Subtalar extra-articular screw arthroereisis: Early North American experience in a novel minimally invasive treatment for pediatric pes planovalgus

Abstract

ABSTRACT: Background: Most children and adolescents who have flexible pes planovalgus (PPV) are asymptomatic, however some have significant daily foot pain that limits their activities. Current acceptable treatment options are conservative measures or full foot reconstruction and at present there is no “middle ground” treatment in the United States. The Subtalar Extra-Articular Screw Arthroereisis (SESA) (aka “calcaneo-stop”) procedure offers a minimally invasive option for PPV correction, and is done commonly in Europe with satisfactory results. Its not clear why this procedure has not yet been widely adopted in North America. The purpose of this study was to assess early single surgeon experience and patient satisfaction in North America with the SESA for treatment of flexible PPV. Methods: A single-center tertiary care departmental database was queried retrospectively to identify patients who had undergone treatment for PPV with SESA correction from 2018–2022. Patients and their caregivers were surveyed cross-sectionally for patient satisfaction and functional outcomes. Demographic, clinical, radiologic, and outcome data were summarized by patient and by foot. Changes in radiographic measurements were assessed using paired t-tests. Results: Thirty-seven feet (51% female) with PPV treated with SESA correction in 20 patients were analyzed at an average of 12 months (8–21 mo) after surgery. Average patient age was 13.3 years (SD, 2.3; Range, 9.4–18.8) at surgery. Concomitant procedures were done in 20 feet (63%), including 12 Achilles lengthenings, 5 accessory navicular excisions, 2 medial distal femoral hemiepiphysiodesis, and 1 hallux valgus correction. Mean radiographic improvement was seen from preoperative to postoperative: (1) standing anterior-posterior (SAP) talus-1st metatarsal angle of 14.6 degrees (P < .001), (2) SAP navicular coverage angle of 23.4 degrees (P < .001) and (3) standing lateral talus-1st metatarsal angle of 10.1 degrees (P < .001). Overall patient satisfaction with the procedure was 90% and 94% of patients would recommend the procedure to others. Conclusions: The minimally invasive SESA procedure for treatment of pediatric PPV shows promising initial outcomes. Postoperatively, the procedure (1) produces foot function scores that are similar to the general pediatric population and (2) is extra-articular. The SESA procedure for treatment of PPV may be considered as an option for treatment of painful flexible PPV. Ongoing investigation is needed to further elucidate surgical indications, long-term patients reported outcomes, and radiographic changes. Key Concepts: 1) SESA (Subtalar Extra-Articular Screw Arthroereisis) is a minimally invasive treatment for pediatric pes planovalgus (PPV) with over two decades of success in Europe. 2) This initial cohort by the senior author shows promising results for SESA treatment of PPV in the United States. 3) Further study of SESA is needed to refine surgical indications and assess long-term outcomes. Level of Evidence: IV

Keywords

• Pes planovalgus
• Pediatric foot
• Calcaneo-stop
• Subtalar Extra-Articular Screw Arthroereisis