Treat flat feet: Should you consider subtalar arthroereisis? 

Pediatrician working with a patient with flat feet

Subtalar arthroereisis has emerged as a minimally-invasive, effective treatment of flat foot. It’s low-risk in the pediatric population, and effective on its own or with other treatments. 

What is flat foot?

Also called fallen arches, flat foot is a condition in which the sole lies on the floor when the foot touches the floor. Common during childhood, a flat foot usually disappears as a child develops arches. No pain is associated with it, so if you develop pain, you should see a doctor.

How does subtalar arthroereisis fix a flat foot?

Subtalar arthroereisis is surgery to treat flat feet in children prior to completing their skeletal growth. It is accomplished by placing an implant in the sinus tarsi. It can help normalize the foot by stabilizing the subtalar joint. It blocks forward, downward, and medial talus displacement.

The talus is a bone and the main connector between the foot and leg. It helps transfer weight and pressure across the ankle joint.

By blocking talus displacement, subtalar arthroereisis implants limit excessive hindfoot motion. The procedure can be part of a plan of corrective measures that often includes:

  • Gastroc or Achilles lengthening

Advantages of subtalar 

Subtalar Arthroereisis is a minimally invasive surgery that hopefully prevents further surgery as an adult. . This makes it easy and quick, without significant risk. of nonunion or malunion. Nonunion is when a fractured bone fails to heal over time. Malunion is when a fractured bone heals abnormally, which can impair function and affect appearance.

There is no risk of damaging the medial neurovascular structures and the sural nerve with this procedure. Neurovascular structures are where the function and structure of the nervous and vascular systems combine. The sural nerve provides sensation to the skin on the back and side of the lower leg. It also provides sensation to the back of the foot, heel, and ankle.

This procedure requires less time for a patient to remain immobile and non-weight bearing. Recovery time is shorter as a result.

When is subtalar arthroereisis recommended?

It’s recommended for children only if the feet don’t correct on their own or are symptomatic. Symptoms that might warrant surgery include:

  • Cramps
  • Difficulty playing sports or walking on uneven surfaces
  • Fatigue
  • Pain

Most physicians won’t normally suggest surgery unless the patient meets certain criteria:

  • Flat foot without improvement after aggressive conservative care. 
  • Hindfoot valgus greater than 10 degrees
  • Pathologic X-ray measurements
  • Shortness of the Achilles 

Hindfoot valgus happens when the mid-calcaneal axis deviates from the body’s midline. The mid-calcaneal axis is a line through two points in the calcaneus, or the heel bone.

Visit Wilmington Health for TRUE Care in orthopaedic medicine

Wilmington Health’s Dr. Sharrona Williams performs subtalar arthroereisis and is passionate about it. She is part of an excellent team in our Orthopaedic and Sports Medicine Department. You can learn more about this and other foot surgeries from our specialists online.

Visit our Orthopaedic and Sports Medicine Department