Complications of calcaneo-stop procedure in pediatric flexible flatfoot: a systematic review and meta-analysis

The calcaneo-stop procedure is a minimally invasive surgical technique widely used to treat symptomatic flexible flatfoot (FFF) in pediatric patients. Although generally considered safe, complication rates vary across studies, and no quantitative synthesis has specifically evaluated its adverse event profile. A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Five databases were searched up to May 2025. Studies reporting postoperative complications after calcaneo-stop in patients younger than 18 years were included. Pooled complication rates were calculated using random-effects models, with subgroup analyses based on age, sex, screw type, and diameter. Twenty-two studies involving 1777 patients and 3082 operated feet were included. The overall pooled complication rate was 7.97% (95% confidence interval: 5.96-9.97%). The most frequent complications were postoperative pain (2.79%), reintervention (2.27%), incision-site symptoms (2.23%), peroneal spasm (1.72%), screw breakage (1.42%), superficial infection (1.37%), and screw loosening (0.72%). Higher complication rates were observed in patients older than 13 years (15.84%; P < 0.001), in cortical screws (13.2%), and in screws greater than or equal to 4.5 mm in diameter (13.9%; P = 0.0019). Bioabsorbable screws and 6.5 mm implants showed the lowest complication rates. The calcaneo-stop procedure appears to be a safe and effective treatment for symptomatic pediatric FFF, with complication risk influenced by patient age and implant characteristics.