Adult flat foot reconstruction using arthroereisis

A.C. Peek, F. Malagelada, C. Clark

Introduction: The use of an arthroereisis screw is well described in the paediatric population for the correction of flexible flat feet. In this study, we aimed to evaluate the functional and radiographic results when a subtalar arthroereisis screw was used to augment reconstruction in adult patients with Posterior Tibialis Tendon insufficiency (PTTI).

Materials and methods: We included 23 feet with stage 2 PTTI that underwent flexor digitorum longus transfer, reefing of the spring ligament, translational medialising calcanaeal osteotomy and augmentation with arthroereisis screw (Kalix, Integra). In all cases the screw was removed 6 months later. Functional and radiographic values were assessed pre- and post-operatively at a minimum of 1 year follow-up.

Results: The mean age of patients at operation was 58 years. The calcaneal pitch was raised, Meary's angle decreased, the medial cuneiform height increased and the talonavicular coverage angle improved post-operatively compared to pre-operative measurements (p< 0.05). The Manchester Oxford Foot Questionnaire, EQ-5D and VAS scores for pain improved in all cases post-operatively when compared to pre-operatively (p< 0.05).

Conclusion: We conclude that the use of an arthroereisis screw is a promising adjunct to conventional reconstruction in adult PTTI that protects the corrective surgery during the initial healing time of the soft tissues. Excellent radiological and functional results were obtained in our series.