SLR - October 2015 - Joseph Genualdi
Reference: Chong DY, Macwilliams BA, Hennessey TA, Teske N, Stevens PM. Prospective Comparison of Subtalar Arthroereisis with Lateral Column Lengthening for Painful Flatfeet. J Pediatr Orthop B. 2015 Jul; 24(4):345-53.Scientific Literature Review
Reviewed By: Joseph Genualdi, DPM
Residency Program: University Hospital- Newark, NJ
Podiatric Relevance: Surgical correction of symptomatic pediatric pes planovalgus is a frequently encountered pathology and requires an experienced surgeon to perform a thorough examination of the patient’s subjective complaints, biomechanics, gait and radiography. The authors’ purpose of the study was to evaluate two different surgical treatment options for symptomatic pes planovalgus: lateral column lengthening and subtalar arthroereisis. The authors hypothesized that both surgical procedures would produce similar results and both groups would experience significant improvement in outcomes.
Methods: There were a total of 15 patients enrolled for a total of twenty-four feet. The mean age of the subjects was 12.8 years. Inclusion criteria were patients with painful pes planovalgus whom failed conservative treatment of at least six months. Exclusion criteria were patients with neuromuscular disorders and subjects unable to follow directions for gait lab study. The subjects were evaluated preoperatively and postoperatively with use of kinematics, pedobarography, radiographic measurements and subjective measures with the use of the Oxford Foot and Ankle Score.
Results: The authors reported statistically significant decreases in postoperative lateral talocalcaneal angle, AP and lateral talo-first metatarsal angle, and AP talonavicular coverage. Both groups showed clinically significant improvement in hindfoot and midfoot motion. Both groups also showed a statistically significant lateralization of both the hindfoot and midfoot center of pressure measurements. The Oxford foot and ankle scores had reached or approached statistically significant improvements for both groups.
Conclusions: The authors concluded that there were no significant changes seen between the two groups to recommend one over the other. However, in the authors’ opinion, lateral column lengthening should be utilized for patients with significant transverse plane deformity. In comparison, the authors believe that arthroereisis has the benefit of faster recovery and less morbidity.
Aside from having a small sample size, it is my opinion that the indication for these two procedures is separate and should not be compared. In treating symptomatic flatfeet, surgical procedures should be selected on planal dominance. In addition, these procedures are infrequently performed in isolation. The only radiograph provided for the arthroereisis group had significant transverse and sagittal plane deformity. Additionally, the authors failed to provide calcaneal axial imaging for evaluation of frontal plane deformity, which is the primary plane indicated for any talocalcaneal implant. Surgical management of symptomatic pes planovalgus can be challenging, selecting the appropriate procedures can avoid complications and improve overall outcomes.