# Clinical and radiographic efficacy of subtalar screw arthroereisis in the treatment of pediatric flexible flatfoot

## TL;DR

This study evaluates the effectiveness of subtalar screw arthroereisis in treating flexible flatfoot in children, finding it generally successful but with notable complications.

## Contribution

The study provides updated clinical and radiographic outcomes of subtalar screw arthroereisis in pediatric flexible flatfoot treatment.

## Key findings

- 96.31% of feet showed clinical improvement after subtalar screw arthroereisis.
- 83.33% of radiographic angular measurements showed significant correction, with the calcaneal pitch showing the strongest effect.
- 41.08% of cases experienced postoperative complications, mostly resolved non-surgically.

## Abstract

Subtalar arthroereisis has been reported to be an effective treatment technique for flexible flatfoot (FF) in children. Although many devices for this procedure exist, arthroereisis using screws is still globally used. Therefore, this study aims to revisit subtalar screw arthroereisis (SSA) and investigate its outcomes.

We retrospectively reviewed 353 flexible flatfeet in 178 pediatric patients who underwent SSA between 2007 and 2020. Clinical and radiological assessments were conducted pre-implantation and pre-explantation. Radiographic angles were measured to quantify correction. Statistical analyses included chi-squared tests and Student’s t-tests to evaluate clinical improvement and the impact of variables on outcomes.

The mean patient age at implantation was 11.96 years. 96.31% of feet showed clinical improvement postoperatively. Radiographic analysis demonstrated significant correction in most (83.33%) angular measurements, with the calcaneal pitch showing the strongest effect size. Postoperative complications occurred in 41.08% of FF, predominantly pain, and were mainly (84.13%) resolved with non-surgical treatment. 4.25% required implant revision, which was significantly more frequent in the younger age and female group.

SSA for treatment of FF in children showed favorable results regarding improved clinical aspects and radiographic measurements. Nevertheless, an accurate indication for surgical treatment is necessary.

Clinical retrospective research—Level III.

The online version contains supplementary material available at 10.1007/s00590-026-04669-2.