The use of subtalar arthroereisis in the treatment of flexible flat foot in children with joint hypermobility
Background. Flexible flat foot is one of the most frequent skeletal abnormalities in children and adolescents. The technique of surgical subtalar arthroereisis is frequently used for the treatment of painful planovalgus feet, but there are no reports on the use of this method in children with joint hypermobility due to a connective tissue disorders. Materials and methods. Eight patients (16 feet) with connective tissue disorders underwent surgical treatment for painful flexible flatfoot. Age ranged from 6 to 14 years (7 males, 1 female). The diagnosis of connective tissue disorder was made using the Brighton criteria, and the degree of hypermobility of the joints was evaluated by the Beighton score. The talocalcaneal angle, the calcaneal inclination angle, and talar-metatarsal angles were measured on radiographs taken before and after surgical treatment. Results of surgical treatment were assessed with the American Association of Foot and Foot Surgery scale (AOFAS) for the hindfoot, and statistical analysis was performed. Results. Joint hypermobility was diagnosed according to Beighton score: 8 points were registered in 1 patient, 7 — in 5 (48 %), and 6 points — in 2 individuals (42 %). All patients were pain-free after surgery. Based on the analysis of the X-ray of the foot before and after the surgical treatment, statistically significant improvements of the talo-metatarsal angle (р < 1.01 E–10), the calcaneal inclination angle (р < 3.39 E–11) and the talocalcaneal angle (р < 4.05893 E–11) were noted after surgical treatment. An excellent result on the AOFAS scale was obtained in 2 patients (25 %) and a good result — in 6 persons (75 %). Conclusions. A subtalar extra-articular screw arthroereisis is an appropriate choice for the treatment of flexible symptomatic flat foot in children with hypermobility syndromes, as it allows for effective correction of the deformity and improves pain and walking.
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