Conical talar screw arthroereisis for symptomatic flexible pediatric flatfoot correction: A prospective case series

Pediatric flatfoot is the most common foot deformity observed in clinical practice, and symptomatic pes planovalgus may require surgical intervention in selected cases, particularly after failure of conservative management. This study aimed to analyze the radiological and clinical efficacy of subtalar extra-articular arthroereisis with a conical talar screw in treating pediatric patients with symptomatic idiopathic flexible flatfoot.

This was a prospective case series conducted at a single teaching hospital. We recruited patients diagnosed with symptomatic flexible flatfoot who underwent surgical correction through subtalar arthroereisis with a conical talar screw. The study assessed surgery duration, patient satisfaction across multiple domains, pain, ability to walk without aids, resumption of sports activities, complications, and radiographic measurements.

A total of 160 feet in 80 patients were evaluated. The mean age at surgery was 12.1±1.4 years. The mean surgical time, which includes the bilateral procedure, was 21±6.9 minutes. The VAS pain score decreased from 7.0±1.9 to 0.8±1.3 at the six-month postoperative follow-up. The OxAFQ-C questionnaire, evaluated at 12 months follow-up, revealed an improvement in patients' subjective perception of their health status. We observed statistically significant improvements in all measured radiographic parameters, including the Costa-Bertani angle, talocalcaneal (Kite) angle, calcaneal pitch, and talar declination angle. Children started walking without aids 17.7±8 days after surgery and resumed physical and sports activities 42.5±15.4 days after surgery.

Conical talar screw arthroereisis is a fast and simple technique that allows simultaneous bilateral correction and is associated with favorable radiographic and clinical outcomes, with progressive weight bearing from the outset and early return to everyday activities.