Use of the Arthrex ProStop Subtalar Arthroeresis Screw in the Management of Symptomatic Paediatric Flexible Flatfoot

Introduction: Paediatric flexible flatfoot (PFFF) is a common, potentially debilitating condition affecting a significant proportion of active children. Despite its prevalence, there is a lack of consensus on optimal operative management in symptomatic children. We report a unique case series of six feet treated with the Arthrex ProStop Subtalar Arthroeresis Screw (Arthrex, UK) in the North West of England.

Methods: Following a comprehensive review of available literature, we performed a retrospective study of six feet (four patients, aged 11-15 years, including one female and one male with bilateral disease) managed with the Arthrex ProStop Subtalar Arthroeresis Screw from 2019 to 2023. Radiographic and clinical findings pre- and post-operatively were compared with a two-year follow-up.

Results: Post-operative radiographs demonstrated an increase in calcaneal pitch, an average of a 17.6° improvement in Meary's angles and a reduction in talonavicular joint uncoverage. Clinical improvement was seen in both stance and heel valgus. The intervention resulted in improved patient satisfaction in all. In this series, there were no infections. However, one implant was removed at 14 months due to persistent pain. All remaining screws were removed at two years due to a lack of research into the long-term outcomes of the device in paediatric patients.

Conclusions: This study highlights that subtalar arthroereisis is an effective surgical management option for treating PFFF in adolescents, with limited available literature. Further, large-scale comparative studies with long-term follow-up are required to delineate the true benefit of this procedure.