Comparison of the effectiveness of two kinds of surgeries for treatment of flexible flatfoot combined with painful accessory navicular bone in children / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of subtalar arthroereisis (STA) combined with modified Kidner procedure versus STA alone in the treatment of flexible flatfoot combined with painful accessory navicular bone in children.@*METHODS@#The clinical data of 33 children with flexible flatfoot combined with painful accessory navicular bone who were admitted between August 2018 and August 2021 and met the selection criteria were retrospectively analyzed. They were divided into a combination group (17 cases, treated by STA combined with modified Kidner procedure) and a control group (16 cases, treated by STA alone) according to the surgical methods. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, affected side of the foot, disease duration, and preoperative visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talonavicular coverage angle (TCA), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle), and heel valgus angle (HV). The operation time, incision length, intraoperative blood loss, number of intraoperative fluoroscopies, and perioperative complications were recorded in both groups. The anteroposterior, lateral, and calcaneal axial X-ray films for the affected feet were taken regularly, and T1MT, T2MT, TCA, Meary angle, Pitch angle, and HV were measured. The VAS score, AOFAS ankle-hindfoot score were used to evaluate pain and functional recovery before and after operation.@*RESULTS@#Surgeries in both groups were successfully performed without surgical complication such as vascular, nerve, or tendon injuries. Less operation time, shorter incision length, less intraoperative blood loss, and fewer intraoperative fluoroscopies were found in the control group than in the combination group ( P<0.05). One case in the combination group had partial necrosis of the skin at the edge of the incision, which healed after the dressing change and infrared light therapy, and the rest of the incisions healed by first intention. All children were followed up 12-36 months, with a mean of 19.6 months. At last follow-up, VAS score and AOFAS ankle-hindfoot score significantly improved in both groups when compared with preoperative ones ( P<0.05), and the differences of these scores between before and after operation improved more significantly in the combination group than in the control group ( P<0.05). Imaging results showed that the T1MT, T2MT, TCA, Meary angle, and HV significantly improved in both groups at last follow-up when compared with preoperative ones ( P<0.05), and the Pitch angle had no significant difference when compared with preoperative one ( P>0.05). But there was no significant difference in the difference of these indicators between before and after operation between the two groups ( P>0.05).@*CONCLUSION@#Both procedures are effective in the treatment of flexible flatfoot children with painful accessory navicular bone. STA has the advantage of minimally invasive, while STA combined with modified Kidner procedure has better effectiveness.

Controversy of subtalar arthroereisis in symptomatic flatfoot / 中国骨伤

Flatfoot could be divided into flexible flatfoot and rigid flatfoot. Flatfoot with symptoms is called symptomatic flatfoot, surgical treatment is required if conservative treatment is not effective. Subtalar arthroereisis is a minimally invasive procedure which has been used for many years with good results in flexible flatfoot, however, still has many controversial points. Controversial points focus on indications and contraindications, optimal age, subtalar arthroereisis alone or not, efficacy and safety of absorbable material implants, and implant removal. The paper reviewed and summarized the use and controversies of subtalar arthroereisis in symptomatic flatfoot as follows:the best indication for subtalar arthroereisis was pediatric flexible flatfoot syndrome and aged from 10 to 12 years old was optimal age for treatment;tarsal coalitions with flatfoot and adult flatfoot were relative indications. Stiff flatfoot, joint laxity, and subtalar arthritis were contraindications;obesity and neurogenic flexible flatfoot were relative contraindications. The correction ability of subtalar arthroereisis alone was limited, and it's combined with other procedures depending on patient's situation. The safety and efficacy of absorbable material implants had been reported. Routine removal of the implant was not necessary, the main reason of which was tarsal sinus pain.

Subtalar Arthroereisis Using Kalix® Sinus Tarsi Implant for Pediatric Flexible Flatfoot / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the radiographic and clinical outcomes of subtalar arthroereisis as a method of treatment for pediatric flexible flatfoot. MATERIALS AND METHODS: We retrospectively investigated 14 feet among 10 patients with flexible flatfoot, who were treated with a subtalar arthroereisis using a sinus tarsi implant between March 2007 and June 2012. Radiographically, the talo-1st metatarsal angle, talar declination, and calcaneal pitch angle have all been measured on lateral radiographs. The talo-navicular coverage angle and talo-1st metatarsal angle was measured on anteroposterior (AP) radiographs and tibio-calcaneal angle was assessed by hindfoot alignment view. Visual analogue scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used for clinical evaluation. RESULTS: The mean follow-up was 48.7 months (16–98 months), and the mean age was 11.6 years (6–19 years). Radiographically, the mean pre-operative and postoperative values measured by the lateral foot radiograph were −25.1° and −7.5° for talo-1st metatarsal angle, 37.4° and 23.2° for talar declination, and 8.3° and 15.0° for calcaneal pitch angle, respectively. The mean preoperative and postoperative values measured by foot AP radiograph were 23.0° and 11.9° for talo-navicular coverage angle and 17.2° and 9.0° for talo-1st metatarsal angle, respectively. Moreover, tibio-calcaneal angle improved from valgus 17.4° on average to 4.5° on average. Clinically, the VAS score and AOFAS score was improved from 5.8 to 1.5 and from 61.8 to 90.4, respectively. Complication was sinus tarsi pain that occurred in 5 cases (35.7%). CONCLUSION: We achieved a satisfactory correction of pediatric flexible flatfoot deformities via subtalar arthroereisis, using a sinus tarsi implant with favorable radiographic and clinical measures. However, high potential complication rate of postoperative sinus tarsi pain on weight-bearing should carefully be considered.

Calcaneo-stop Procedure for Management of Pediatric Symptomatic Flexible Flatfoot / 대한족부족관절학회지

PURPOSE: The aim of the current study is to report on the clinical and radiographic results after calcaneo-stop procedure in Korean children with symptomatic flexible flatfoot. MATERIALS AND METHODS: Twenty-two children suffering pain along the medial aspect of midfoot with flexible flatfoot whose symptoms did not improve with conservative measures and therefore underwent calcaneo-stop procedure were identified retrospectively. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and visual analogue scale (VAS) were evaluated. Radiographically, standing anteroposterior and lateral radiographs of the foot and Saltzman's alignment views were taken and talonavicular coverage angle, lateral talo-first metatarsal angle, and hindfoot alignment angles were measured and analyzed. RESULTS: Clinically, AOFAS ankle-hindfoot scale improved from 70.3+/-5.6 to 97.3+/-2.5 and VAS improved from 6.4+/-1.6 to 0.2+/-0.4. Radiographically, talonavicular coverage angle improved from 28.3degrees+/-12.3degrees to 10.9degrees+/-8.1degrees, lateral talo-first metatarsal angle improved from -19.3degrees+/-9.0degrees to -2.4degrees+/-8.1degrees, and hindfoot alignment angle improved from valgus 11.9degrees+/-10.0degrees to 3.5degrees+/-4.3degrees at minimum 2-year follow-up. No complications occurred postoperatively. CONCLUSION: Calcaneo-stop procedure is a simple and very effective procedure for management of pediatric symptomatic flexible flatfoot that does not respond to conservative treatment.

Clinical Results of the Subtalar Arthroereisis for the Flat Foot / 대한족부족관절학회지

PURPOSE: To determine the clinical and radiographic results of arthroereisis using the Kalix(R) implant (Newdeal, Lyon, France) for the treatment of flexible flatfoot deformity. MATERIALS AND METHODS: From February 2005 to February 2007, we performed the subtalar arthroereisis on 8 patients (9 feet) of symptomatic flexible flat feet after more than 6 months of conservative treatment. Average age was 14.5 years (11~29 years) old. We checked the functional status with AOFAS functional score pre-operatively and at final follow-up. Radiologically, we took weight bearing anterior to posterior and lateral view of the feet, and measured the talo-first metatarsal angle, calcaneal pitch angle in pre-operatively and at final follow-up. RESULTS: Mean follow up period was 34.4 months. Average AOFAS score improved from preoperatively 65.6 to postoperatively 94.8. Average lateral talo-first metatarsal angle reduced from 12.8degrees preoperatively to 1.6degrees at final follow-up. Average anterior to posterior talo-first metatarsal angle was reduced from 15.1degrees preoperatively to 8.3degrees at final follow-up. Average calcaneal pitch angle was increased from 9.5degrees preoperatively to 12.0degrees at final follow-up. CONCLUSIONS: Subtalar arthroereisis with Kalix(R) implant can be considered to be one of treatment options symptomatic flatfoot deformity patients.

The Treatment of Failed Kidner Procedure for Adolescent Prehallux: A Case Report / 대한족부족관절학회지

Cause of flexible flat foot is predominantly idiopathic but pediatric flexible flatfoot is typically congenital. Neuromuscular disorders, tarsal coalition and prehallux are possible causes and there has been a controversy for diagnosis and surgical treatment guideline. Therefore we present 11-year old male with prehallux and flexible flat foot who was treated with Kidner procedure and subtalar arthroereisis using Kalix endoprothesis and reported good clinical outcome at 2-years follow up postoperatively.

The Results of Subtalar Arthroereisis for Flexible Flatfoot of Children / 대한족부족관절학회지

PURPOSE: We evaluate the results of subtalar arthroereisis with Kalix(R) implant (Newdeal, Lyon, France) that were performed in painful flatfoot deformity. MATERIALS AND METHODS: We performed the subtalar arthroereisis on 16 feet of children symptomatic flexible flat feet after more than 6 months of conservative treatment. Average age was 11 years (8-14 years) old. We checked the functional status with AOFAS functional score in pre-operatively and at final follow-up. Radiologically, we took weight bearing anterior to posterior and lateral view of the feet, and measured the talo-1st metatarsal angle, calcaneal pitch angle, cuboid-surface height. Finally, we asked to patient's parents for satisfaction of the surgery. RESULTS: Mean follow up period was 34.1 months. Average AOFAS score improved from preoperatively 71.9 to postoperatively 91.3. Only one patient has subtalar pain. Average lateral 1st metatarsal angle reduced from -18.2 degrees preoperatively to -4.6 degrees at final follow-up. Average anterior to posterior 1st metatarsal angle was reduced from 18.9 degrees preoperatively to 6.5 degrees at final follow-up. Average calcaneal pitch angle was increased from 8.6 degrees preoperatively to 12.6 degrees at final follow-up. Average cuoboid-surface height was improved from 12.1 mm preoperatively to 16.0 mm at final follow-up. All patients had excellent or good satisfaction. CONCLUSIONS: Subtalar arthroereisis with Kalix(R) implant is a viable surgical alternative for painful flatfoot deformity of children.

Adult Idiopathic Flexible Flat Foot Treated with Medial Sliding Calcaneal Osteotomy and Subtalar Arthroereisis: Report of 1 Case / 대한족부족관절학회지

There have been many reports about surgical treatments of flexible flatfoot in children and acquired adult flatfoot deformity due to posterior tibial tendon dysfunction common in the 5th and 6th decades. However there has been a controversy for surgical treatment guideline for painful idiopathic flexible flatfoot deformities in young adults. Therefore, we present a 27-year-old female with severe painful idiopathic flexible flatfoot who was treated with medial sliding calcaneal osteotomy and subtalar arthroereisis using Kalix(R) (Newdeal SA, Vienne, France) endoprosthesis and had good clinical outcome with high patient satisfaction at 10 months follow-up postoperatively.