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Symptomatic Flat Foot In Teenagers:
Our Experience In Treatment With
Arthroereisis
Authors: Cristián Ortiz, Emilio Wagner, Andrés Keller, Diego
Zanolli, Amanda Riquelme, Pablo Wagner, Pablo Mocoçain,
Ximena Ahumada
Clínica Alemana de Santiago-Universidad del Desarrollo
Santiago. Chile
Symptomatic Flat Foot In Teenagers:
Our Experience In Treatment With
Arthroereisis
Emilio Wagner H
My disclosure is in the
Final AOFAS Mobile App.
I have no potential conflicts with
this presentation
Introduction
• Initial management:
conservative
• If it fails surgery
– Tendon transferences
– Osteotomies
– Arthrodesis
– Arthroereisis
• Extraarticular procedures
are recommended
because they preserve
the joint surface
Fernandez de Retana, Alvarez, Viladot. Foot Ankle Clin.
2010 Jun;15(2):323-35
Objectives
• To describe multiple arthroereisis
techniques, with their respective clinical,
functional and radiologic results
Methods
Retrospective Study
• Teenager symptomatic flat foot
• Surgery between 2008 and 2013
Methods
• Surgical technique: Calcaneo Stop, Kalix™, Sinus™
• Clinic and radiographic results
• VAS, function, and AOFAS post op score
• Short and medium term follow up (6– 48 months)
Technique example:
Calcaneo Stop
Results • 17 foot (9 patients)
– 11 arthroereisis with
Kalix™
– 2 arthroereisis with
Sinus™
– 4 Calcaneo Stop
• Resection of the
coalition before the
arthroereisis in:
– 2 Kalix™
– 2 Sinus™
Results
• Clinic and radiologic correction in 15/17
• 4 implants (2 Kalix™, 2 Sinus™) needed to be
removed because of pain
• 17/17 VAS 0/10, performing sports
• AOFAS Score: 92 points average (60-100)
Discussion
• Arthroereisis good alternative in
symptomatic flat foot
– Excellent radiological and
clinical outcomes
– Mechanical and proprioceptive
effect
– Low morbidity
– Remodelling the foot anatomy in
children and adolescents
Schon LC. Foot Ankle Clin. 2007 Jun;12(2):329-39
Discussion
• There is no gold standard
– Important: to preserve the articular surface
and bone stock
Roth S, Sestan B, Tudor A, et al. Foot Ankle Int
2007;28:991–5
PRE OP POST OP
Discusion
• Arthroereisis:
– Good results
– Low complication rate
• Using single screw (like
“Calcaneo Stop”)
– Low cost compared with
other techniques
evaluated
– Our choice when
performing arthroereisis
Usuelli FG, Montrasio UA. Foot Ankle Clin. 2012
Jun;17(2):183-94
References
• Schon LC. Subtalar arthroereisis: a new exploration of an old concept. Foot
Ankle Clin. 2007 Jun;12(2):329-39
• Fernandez de Retana, Alvarez, Viladot. Subtalar arthroereisis in pediatric
flatfoot reconstruction. Foot Ankle Clin. 2010 Jun;15(2):323-35
• Mosca VS. Flexible flatfoot and tarsal coalition. In: Canale ST, editor.
Orthopedic knowledge update: pediatrics 2. Chicago (IL): American
Academy of Orthopaedic Surgeons; 2002. p. 215–7
• Roth S, Sestan B, Tudor A, et al. Minimally invasive calcaneo-stop method
for idiopathic, flexible pes planovalgus in children. Foot Ankle Int
2007;28:991–5
• Usuelli FG, Montrasio UA. The calcaneo-stop procedure. Foot Ankle Clin.
2012 Jun;17(2):183-94
• Alvarez R. Calcaneo stop. Tecnica personal original para el tratamiento
quirurgico del pie plano-valgo del niño y del adolescente joven. In:
Epeldegui T, editor. Pie plano y anomalıas del antepie, Madrid, Spain:
Madrid Vicente; 1995. p. 174–7