# Comparing the clinical outcomes of arthroereisis and osteotomy in the treatment of paediatric patients with idiopathic flexible pes planus: a systematic review and meta-analysis

## TL;DR

This study compares two surgical treatments for flat feet in children, finding that both improve outcomes but differ in specific corrections and complications.

## Contribution

The paper provides a systematic review and meta-analysis comparing arthroereisis and osteotomy for idiopathic flexible pes planus in children.

## Key findings

- Osteotomy showed greater radiographic correction of calcaneal inclination and hindfoot valgus.
- Arthroereisis provided better restoration of the lateral longitudinal arch and forefoot adduction.
- Both procedures resulted in similar functional improvements and complication rates.

## Abstract

Both subtalar arthroereisis and osteotomies are well-recognised surgical reconstructive options for paediatric pes planus deformity. We compared the clinical and radiographic outcomes of subtalar arthroereisis versus osteotomies in the surgical management of symptomatic idiopathic flexible pes planus in paediatric patients 2–18 years old. Specifically, we evaluated changes in key radiographic parameters and validated patient-reported outcome measures, as well as complications, to determine relative efficacy and safety.

Electronic databases (PubMed, Embase, and The Cochrane Library) were searched from inception through August 23, 2024, following PRISMA guidelines. We reviewed studies involving patients aged 18 years or younger with idiopathic pes planus. The inclusion criteria encompassed all types of osteotomy procedures and subtalar arthroereisis, including both exosinotarsal (screw-type) and endosinotarsal (spacer-type) techniques. A random-effects meta-analysis was conducted to assess unweighted mean differences for radiographic angles and AOFAS scores.

Sixty studies (4,555 feet) were included: 46 arthroereisis (4,089 feet), 15 osteotomy (448 feet), and 1 combined (18 feet). Osteotomy demonstrated greater radiographic improvement in AP Meary’s angle (MD − 12.7 degrees vs. − 9.8 degrees; p < .0001), calcaneal pitch (MD 11.1 degrees vs. 4.1 degrees; p < .0001), and Kite’s angle (MD − 11.7 degrees vs. − 6.8 degrees; p < .0001). Arthroereisis achieved superior correction of lateral Meary’s (MD − 11.7 degrees vs. − 10.1 degrees; p < .0001), lateral Kite’s (MD − 7.1 degrees vs. − 4.2 degrees; p < .0001), and talonavicular coverage (MD − 15.6 degrees vs. − 12.7 degrees; p < .0001). Post-operative AOFAS improvements were similar (MD 29.2 vs. 26.4). Overall complication rates were 9.2% for arthroereisis (predominantly sinus tarsi pain) and 10.5% for osteotomy (primarily infections).

While osteotomy yields greater correction of calcaneal inclination and hindfoot valgus, subtalar arthroereisis provides superior restoration of the lateral longitudinal arch and forefoot adduction. Despite these radiographic differences, both techniques provide equivalent functional gains. Due to its minimally invasive nature and favorable safety profile, arthroereisis is a viable first-line option, while osteotomy remains essential for correcting severe structural calcaneal pathology.