Mazzotti Antonio, Langone Laura, Zielli Simone Ottavio, Artioli Elena, Arceri Alberto, Brognara Lorenzo, Traina Francesco, Faldini Cesare
1st Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy.
Children (Basel). 2024 Jun 22;11(7):760. doi: 10.3390/children11070760.
Subtalar Arthroereisis (STA) is a surgical intervention for pediatric flexible flatfoot (PFF), primarily targeting hindfoot alignment by limiting excessive subtalar eversion. However, its effects on forefoot parameters remain underexplored. This study aims to investigate radiological changes following STA in pediatric patients.
A retrospective analysis was conducted on consecutive patients treated with STA for PFF. First ray-related angles, including the Hallux Valgus Angle (HVA) and the Intermetatarsal Angle (IMA), alongside hindfoot radiological parameters such as the Meary, Calcaneal Pitch, and Costa Bartani angles, were assessed. Subgroup analysis by gender was performed, and correlations between demographic and preoperative radiological parameters were examined.
Forty-one patients (81 feet) with an average age of 11.6 years were included, with a mean follow-up duration of 6.4 months. No significant differences were observed in first ray-related angles pre-and postoperatively, with the mean IMA changing from 7.97° to 7.18° and the mean HV angles changing from 9.51° to 8.66°. Noteworthy improvements were seen in flat foot angles, including the Meary, Calcaneal Pitch, and Costa Bartani angles, postoperatively. The age subgroup analysis revealed similar trends in IMA and HVA changes between Group A (who underwent surgery before peak growth) and Group B (who underwent surgery after peak growth). Higher preoperative angles tended to improve, while lower preoperative IMAs and HVAs tended to worsen postoperatively, all remaining within normal ranges.
STA showed positive radiological outcomes for PFF treatment, while negligible changes in first ray-related angles were observed. The age subgroup analysis indicated similar trends regardless of operation timing. Higher preoperative angles tended to improve, while lower preoperative angles tended to worsen postoperatively, despite all falling within non-pathological ranges. Further research is warranted to confirm this correlation.
距下关节制动术（STA）是一种针对小儿柔性扁平足（PFF）的外科手术干预，主要通过限制距下关节过度外翻来调整后足对线。然而，其对前足参数的影响仍未得到充分研究。本研究旨在调查小儿患者接受STA术后的影像学变化。
对连续接受STA治疗的PFF患者进行回顾性分析。评估了与第一跖骨相关的角度，包括拇外翻角（HVA）和跖间角（IMA），以及后足影像学参数，如Meary角、跟骨倾斜角和科斯塔·巴尔塔尼角。进行了性别亚组分析，并检查了人口统计学参数与术前影像学参数之间的相关性。
纳入41例患者（81只足），平均年龄11.6岁，平均随访时间6.4个月。术前和术后与第一跖骨相关的角度无显著差异，平均IMA从7.97°变为7.18°，平均HV角从9.51°变为8.66°。术后平足角度，包括Meary角、跟骨倾斜角和科斯塔·巴尔塔尼角有显著改善。年龄亚组分析显示，A组（在生长高峰期前接受手术）和B组（在生长高峰期后接受手术）在IMA和HVA变化方面有相似趋势。术前角度较高的往往有所改善，而术前IMA和HVA较低的术后往往恶化，所有这些仍在正常范围内。
STA在治疗PFF方面显示出积极的影像学结果，而与第一跖骨相关的角度变化可忽略不计。年龄亚组分析表明，无论手术时机如何，趋势相似。术前角度较高者往往改善，而术前角度较低者术后往往恶化，尽管所有这些都在非病理范围内。需要进一步研究来证实这种相关性。
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