الفهرس 
Comparative study between arthroereisis and combined arthroereisis with medial displacement calcaneal osteotomy for the management of planovalgus feet
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Abstract
Management of flatfoot is still a challenge for orthopaedic surgeons. With increasing interest in minimally invasive procedures and joint sparing techniques, arthroereisis has become widely accepted and popular. However, some aspects are still under question.
The aim of this study is to evaluate the functional and radiological outcomes of subtalar arthroereisis (STA) alone in comparison to combined STA/Medial Displacement Calcaneal Osteotomy (MDCO) in the management of symptomatic flexible pes planus.
Methods
A single-centre, prospective randomized control trial included 36 feet (30 patients), 19 feet in the STA group (group A) & 17 feet in the combined STA/MCDO group (group B). The study was conducted from October 2018 to November 2020. Functionally, patients were assessed by AOFAS scores. Radiographic evaluation included AP talo-first metatarsal, AP talo-calcaneal angles, the talar coverage percentage, calcaneal inclination angle, lateral talo-1st metatarsal and lateral talo-calcaneal angle.
Results
Pre-operative and one year follow-up score and angles were compared between both groups. This study showed improvement in all parameters of correction including AOFAS score and all foot angles in both groups. No statistically significant difference could be detected between both groups. However, the data showed statistically significant difference in each group when comparing pre-operative and one year follow-up score and angles (P value < 0.05). group B was superior in the power of correction in some parameters and showed statistically significant difference in the power of correction of calcaneal inclination angle, lateral talo-calcaneal angle and AP talo 1st metatarsal angles (P value < 0.05). The AOFAS score correlated positively with all the foot angles. The mean length of follow up period 15.22 ±4.77 months (range 12- 24 months). The most common complication was sinus tarsi pain, encountered in 4 feet (11.1%) and showed relatively lower rates in (group B) when combined with MDCO.
Conclusions
The combination of arthroereisis with MDCO showed satisfactory radiographic and functional outcomes and can be a valid option in the management of flexible pes planus in older children and adults, especially in moderate and severe deformities. When considering STA, proper patient selection, assessment and counselling are necessary to tailor the correct procedures and consider adjunct procedure if needed for each patient. Authors recommend STA alone is preferred in mild and moderate deformities while the combined STA/MDCO is preferred in severe deformity due to relatively higher corrective power and possible contribution to decrease the stresses over the arthroereisis implant.