Surgical Treatment of Flexible Flatfoot in Children
A Four-Year Follow-up Study
Sandro Giannini, MD; Francesco Ceccarelli, MD; Maria Grazia Benedetti, MD; Fabio Catani, MD; Cesare Faldini, MD


Flexible flatfoot in children is one of the most common disorders in orthopaedics1,2. Despite numerous papers published in the literature, the definition and etiology of flexible flatfoot; the level of disability that it may cause; and the opportunity for, appropriate time of, and efficacy of its treatment are still open to debate3,4. In fact, if the foot is only morphologically flat, characterized by a lower medial arch and a broadening of the footprint, it can be well tolerated throughout the person’s life. If, however, the foot is also functionally flat—that is, a foot that during weight-bearing and walking stays in a prevalent or persistent pronation—can cause secondary problems5,6.

Functional Consequences

Persistent pronation of the subtalar joint during the propulsive phase of gait is mostly responsible for major deformities in adult life7. Hallux valgus, metatarsalgia, tarsal tunnel syndrome, posterior tibial tendon dysfunction, and osteoarthritis of the subtalar and midtarsal joints are often the consequences and the “natural history” of this deformity8,9.

In order to avoid these problems, surgical correction of the deformity during growth is recommended10. The goal of surgical treatment is to correct the subtalar pronation, thereby restoring the appropriate relationship between the talus and the calcaneus11. The procedures that have been described are arthrodesis, osteotomy, and arthroereisis1,2,8,11,12. While arthrodesis is indicated in adults with degenerative changes in the subtalar joint, osteotomy and arthroereisis are the two principal options for children9.

Aim of the Study

The aim of this study was to evaluate the outcomes four years after correction of flexible flatfoot, in growing children, with arthroereisis of the subtalar joint with use of a bioreabsorbable implant made of poly-l-lactic acid (PLLA) …

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