Forefoot morphology change following subtalar arthroereisis for symptomatic flexible flatfoot in children.

BACKGROUND

When symptomatic pediatric flexible flatfoot treated with subtalar arthroereisis to improve hindfoot alignment, the postoperative forefoot supinatus can be a concern.

METHODS

We retrospectively reviewed 110 patients (220 feet), ages 5-12, who underwent subtalar arthroereisis from January 2017 to December 2019, with at least two years of follow-up. Of these, 22 patients (44 feet) developed forefoot supinatus with metatarsus primus elevatus (MPE). Radiographic evaluations assessed postoperative forefoot supinatus, calcaneus and talus height. Functional outcomes were measured using the modified American Orthopaedic Foot & Ankle Society (AOFAS) Forefoot Score.

RESULTS

Improvements in forefoot supinatus were seen over time, with self-correction typically occurring around 6-7 months post-surgery. Bone growth positively influenced symptom relief, while demographic factors had minimal impact. The modified AOFAS score also improved.

CONCLUSION

Forefoot supinatus and MPE following subtalar arthroereisis tend to self-correct over several months, aligning with pediatric foot bone growth.

LEVEL OF EVIDENCE: III.