Subtalar Arthroreisis with Calcaneostop Screw in juvenile Flexible Symptomatic Pes Plano Valgus Management – Initial Clinical Experience

The juvenile flatfoot is a physiological condition that usually undergoes spontaneous correction or asymptomatic during the first 10 years of life. Those who are symptomatic and not improved after conservative treatment, require surgical management.

The operative options include calcaneal osteotomies with or without talo-navicular joint capsule and tibialis posterior tendon shortening, lengthening of short calf muscles and subtalar arthroreisis. Arthroreisis procedure suggests insertion of calcaneostop screw for lateral process of talus support; is extra-articular and minimally invasive and indicated for treatment of flexible symptomatic flatfoot.

During the period from 01/2018 till 06/2018 we treated 9 children by subtalar arthroreisis with age range from 8 to 12 years, 8 female and one male patient.

The rapid clinical correction with elevation of the longitudinal arch occurs immediately after the operation. Radiological and pedometric examination on early follow up examination demonstrated a significant improvement of the relevant angles (talo-calcaneal angle, calcaneus pitch angle, TMT index) and footprints. No cases of infection, overcorrection or under correction were reported. Long term follow up is required.

Subtalar Arthroreisis with a Calcaneostop screw may be a good alternative treatment for juvenile symptomatic flexible flatfoot. The minimal invasive procedure with a low complications rate, short operative time, allows an immediate mobilization, full weight bearing and rapid reintegration in the school and sport activities. There is no need for further orthotic support or physical therapy. A prospective study is planed with a long term follow up after screw removal, usually performed after bone maturation.