The most difficult aspect regarding treatment of the pediatric flatfoot is understanding who needs surgery,when it is necessary, and what procedure to be done.A thorough history, clinical examination, and imaging shou...The most difficult aspect regarding treatment of the pediatric flatfoot is understanding who needs surgery,when it is necessary, and what procedure to be done.A thorough history, clinical examination, and imaging should be performed to guide the surgeon through an often complex treatment path. Surgical technique can be divided in three categories: Soft tissue, bony,and arthroereisis. This paper will describe the jointpreserving techniques and their application to treat the pediatric flatfoot deformity.展开更多
BACKGROUND Flexible flatfoot(FFF)is a very common condition in children,characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot.Arthroereisis(AR)procedures are w...BACKGROUND Flexible flatfoot(FFF)is a very common condition in children,characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot.Arthroereisis(AR)procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop(CS).AIM We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients.We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population,young athletes,and obese people according to material device.METHODS Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses,a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6,2020.The research string used was(pediatric OR children OR Juvenile NOT adult)AND(flexible NOT rigid)AND(flat foot OR pes planus)AND(calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal).The risk of bias assessment was performed using the Dutch checklist form for prognosis.RESULTS A total of 47 articles were found.Ultimately,after reading the full text and checking reference lists,we selected 17 articles that met the inclusion and exclusion criteria.A total of 1864 FFFs were identified.Eight studies concerned the subtalar AR(47.1%)and nine concerning CS(52.9%).The average age of patients at start of treatment was 11.8 years,the average follow-up of the studies was 71.9 mo(range 29.1-130).Globally,complications occurred in 153 of the 1864 FFF treated,with a rate of 8.2%.CONCLUSION Both AR procedures are valid surgical techniques for treating FFF.Surgeon experience,implant cost,and cosmetic correction are the most common considerations included in the orthopedic device decision-making process.In obese patients,the subtalar AR is not reco展开更多
BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide.Although relationships between obesity and flatfoot have been shown,no studies have investigated the influen...BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide.Although relationships between obesity and flatfoot have been shown,no studies have investigated the influence of obesity on arthroereisis outcomes.AIM To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants.METHODS This retrospective study included one hundred and sixty-nine pediatric patients(10-14 years old)who underwent subtalar arthroereisis(PEEK PitStop®device)for severe flexible flatfoot.Exclusion criteria were additional procedures,revision of previous corrective surgeries,rigid flatfoot with severe deformity,and neurologi-cal or post-traumatic flatfoot.Preoperative/postoperative European Foot and Ankle Society(EFAS)and visual analogue scale(VAS)scores were determined;radiographic assessment was conducted on weight-bearing foot X-rays:Kite angle,first metatarsal-talus angle,Meary angle,calcaneal pitch angle and lateral talo-calcaneal angle were analyzed.RESULTS EFAS and VAS scores improved post-operatively in the whole population.Only seven cases with complications were reported.Radiographic assessment revealed an improvement in all angles.Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes:Relationships were reported between BMI and postoperative EFAS/VAS scores,postoperative calcaneal pitch angle,Kite angle,Meary angle and talo-first meta-tarsal angle.CONCLUSION Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children,obesity significantly influences clinical and radiographic outcomes of arthroereisis,and obese children tend to perceive more pain and discomfort.展开更多
文摘The most difficult aspect regarding treatment of the pediatric flatfoot is understanding who needs surgery,when it is necessary, and what procedure to be done.A thorough history, clinical examination, and imaging should be performed to guide the surgeon through an often complex treatment path. Surgical technique can be divided in three categories: Soft tissue, bony,and arthroereisis. This paper will describe the jointpreserving techniques and their application to treat the pediatric flatfoot deformity.
文摘BACKGROUND Flexible flatfoot(FFF)is a very common condition in children,characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot.Arthroereisis(AR)procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop(CS).AIM We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients.We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population,young athletes,and obese people according to material device.METHODS Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses,a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6,2020.The research string used was(pediatric OR children OR Juvenile NOT adult)AND(flexible NOT rigid)AND(flat foot OR pes planus)AND(calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal).The risk of bias assessment was performed using the Dutch checklist form for prognosis.RESULTS A total of 47 articles were found.Ultimately,after reading the full text and checking reference lists,we selected 17 articles that met the inclusion and exclusion criteria.A total of 1864 FFFs were identified.Eight studies concerned the subtalar AR(47.1%)and nine concerning CS(52.9%).The average age of patients at start of treatment was 11.8 years,the average follow-up of the studies was 71.9 mo(range 29.1-130).Globally,complications occurred in 153 of the 1864 FFF treated,with a rate of 8.2%.CONCLUSION Both AR procedures are valid surgical techniques for treating FFF.Surgeon experience,implant cost,and cosmetic correction are the most common considerations included in the orthopedic device decision-making process.In obese patients,the subtalar AR is not reco
文摘BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide.Although relationships between obesity and flatfoot have been shown,no studies have investigated the influence of obesity on arthroereisis outcomes.AIM To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants.METHODS This retrospective study included one hundred and sixty-nine pediatric patients(10-14 years old)who underwent subtalar arthroereisis(PEEK PitStop®device)for severe flexible flatfoot.Exclusion criteria were additional procedures,revision of previous corrective surgeries,rigid flatfoot with severe deformity,and neurologi-cal or post-traumatic flatfoot.Preoperative/postoperative European Foot and Ankle Society(EFAS)and visual analogue scale(VAS)scores were determined;radiographic assessment was conducted on weight-bearing foot X-rays:Kite angle,first metatarsal-talus angle,Meary angle,calcaneal pitch angle and lateral talo-calcaneal angle were analyzed.RESULTS EFAS and VAS scores improved post-operatively in the whole population.Only seven cases with complications were reported.Radiographic assessment revealed an improvement in all angles.Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes:Relationships were reported between BMI and postoperative EFAS/VAS scores,postoperative calcaneal pitch angle,Kite angle,Meary angle and talo-first meta-tarsal angle.CONCLUSION Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children,obesity significantly influences clinical and radiographic outcomes of arthroereisis,and obese children tend to perceive more pain and discomfort.
