Comparative study of subtalar arthroereisis, medializing calcaneal osteotomy and the combination of both techniques for the treatment of symptomatic adult flatfeet

• Published in: Foot and ankle surgery 2024-10
• Main Authors: Stichnoth, Maike, Lüders, Katja A., Hell, Anna K., Stinus, Hartmut
• Format: Article
• Language: English
• Subjects: Flatfeet; Medializing calcaneal osteotomy; Pedobarography; Pes planovalgus; Subtalar arthroereisis
• ISSN: 1268-7731; 1460-9584; 1460-9584
• DOI: 10.1016/j.fas.2024.10.006

Symptomatic adult flatfeet are a common problem that is treated with various therapeutic approaches. In this study, three different surgical approaches, subtalar arthroereisis (SA), medializing calcaneal osteotomy (MDCO) and a combination of both techniques (SA+MDCO) were analyzed. 32 patients (36 feet) with pes planovalgus (mean age 49 +/- 16 years) were surgically treated with either SA (n = 8 feet), MDCO (n = 9 feet) or SA+MDCO (n = 19 feet). The American Orthopaedic Foot and Ankle Society (AOFAS) and the European Foot and Ankle Society (EFAS) questionnaires, as well as radiological parameters were compared before and after surgery within and between groups. At follow up (6 +/- 2 years) patients were additionally invited for dynamic pedobarography and static hindfoot axis examination. Within all three groups AOFAS and EFAS questionnaire values and radiological parameters improved significantly after surgery. Questionnaires did not differ between all groups. Before surgery the SA+MDCO group displayed the most severe radiological flatfeet parameter in comparison to the other cohorts. After surgery, the SA and SA+MDCO groups were greatly improved, while the MDCO group displayed less correction, indicating poorer surgical results with MDCO only. Pedobarography of surgically treated feet revealed similar results in comparison to the contralateral side within all three groups and all feet displayed a normal gait line after surgery. Analyzing questionnaires and radiographs, all three surgical techniques (SA, MDCO and SA+MDCO) significantly improved the severity of flatfoot deformity. Pedobarography revealed similar dynamic properties of treated feet in comparison to the contralateral side. While treatment with SA showed better results than treatment with MDCO alone, the combination of SA+MDCO was most effective. In this study, severe adult flatfeet benefited most from a surgical combination of SA+MDCO with respect to normalization of radiological parameter. Therapeutic Level III