Correction of pediatric flexible flatfoot using arthroereisis

Abstract

Objective: The aim of this study was to evaluate the effectiveness of arthroereisis using synthetic polyethylene implants as a method to correct deformities of excessive valgus in pediatric patients with flexible flatfoot (FF). Methods: This was a study of 20 patients between 5 and 12 years of age with symptomatic FF who received surgery between January 2011 and July 2016. Evaluations were made on the basis of the Valenti podoscopic classification, radiographic images, and AOFAS criteria. Patients with preoperative Valenti classification grades of III and IV were selected for the study. These patients received surgical treatment by arthroereisis with the interposition of a synthetic implant in the sinus tarsi, with or without stretching of the Achilles tendon (Vulpius surgery). A multiple linear regression analysis was performed with backward selection of the following variables: Valenti preoperative classification and the preand postoperative Bordelon, Kite, Gould, Meary and Pitch angles that were measured from the radiographic images of the patients who received arthroereisis. Results: Arthroereisis with synthetic material interposition was satisfactory, with 21 of the feet (91% of cases) showing clinical and radiographic improvement with angle correction and improved degree of deformity based on the Valenti classification. Two cases experienced implant loosening. The Bordelon and Pitch angle variables had a significant effect (p<0.05) on the improvement in degree of deformity correction based on the Valenti classification. Conclusion: Arthroereisis resulted in significant improvements in the patients who were studied, with pronounced clinical improvement and high degrees of satisfaction. Level of evidence IV; Therapeutic Studies; Case Series.