The arthroereisis procedure in adult flexible flatfoot grade IIA due to insufficiency of posterior tibial tendon

Background: To report on the functional, biomechanical, and radiographic results of patients who had undergone arthroereisis plus tensioning of the posterior tibial tendon for flexible flatfoot. The hypothesis is that arthroereisis associated to a tensioning of the posterior tibial tendon give a good correction with great satisfaction in patients with flexible flatfoot in grade IIA. Methods: We evaluated 29 patients (31 feet), mean age of 46.4 years, who had been surgically treated for adult flatfoot grade IIA according to Myerson. Mean follow-up was 34.15 months. For clinical evaluation, the AOFAS hindfoot and VAS-FA scores were used. Results: Postoperative results showed significant increases in both AOFAS and VAS-FA scores: 54.2-81.9 and 61.5-83.2 points, respectively. For the X-ray parameters, we observed a significant variation in the talo-first metatarsal angle, from 13.8 degrees in pre-op to 7.4 degrees in post-op. In lateral view, Djian Annonier angle was improved from 146.6 degrees to 134.1 degrees. The Meary's angle, compared to an average of 8.8 degrees in pre-operative stage improved to 4.3 degrees in the post-operative stage. Postoperative satisfaction was excellent-good according to 23 patients (79.4%). Pain in the tarsal sinus was reported in 5 out of 31 feet (16.1%) for the first three months after surgery. Conclusions: Arthroereisis and tensioning of the posterior tibial tendon provided good functional outcomes for patients under 60 years of age having stage IIA flexible flatfoot without arthritic manifestations. (C) 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.