Clinical Scorecard: Evaluating the clinical effectiveness of arthroereisis versus osteotomy for treating idiopathic flexible flatfoot in children: a systematic review and meta-analysis

At a Glance

Key Highlights

• FFF accounts for over 95% of flatfoot cases in children and is typically asymptomatic but may require surgery if conservative treatments fail
• Subtalar arthroereisis is a minimally invasive procedure gaining traction due to lower complication rates and shorter hospital stays compared to osteotomies
• This systematic review and meta-analysis compares arthroereisis and osteotomy using radiographic parameters and patient-reported outcome measures (PROMs)

Guideline-Based Recommendations

Diagnosis

• Diagnosis is based on clinical assessment of hindfoot valgus, forefoot abduction, and medial arch collapse
• Radiographic measurements including talo-first metatarsal angle, calcaneal pitch, talocalcaneal angle, and talonavicular coverage angle are used to evaluate deformity

Management

• Conservative treatments such as corrective shoes, foot orthoses, and exercise therapies are first-line for symptomatic FFF
• Operative interventions including soft-tissue techniques, osteotomies, and subtalar arthroereisis are considered after failure of conservative management
• Subtalar arthroereisis involves insertion of synthetic implants into the sinus tarsi to stabilize the subtalar joint and correct deformity

Monitoring & Follow-up

• Postoperative assessment includes radiographic evaluation of foot alignment and validated patient-reported outcome measures such as the AOFAS Ankle-Hindfoot score

Risks

• Arthroereisis is associated with lower complication rates and shorter hospital stays compared to osteotomies
• Careful patient selection is necessary to exclude secondary causes of flatfoot and other pathologies

Patient & Prescribing Data

Children and adolescents with symptomatic idiopathic flexible flatfoot unresponsive to conservative treatment

Arthroereisis offers a minimally invasive alternative to osteotomy with potential benefits in complication rates and recovery, but evidence quality has been variable

Clinical Best Practices

• Perform thorough clinical and radiographic assessment to confirm idiopathic flexible flatfoot and exclude secondary causes
• Initiate conservative management prior to considering surgical options
• Select surgical technique based on patient-specific factors, deformity severity, and surgeon expertise
• Use standardized radiographic parameters and validated PROMs for pre- and postoperative evaluation
• Ensure multidisciplinary discussion and informed consent regarding risks and benefits of arthroereisis versus osteotomy

References

• Bernasconi et al. 2017 review on subtalar arthroereisis
• PRISMA 2020 Statement
• Kitaoka et al. AOFAS Ankle-Hindfoot score development