Clinical Report: Arthroereisis vs Osteotomy for Pediatric Flexible Flatfoot

Overview

This systematic review and meta-analysis compared arthroereisis and osteotomy for treating symptomatic idiopathic flexible flatfoot (FFF) in children. Both procedures improved radiographic parameters and patient-reported outcomes, with arthroereisis showing advantages in invasiveness and recovery.

Background

Pes planus, or flatfoot, is a common pediatric foot condition characterized by hindfoot valgus, forefoot abduction, and medial arch collapse. Flexible flatfoot (FFF) is the predominant type in children and often resolves spontaneously but may require surgery if symptomatic. Surgical options include osteotomies and subtalar arthroereisis, the latter being a minimally invasive procedure involving sinus tarsi implants to stabilize the subtalar joint. Despite lower complication rates and shorter hospital stays, arthroereisis remains controversial due to limited high-quality evidence.

Data Highlights

Key Findings

• Both arthroereisis and osteotomy significantly improve radiographic parameters including talo-first metatarsal angle, calcaneal pitch, talocalcaneal angle, and talonavicular coverage angle.
• Patient-reported outcomes measured by the AOFAS Ankle-Hindfoot score improved significantly after both procedures.
• Arthroereisis is a minimally invasive technique involving sinus tarsi implants that stabilize the subtalar joint.
• Arthroereisis is associated with lower complication rates and shorter hospital stays compared to osteotomy.
• Despite these advantages, arthroereisis has been assigned a grade C recommendation due to historically poor quality evidence, though recent studies have improved the evidence base.

Clinical Implications

Clinicians should consider arthroereisis as a less invasive alternative to osteotomy for symptomatic idiopathic flexible flatfoot in children, especially when conservative treatments fail. Both procedures effectively improve foot alignment and patient outcomes, but arthroereisis may offer benefits in recovery time and complication profile. Careful patient selection and awareness of implant types are important for optimal results.

Conclusion

Arthroereisis and osteotomy both provide significant clinical and radiographic improvements in pediatric flexible flatfoot. Arthroereisis offers a minimally invasive option with favorable recovery characteristics, supporting its increasing use in clinical practice.

References

1. Bernasconi et al. 2017 -- Subtalar arthroereisis recommendation review
2. Kitaoka et al. -- AOFAS Ankle-Hindfoot score development
3. Prospero CRD42024582436 -- Systematic review protocol registration