SLR - February 2012 - Kylin Kovac
Reference: Kellerman P, Roth S, Goin K, Boda K., and Toth K. Arch Orthop Trauma Surg 131, 1363-7, 2011.
Scientific Literature Review
Reviewed by: Kylin Kovac, DPM
Residency Program: Detroit Medical Center
Podiatric Relevance:
Flexible flatfoot deformity is frequently encountered in the pediatric population. In recent literature there has been an increasing focus on the various implants and arthroeresis procedures used to correct this deformity. This article explores an alternative technique of placing a percutaneous screw through the sinus tarsi and into the body of the talus.
Methods:
Between August 2008 and January 2010, 43 calcaneo-stop procedures were performed on 25 patients with a mean age of 10 years at the time of surgery. The operative technique included percutaneous screw insertion (Bonestar, Instrumentaria PLC, Sesvete, Croatia) over a K-wire through the sinus tarsi and into the body of the talus aimed towards the apex of the dome of the talus. The large head of the specially designed screw remains within the sinus tarsi to provide a mechanical and proprioceptive stop to pronation. Mean follow up time was 9.7 months. Outcome measures include patient satisfaction rates, radiographic evaluation as well as a dynamic pedographic assessment using a force plate.
Results:
Patient satisfaction rates were reported as excellent in 33 feet (77 percent), good in 8 feet (19 percent) and poor in 2 feet (4 percent). Mean resting heel valgus position changed significantly from 13.4° to 2.8° (p< 0.05). Meary’s talo-first metatarsal angle on lateral radiographs changed significantly from 160.2° to 175.9° (p< 0.001). Pedographic force plate evaluation revealed significant decrease in total contact surface area as well as a shift in pressures from medial to lateral.
Conclusions:
The calcaneo-stop procedure is a simple and reliable method for correction of severe pediatric flexible flatfoot. The technique of anterograde screw insertion into the talus provides an alternative arthroeresis method with results similar to other techniques and devices.