Background: While surgical stabilisation of the subtalar joint (arthroeresis) in children remains controversial in the USA, it is widely practised worldwide, with reportedly good outcomes. We are presenting a series of patients who met our criteria for calcaneal lengthening, but whose parents chose the less invasive option of talo-tarsal stabilisation (TTS). The goal of this surgery was to forestall or prevent hindfoot osteotomy.
Materials and methods: With IRB approval, we conducted this retrospective review of 32 patients (60 ft), who underwent TTS for flexible planovalgus deformity and had a minimum of 1-year follow-up. The aetiology was idiopathic for the majority, with a few being neurogenic or syndromic. The age range was 6–15 years; the younger patients had neuromuscular aetiology or underlying syndromes. Concomitant procedures included percutaneous Achilles lengthening (33 ft), Kidner (9 ft) and guided growth for ankle valgus (2).
Results: In the early post-immobilisation phase, peroneal spasm occurred in four patients (6 ft). This resolved with Botox injection in the peroneus brevis in three patients and required transfer of the peroneus brevis to the peroneus longus in one patient. At follow-up, ranging from 1 to 4.5 years, 50 implants (83.4%) were retained and the patients reported satisfactory outcomes. Henceforth, those patients will be monitored on a p.r.n. basis. Due to lingering discomfort, implants were repositioned in one and removed in five patients (10 ft = 16.6%). Upon further follow-up, these patients have not manifested recurrent deformity. Therefore, subsequent salvage by osteotomy and/or lengthening of the calcaneus has not been necessary.
Conclusion: TTS for the symptomatic flatfoot, combined with other procedures as indicated, offers advantages over the currently more accepted methods of medial shift osteotomy or calcaneal lengthening. The outcome at 1 year is a good forecast of whether or not further treatment will be required. This is a simpler and preferred option as compared to other methods of surgical management and, in our experience, has obviated the need for osteotomy or lengthening of the calcaneus.
Level of evidence: IV retrospective case series.
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