Impact-Blocking Device Versus Self-Locking Implant Arthroereisis for Treatment of Symptomatic Pediatric Flatfoot in Developing Countries

Document Type : Original Article

Authors

1 Department of Orthopedic Surgery, Faculty of Medicine, Benha University, Egypt.

2 Department of Orthopedic Surgery, Faculty of Medicine, Helwan University, Egypt.

Abstract

Background
Pediatric flexible flatfoot is a common presenting condition. Surgical treatment is only indicated for symptomatic cases not responding to conservative measures. Surgical options include soft tissue enforcement, arthroereisis, osteotomies, and arthrodesis. Arthroereisis carries a lot of controversies regarding age limit, mechanism of action, implants, durability, complications and the exact time for removal. In this study we design a randomized comparative study to evaluate the differences between impact blocking device and self-locking implant used in subtalar arthroereisis.
Subjects and Methods
Seventy feet were included in the study in forty five patients. Symptomatic flexible flatfeet not responding to the conservative treatment in patients whom ages ranged from 10 to 14 years were included in the study. Patients were randomly divided in 2 groups for each procedure. Preoperative and 3 years postoperative clinical, radiological and functional assessment was done with evaluation of complications.
Results
Three patients who did not complete 3 years follow up were excluded in which 31 feet were operated for impact blocking device (calcaneal stop procedure) and 34 feet were operated for self-locking implant. The overall results of the study showed statistically significant improvement between pre-operative and post-operative hind foot valgus angle, Meary's angle, calcaneal pitch angle, talar head coverage angle and AOFAS score for both groups. No significant differences between the two groups regarding clinical, radiographic or functional outcomes.

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