Radiographic Changes and Recorded Complications After Nonabsorbable Endosinotarsal Screw Arthroereisis for Symptomatic Pediatric Flexible Flatfoot: A Retrospective Cohort Study
5 affiliations
- 1Orthopaedics and Traumatology Unit, Department of Surgery, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
- 2Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy
- 3Department of Orthopaedics and Traumatology, Policlinico Tor Vergata, 00133 Rome, Italy
- 4Faculty of Medicine and Surgery, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
- 5Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Abstract
Background: Subtalar arthroereisis is used for selected children with symptomatic flexible flatfoot that persists despite nonoperative management, but published evidence is limited by heterogeneous indications and frequent failure to account for bilateral observations. This study evaluated radiographic change and the complications recorded after nonabsorbable endosinotarsal screw arthroereisis. Methods: We retrospectively reviewed consecutive patients aged 8–15 years treated at a tertiary pediatric orthopedic center between 2018 and 2024. Eligible patients had symptomatic flexible planovalgus deformity, failure of at least 6 months of conservative treatment, isolated screw arthroereisis, and complete weight-bearing radiographs obtained preoperatively and at 12 months postoperatively. Meary’s angle, the Costa–Bertani angle, Kite’s angle, and calcaneal pitch were analyzed using linear mixed-effects models with repeated observations at the foot level nested within patients. Results: Seventy-four patients (141 feet) were included in the outcome analysis; 67 patients (90.5%) underwent bilateral procedures. Mean age was 11.5 ± 1.6 years, and radiographic outcomes were assessed at 12 months in all patients; mean clinical follow-up was 18.3 ± 3.7 months. Interobserver reliability was good to excellent. Meary’s angle decreased from 19.0° ± 8.5° to 7.7° ± 5.6° (p < 0.001). The Costa–Bertani angle decreased by 9.0° (p < 0.001), Kite’s angle by 5.5° (p < 0.001), and calcaneal pitch increased by 1.7° (95% CI, 1.0 to 2.4; Holm-adjusted p = 0.001). Sinus tarsi pain occurred in 13 patients (17.6%) and resolved conservatively in 11. Implant removal was required in two patients (2.7%), and one patient underwent reoperation for loss of correction (1.4%). No deep infection or neurovascular injury was recorded. Conclusions: Nonabsorbable endosinotarsal screw arthroereisis was associated with radiographic improvement at the standardized 12-month assessment. Major recorded adverse events and reoperations were uncommon among the patients with available follow-up, whereas residual sinus tarsi pain was recorded in approximately one in six patients, and the implant was not removed in 97.3% of patients. The postoperative mean values indicate partial correction rather than uniform radiographic normalization. Because patient-reported and functional outcomes were unavailable, clinical benefit cannot be inferred from angular changes alone.
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BibTeX
@article{salvatore2026radiographic,
title = {{Radiographic Changes and Recorded Complications After Nonabsorbable Endosinotarsal Screw Arthroereisis for Symptomatic Pediatric Flexible Flatfoot: A Retrospective Cohort Study}},
author = {Sergio De Salvatore and Costanzo Testa and Silvia Salera and Leonardo Oggiano and Edoardo Costici and Fabrizio Donati and Pier Luigi Maglione and Paolo Brigato and Rosa Russo and Pier Francesco Costici},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207950},
url = {https://www.mdpi.com/2077-0383/15/20/7950},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Radiographic Changes and Recorded Complications After Nonabsorbable Endosinotarsal Screw Arthroereisis for Symptomatic Pediatric Flexible Flatfoot: A Retrospective Cohort Study
AU - Sergio De Salvatore
AU - Costanzo Testa
AU - Silvia Salera
AU - Leonardo Oggiano
AU - Edoardo Costici
AU - Fabrizio Donati
AU - Pier Luigi Maglione
AU - Paolo Brigato
AU - Rosa Russo
AU - Pier Francesco Costici
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207950
UR - https://www.mdpi.com/2077-0383/15/20/7950
AB - Background: Subtalar arthroereisis is used for selected children with symptomatic flexible flatfoot that persists despite nonoperative management, but published evidence is limited by heterogeneous indications and frequent failure to account for bilateral observations. This study evaluated radiographic change and the complications recorded after nonabsorbable endosinotarsal screw arthroereisis. Methods: We retrospectively reviewed consecutive patients aged 8–15 years treated at a tertiary pediatric orthopedic center between 2018 and 2024. Eligible patients had symptomatic flexible planovalgus deformity, failure of at least 6 months of conservative treatment, isolated screw arthroereisis, and complete weight-bearing radiographs obtained preoperatively and at 12 months postoperatively. Meary’s angle, the Costa–Bertani angle, Kite’s angle, and calcaneal pitch were analyzed using linear mixed-effects models with repeated observations at the foot level nested within patients. Results: Seventy-four patients (141 feet) were included in the outcome analysis; 67 patients (90.5%) underwent bilateral procedures. Mean age was 11.5 ± 1.6 years, and radiographic outcomes were assessed at 12 months in all patients; mean clinical follow-up was 18.3 ± 3.7 months. Interobserver reliability was good to excellent. Meary’s angle decreased from 19.0° ± 8.5° to 7.7° ± 5.6° (p < 0.001). The Costa–Bertani angle decreased by 9.0° (p < 0.001), Kite’s angle by 5.5° (p < 0.001), and calcaneal pitch increased by 1.7° (95% CI, 1.0 to 2.4; Holm-adjusted p = 0.001). Sinus tarsi pain occurred in 13 patients (17.6%) and resolved conservatively in 11. Implant removal was required in two patients (2.7%), and one patient underwent reoperation for loss of correction (1.4%). No deep infection or neurovascular injury was recorded. Conclusions: Nonabsorbable endosinotarsal screw arthroereisis was associated with radiographic improvement at the standardized 12-month assessment. Major recorded adverse events and reoperations were uncommon among the patients with available follow-up, whereas residual sinus tarsi pain was recorded in approximately one in six patients, and the implant was not removed in 97.3% of patients. The postoperative mean values indicate partial correction rather than uniform radiographic normalization. Because patient-reported and functional outcomes were unavailable, clinical benefit cannot be inferred from angular changes alone.
SN - 2077-0383
ER -