mm Hg and 4 ± 3 mm Hg, respectively (P = .159). However, for the hyperpronating foot, the pressure decreased from 32 ± 16 mm Hg to 21 ± 10 mm Hg (P < .001) following the placement of HyProCure. In the porta pedis, pressure in the neutral position with and without HyProCure was 2 ± 2 mm Hg and 2 ± 2 mm Hg, respectively (P = .168). However, for the hyperpronating foot, the pressure decreased from 29 ± 15 mm Hg to 18 ± 11 mm Hg (P < .001) following the placement of HyProCure. The pain caused by compression of the posterior tibial nerve in the tarsal tunnel and its branches in the porta pedis, owing to hyperpronation, may be alleviated by implantation of HyProCure.
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Abstract
Flexible flatfoot is a normal foot shape that is present in most infants and many adults. The arch elevates spontaneously in most children during the first decade of life. There is no evidence that a longitudinal arch can be created in a child's foot by any external forces or devices. Flexible flatfoot with a short Achilles tendon, in contrast to simple flexible flatfoot, is known to cause pain and disability in some adolescents and adults. Joint-preserving, deformity-correcting surgery is indicated in flexible flatfeet with short Achilles tendons when conservative measurements fail to relieve pain under the head of the plantar flexed talus or in the sinus tarsi area. Osteotomy is the fundamental and central procedure of choice. In almost all cases, Achilles tendon lengthening is required. In some cases, rigid supination deformity of the forefoot is present, requiring identification and concurrent treatment.
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Affiliation(s)
- Vincent S. Mosca
- Seattle Children’s Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, P.O. Box 5371/W-7706, Seattle, WA 98105 USA
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Scharer BM, Black BE, Sockrider N. Treatment of painful pediatric flatfoot with Maxwell-Brancheau subtalar arthroereisis implant a retrospective radiographic review. Foot Ankle Spec 2010; 3:67-72. [PMID: 20400415 DOI: 10.1177/1938640010362262] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purposes of this study were to evaluate the outcome of pediatric patients who have undergone Maxwell-Brancheau arthroereisis (MBA) subtalar implants for the treatment of painful pediatric flatfoot deformities. In a retrospective study, 39 patients (68 feet) were evaluated clinically and radiographically. The mean age of the patients was 12 years (range, 6-16 years). The mean period of follow-up was 24 months (range, 6-61 months). Statistical evaluation was performed on all radiographic measurements. Additional surgical procedures (gastrocnemius recession, Achilles tendon lengthening, Kidner posterior tibial tendon advancement) were performed in 22 of 68 feet. There were 10 (15%) complications, which consisted of 10 reoperations in 10 feet. Implants were exchanged in 9 feet because of implant migration, undercorrection, and overcorrection. There was 1 reoperation (in 1 foot) for implant removal because of persistent sinus tarsi pain. Radiographic evaluation demonstrated an improvement of all parameters determined. The parameters that were evaluated include talonavicular joint coverage, as well as lateral and anterior-posterior talocalcaneal angles. There were significant changes noted in pre- and postoperative measurements (P < .001). The MBA implant is effective for the correction of painful, flexible flatfoot deformity in children in short-term follow-up. However, this is a multiplanar deformity, and additional procedures may be needed in addition to the MBA.
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Minimally invasive soft-tissue and osseous stabilization (MISOS) technique for midfoot and hindfoot deformities. Clin Podiatr Med Surg 2008; 25:655-80, ix. [PMID: 18722905 DOI: 10.1016/j.cpm.2008.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The surgical repair of unstable midfoot and hindfoot deformities in the high-risk patient remains a challenge with little guidance available in the literature. The author presents a proposed surgical intervention for midfoot and hindfoot deformities utilizing a minimally invasive soft-tissue and osseous stabilization (MISOS) approach. The article presents a detailed, step-by-step description of the procedure used for these difficult limb salvage cases.
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Cicchinelli LD, Pascual Huerta J, García Carmona FJ, Fernández Morato D. Analysis of gastrocnemius recession and medial column procedures as adjuncts in arthroereisis for the correction of pediatric pes planovalgus: a radiographic retrospective study. J Foot Ankle Surg 2008; 47:385-91. [PMID: 18725117 DOI: 10.1053/j.jfas.2008.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Indexed: 02/03/2023]
Abstract
UNLABELLED The radiographic outcomes of 28 feet in 20 pediatric patients with pes planovalgus treated with subtalar arthroereisis, arthroereisis combined with gastrocnemius recession, or arthroereisis combined with gastrocnemius recession and medial column reconstruction were retrospectively analyzed. Preoperative and postoperative radiographic angles for talar declination, calcaneal inclination, and first metatarsal declination in the lateral view, and the angle formed between the longitudinal axis of the talus and the longitudinal axis of the lesser tarsus in the anteroposterior view were compared. Overall, analyses revealed statistically significant differences in the preoperative and postoperative radiographic angles for the 4 measured angles. Analysis by treatment group revealed statistically significant differences in correction of the angle measured in the anteroposterior view. Arthroereisis with gastrocnemius recession showed the greatest correction of this angle (median 19 degrees, range 11 degrees to 34 degrees) compared with the other treatment groups. There were no statistically significant differences in the degree of correction of the calcaneal inclination or talar declination angles, whereas a statistically significant difference in the correction of first metatarsal declination was observed. The greatest degree of angular change was achieved with medial column reconstruction (median 7 degrees, range 0 degrees to 9 degrees). Gastrocnemius recession displayed a notable effect on the correction of transverse plane deformity when used as an adjunct to arthroereisis. However, medial column reconstruction has a negative impact on the degree of correction in the transverse plane when it is used as an adjunct to arthroereisis and gastrocnemius recession. LEVEL OF CLINICAL EVIDENCE 4.
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Chang TJ, Lee J. Subtalar joint arthroereisis in adult-acquired flatfoot and posterior tibial tendon dysfunction. Clin Podiatr Med Surg 2007; 24:687-97, viii. [PMID: 17908637 DOI: 10.1016/j.cpm.2007.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The concept of subtalar arthroereisis seems to be gaining popularity in adult-acquired flatfoot surgery. There is wide acceptance of this approach in the pediatric population, but the use of these devices in the adult population is still controversial. Care needs to be taken to select the proper patients and to avoid overuse of these devices. The authors believe these implants will continue to provide a significant benefit to certain patients when selected properly.
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Affiliation(s)
- Thomas J Chang
- Northern California Foot and Ankle Center, 2281 Cleveland Avenue, San Francisco, CA 95403, USA.
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Zgonis T, Roukis TS, Lamm BM. Charcot foot and ankle reconstruction: current thinking and surgical approaches. Clin Podiatr Med Surg 2007; 24:505-17, ix. [PMID: 17613388 DOI: 10.1016/j.cpm.2007.03.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The surgical repair of unstable diabetic neuropathic osteoarthropathy of the midfoot or the hindfoot and ankle remains a challenge with little guidance available in the medical literature. The authors present their proposed surgical intervention techniques regarding the use of external fixation with or without combined internal fixation. A step-by-step guide through the authors' preferred technique for these difficult limb salvage cases is presented in detail.
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Affiliation(s)
- Thomas Zgonis
- Department of Orthopaedics, Podiatry Division, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7776, San Antonio, TX 78229, USA.
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Saxena A, Nguyen A. Preliminary radiographic findings and sizing implications on patients undergoing bioabsorbable subtalar arthroereisis. J Foot Ankle Surg 2007; 46:175-80. [PMID: 17466243 DOI: 10.1053/j.jfas.2007.01.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Indexed: 02/03/2023]
Abstract
Metallic subtalar arthroereisis implants can require removal. Similarly configured bioabsorbable "interference screws" placed alternatively to metal implants may obviate removal. Radiographic imaging may show the location and sizing of the implant, and evaluate for implant degradation. Patients undergoing subtalar arthroereisis were evaluated with magnetic resonance imaging (computed tomography in one patient) to measure the size of the tarsal canal. The tarsal canal length, along with medial height and lateral height, were assessed. The patient's actual implant size was also noted as well as any signs of implant degradation, bony deformation, granulomas, and so forth. Six patients met the inclusion criteria. The range of implants used was 9 to 12 mm. The radiographic measurements of the tarsal canal were as follows: medial to lateral length, 12.8 +/- 3.4 mm; medial height, 7.3 +/- 2.5 mm; and lateral height, 8.0 +/- 1.7 mm. Two patients underwent implant removal. No cystic or degenerative changes were noted on plain radiographs with bioabsorbable implants. Bioabsorbable interference screws for subtalar arthroereisis placed in the tarsal canal may still require removal, although no detrimental changes were noted radiographically to the surrounding bony structures. The size of the current metallic implants on the market appears larger than the tarsal canal configuration.
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Affiliation(s)
- Amol Saxena
- Palo Alto Medical Foundation, Department of Sports Medicine, Palo Alto, CA 94301, USA.
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Soomekh DJ, Baravarian B. Pediatric and adult flatfoot reconstruction: subtalar arthroereisis versus realignment osteotomy surgical options. Clin Podiatr Med Surg 2006; 23:695-708, v. [PMID: 17067888 DOI: 10.1016/j.cpm.2006.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
One of the most common presenting problems to most foot and ankle surgical practices is the painful flatfoot. Often, the problem is treated with excellent outcomes through a combination of conservative options. In certain cases, conservative care may not alleviate the associated symptoms of foot, ankle, knee, and possibly even back fatigue, pain of the foot and leg, and arthritis of the midfoot, rearfoot, or ankle. In such cases, multiple surgical options are available to treat the underlying deformity and associated symptoms. it is essential to treat the foot and leg as a unit and not to perform surgical based on rapid recovery abut rather on a long-term stable and lasting outcome.
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Affiliation(s)
- David J Soomekh
- The Foot and Ankle Institute of Santa Monica, 2121 Wilshire Boulevard, Suite 101, Santa Monica, CA 90403, USA
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Nelson SC, Haycock DM, Little ER. Flexible flatfoot treatment with arthroereisis: radiographic improvement and child health survey analysis. J Foot Ankle Surg 2004; 43:144-55. [PMID: 15181430 DOI: 10.1053/j.jfas.2004.03.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study was designed to ascertain if there was a statistically significant correction in the foot and to determine the overall health of a child after an arthroereisis procedure. Thirty-seven patients (67 feet) who had undergone Maxwell-Brancheau arthroereisis were retrospectively reviewed at an average of 18.4 months after surgery. The pre- and postoperative lateral talo-first metatarsal and talar declination and the anteroposterior talo-first metatarsal and talocalcaneal angles were measured by using an X-Caliper device (Eisenlohr Technologies, Davis, CA); significance was determined with a t test. Child health questionnaire answers were calculated and converted to a 0 to 100 scaled score and statistically compared with population norms by using a single-sample t test. The lateral radiographic average preoperative talo-first metatarsal and talar declination angles were 11.3 and 27.5, respectively, and were 3.7 and 21.9, respectively, postoperatively. The preoperative average anteroposterior talo-first metatarsal and talocalcaneal angles were 13.8 and 25.6, respectively, and were 6.4 and 19.4, respectively, postoperatively. The t test showed the postoperative angles had a statistically significant (P <.01) change from the preoperative angles. The results of the Child health questionnaire of our 34 pediatric patients (92%) showed scores in 3 domains (role emotional behavior, global behavior, parent time) that were better than population norms, and there was no difference in the remaining domains.
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Affiliation(s)
- Scott C Nelson
- Department of Foot and Ankle Surgery, Joint Township District Memorial Hospital, St. Mary's, Ohio, USA.
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