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Flexible flat foot correction by arthroereisis with subtalar screw in children treated at the "Dr Roberto Gilbert Elizalde" hospital

Abstract:

Objective: To describe the functional results, radiological degrees of improvement and complications presented when performing the technique of subtalar arthroereisis in patients with flexible flatfoot treated at the Hospital “Dr. Roberto Gilbert Elizalde “, Guayaquil, Ecuador. Methods: A descriptive, observational study was carried out in 86 patients selected intentionally from the Hospital “Dr. Roberto Gilbert Elizalde”, with the diagnosis of flexible flatfoot during 2016 and 2017. The technique of arthroereisis with first generation HyProCure® screw placed extraarticular in the subtalar joint to correct talotarsal displacement was used. Radiological assessment was made preoperatively and post-operatively in the dorso-plantar and lateral projections with load, with the objective of measuring the Costa Bartani, as-tragaline inclination, and calcaneal angles. Results: The patients overall age was 10.3±1.3 years (boys: 52.3%). The values of the Costa-Bartani angles pre and post arthroereisis were 149°±5° vs 126°±5° (p=0.02), for the ta-lar inclination angle (preoperative: 41°±7° vs postoperative: 24°±56°, p=0.04) and for calcaneal angulation (preoperative: 12°±5° vs postoperative: 15°±4°, p=0.55). Normal functionality was recovered at 3 months, the frequency of complications was 6.3% and these were fractures of the ankle joint, painful contracture of peroneal muscles and stress fractures of the fourth metatarsal bone. Conclusion: Subtalar arthroereisis is a promising technique for the correction of flexible flatfoot, as it is a fast, safe and showing adequate clinical-radiological improvement.