Bioabsorbable Implants May Reduce Symptoms in Pediatric Flatfoot Surgery

Overview

Subtalar arthroereisis improves clinical and radiographic outcomes in pediatric flexible flatfoot regardless of implant type. Bioabsorbable implants are associated with fewer implant-related symptoms and lower rates of nonroutine removal compared to metallic implants, based on limited comparative evidence.

Background

Flexible flatfoot is a common pediatric condition often treated with subtalar arthroereisis to improve foot alignment and function. Implants used in this procedure can be metallic or bioabsorbable, with differing profiles regarding symptom persistence and implant removal. Understanding the comparative effectiveness and safety of these implant types is critical for optimizing patient outcomes. This systematic review and meta-analysis evaluated over 2,000 feet from 39 studies to assess these factors.

Data Highlights

Key Findings

• Both metallic and bioabsorbable implants significantly improve radiographic measures such as Meary’s angle and calcaneal pitch, achieving near-normal foot alignment.
• Bioabsorbable implants are associated with a lower incidence of persistent sinus tarsi pain (~6%) compared to metallic implants (~8%).
• Nonroutine implant removal or revision rates are lower with bioabsorbable devices (~5%) versus metallic implants (~8%).
• Comparative evidence is limited to two nonrandomized cohort studies, resulting in low to moderate certainty of findings.
• Patient-reported functional and pain outcomes improve across implant types, though reporting is inconsistent between cohorts.
• Heterogeneity in implant design, surgical technique, and concomitant procedures contributes to variability in outcomes.

Clinical Implications

Clinicians should consider bioabsorbable implants as a viable option for subtalar arthroereisis in pediatric flexible flatfoot, given their association with fewer implant-related symptoms and lower removal rates. Implant choice should be individualized based on patient age, deformity severity, and surgeon experience. Awareness of the limited comparative evidence and moderate risk of bias in existing studies is important when counseling patients and families.

Conclusion

Subtalar arthroereisis effectively improves outcomes in pediatric flexible flatfoot regardless of implant material, with bioabsorbable implants potentially offering modest advantages in symptom reduction and implant retention. Further high-quality comparative studies are needed to strengthen evidence guiding implant selection.

References

1. Marletta et al., The Foot, 2024 -- Bioabsorbable Implants May Reduce Symptoms in Flatfoot Surgery