SHORT-TERM EFFECTIVENESS OF Hyprocure SUBTALAR STABILIZATION IN TREATMENT OF ADOLESCENT FLEXIBLE FLATFOOT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FENGPin ¹ , LIJia ¹ , OUYANGXiangyu ¹ , GAOFeng ¹ ,  ZHANGHui ²

1. Department of Orthopedics, Tibetan Chengdu Office Branch Hospital of West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopedics, West China Hospital, Sichuan University;

Corresponding author：

ZHANGHui, Email: caesarzh@163.com

Keywords：

Subtalar stabilization; Adolescent; Flexible flatfoot; Short-term effectiveness

DOI：

10.7507/1002-1892.20160198

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Objective To evaluate the short-term effectiveness of Hyprocure subtalar stabilization for adolescent flexible flatfoot. Methods Between December 2013 and September 2015, 14 cases (26 feet) of adolescent flexible flatfoot were treated with Hyprocure subtalar stabilization. There were 10 males (18 feet) and 4 females (8 feet) with the average age of 14.5 years (range, 12-18 years). There were 12 cases (24 feet) of congenital flatfoot and 2 cases (2 feet) of flatfoot caused by neurological diseases. The preoperative pain visual analogue scale (VAS) was 4.2±0.4; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot function score was 72.2±12.3. Simple Hyprocure subtalar stabilization was used in 8 feet, and a combination of minimally invasive percutaneous Achilles tendon lengthening or gastrocnemius lysis, preposing of posterior tibial tendon and spring ligament tightening surgery, or open dorsal medial cuneiform osteotomy and bone graft in 18 feet. The VAS score and AOFAS ankle and foot function score were used to evaluate the effectiveness. The talus-the first metatarsal angle (T1MT), the talus-the second metatarsal angle (T2MT), and talonavicular coverage angle (TCA) were measured on the anteroposterior X-ray film; the Meary's angle, calcaneal inclination angle (CI), and the talar declination (TD) were measured on the lateral X-ray film. Results All incisions healed well. Two cases (2 feet) had tarsal sinus pain, which was cured after symptomatic treatment. All patients were followed up 5-24 months (mean, 14.5 months). Pain was obviously relieved. At last follow-up, VAS score was significantly decreased to 1.4±0.3 (t=27.676, P=0.000). AOFAS ankle and foot function score was significantly increased to 94.5±10.8 (t=7.765, P=0.000). The postoperative X-ray film showed that medial arch was elevated after the Hyprocure subtalar stabilization was placed in tarsal sinus. At last follow-up, the T1MT, T2MT, TCA, Meary's angle, and TD were significantly improved when compared with preoperative ones (P < 0.05); CI has no significant improvement (t=0.109, P=0.598). Conclusion Hyprocure subtalar stabilization is simple, effective for adolescent flexible flatfoot, the short-term effectiveness is good. But the indications should be strictly controlled, treatment should be individualized, corresponding auxiliary soft tissue and bone surgery is needed. The long-term effectiveness needs further follow-up.

Citation： FENGPin, LIJia, OUYANGXiangyu, GAOFeng, ZHANGHui. SHORT-TERM EFFECTIVENESS OF Hyprocure SUBTALAR STABILIZATION IN TREATMENT OF ADOLESCENT FLEXIBLE FLATFOOT. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(8): 975-979. doi: 10.7507/1002-1892.20160198 Copy

1.	Fabry G. Clinical practice. Static, axial, and rotational deformities of the lower extremities in children. Eur J Pediatr, 2010, 169(5):529-534.
2.	Harris EJ, Vanore JV, Thomas JL, et al. Diagnosis and treatment of pediatric flatfoot. J Foot Ankle Surg, 2004, 43(6):341-373.
3.	Lin CJ, Lai KA, Kuan TS, et al. Correlating factors and clinical significance of flexible flatfoot in preschool children. J Pediatr Orthop, 2001, 21(3):378-382.
4.	Evans AM, Rome K. A Cochrane review of the evidence for nonsurgical interventions for flexible pediatric flat feet. Eur J Phys Rehab Med, 2011, 47(1):69-89.
5.	Abolarin T, Aiyegbusi A, Tella A, et al. Predictive factors for flatfoot:The role of age and footwear in children in urban and rural communities in South West Nigeria. Foot (Edinb), 2011, 21(4):188-192.
6.	Labovitz JM. The algorithmic approach to pediatric flexible pes planovalgus. Clin Podiatr Med Surg, 2006, 23(1):57-76.
7.	Kwon JY, Myerson MS. Management of the flexible flat foot in the child:a focus on the use of osteotomies for correction. Foot Ankle Clin, 2010, 15(2):309-322.
8.	De Pellegrin M, Moharamzadeh D, Strobl WM, et al. Subtalar extraarticular screw arthroereisis (SESA) for the treatment of flexible flatfoot in children. J Child Orthop, 2014, 8(6):479-487.
9.	Jerosch J, Schunck J, Abdel-Aziz H. The stop screw technique-a simple and reliable method in treating flexible flatfoot in children. Foot Ankle Surg, 2009, 15(4):174-178.
10.	Bandholm T, Boysen L, Haugaard S, et al. Foot medial longitudinalarch deformation during quiet standing and gait in subjects with medial tibial stress syndrome. J Foot Ankle Surg, 2008, 47(2):89-95.
11.	Shultz SJ, Nguyen AD, Levine BJ. The relationship between lower extremity alignment characteristics and anterior knee joint laxity. Sports Health, 2009, 1(1):54-60.
12.	Bowman GD. New concepts in orthotic management of the adult hyperpronated foot:preliminary findings. J Prosthet Orthot, 1997, 9(2):77-81.
13.	Sobel E, Levitz SJ, Caselli MA. Orthoses in the treatment of rearfoot problems. J Am Podiatr Med Assoc, 1999, 89(5):220-233.
14.	Butler MT. Tibialis posterior dysfunction. Aus J Podiatr Med, 2003, 37:35-42.
15.	Zaw H, Calder JD. Operative management options for symptomatic flexible adult acquired flatfoot deformity:a review. Knee Surg Sports Traumatol Arthrosc, 2010, 18(2):135-142.
16.	Wenger DR, Leach J. Foot deformities in infants and children. Pediatr Clin North Am, 1986, 33(6):1411-1427.
17.	Jane MacKenzie A, Rome K, Evans AM. The efficacy of nonsurgical interventions for pediatric flexible flat foot:a critical review. J Pediatr Orthop, 2012, 32(8):830-834.
18.	Catanzariti AR, Mendicino RW, Saltrick KR, et al. Subtalar joint arthrodesis. J Am Podiatr Med Assoc, 2005, 95(1):34-41.
19.	Easley ME, Trnka HJ, Schon LC, et al. Isolated subtalar arthrodesis. J Bone Joint Surg (Am), 2000, 82(5):613-624.
20.	Vora AM, Tien TR, Parks BG, et al. Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer. J Bone Joint Surg (Am), 2006, 88(8):1726-1734.
21.	Addante JB, Chin MW, Loomis JC, et al. Subtalar joint arthroereisis with SILASTIC silicone sphere:a retrospective study. J Foot Surg, 1992, 31(1):47-51.
22.	Graham ME, Jawrani NT, Chikka A. Extraosseous talotarsal stabilization using HyProCure^® in adults:a 5-year retrospective follow-up. J Foot Ankle Surg, 2012, 51(1):23-29.
23.	Graham ME, Parikh R, Goel V, et al. Stabilization of joint forces of the subtalar complex via HyProCure sinus tarsi stent. J Am Podiatr Med Assoc, 2011, 101(5):390-399.
24.	Graham ME, Jawrani NT, Goel VK. Evaluating plantar fascia strain in hyperpronating cadaveric feet following an extra-osseous talotarsal stabilization procedure. J Foot Ankle Surg, 2011, 50(6): 682-686.
25.	Graham ME, Jawrani NT, Goel VK. Effect of extra-osseous talotarsal stabilization on posterior tibial nerve strain in hyperpronating feet:a cadaveric evaluation. J Foot Ankle Surg, 2011, 50(6):672-675.
26.	Graham ME, Jawrani NT, Goel VK. Effect of extra-osseous talotarsal stabilization on posterior tibial tendon strain in hyperpronating feet. J Foot Ankle Surg, 2011, 50(6):676-681.
27.	Graham ME, Jawrani NT. Extraosseous talotarsal stabilization devices:a new classification system. J Foot Ankle Surg, 2012, 51(5): 613-619.
28.	Crawford AH, Kucharzyk D, Roy DR, et al. Subtalar stabilization of planovalgus foot by stable arthroereisis in young children who have neuromuscular problems. J Bone Joint Surg (Am), 1990, 72(6):840-845.
29.	Yagerman SE, Cross MB, Positano R, et al. Evaluation and treatment of symptomatic pes planus. Curr Opin Pediatr, 2011, 23(1):60-67.
30.	Herrera-Soto JA. Pediatric foot and ankle disorders. Curr Opin Orthop, 2004, 15(6):417-422.
31.	Carranza A, Gimeno V, Gomez JA, et al. Giannini's prosthesis in the treatment of juvenile flatfoot. J Foot Ankle Surg, 2000, 6:11-17.
32.	Bohay DR, Anderson JG. Stage IV posterior tibial tendon insufficiency:the tilted ankle. Foot Ankle Clin, 2003, 8(3):619-636.
33.	Harris EJ. The natural history and pathophysiology of flexible flatfoot. Clin Pod Med Surg, 2012, 27(1):1-23.
34.	Graham ME, Chikka A, Jones PC. Validation of the talar-second metatarsal angle as a standard measurement for radiographic evaluation. J Am Podiatr Med Assoc, 2011, 101(6):475-483.
35.	Graham ME, Jawrani NT, Chikka A, et al. Surgical treatment of hyperpronation using an extraosseous talotarsal stabilization device: radiographic outcomes in 70 adult patients. J Foot Ankle Surg, 2012, 51(5):548-555.
36.	Forg P, Feldman K, Flake E, et al. Flake-Austin modification of the STA-Peg arthroereisis:a retrospective study. J Am Podiatr Med Assoc, 2001, 91(8):394-405.
37.	Cicchinelli LD, Pascual Huerta J, García Carmona FJ, et al. Analysis of gastrocnemius recession and medial column procedures as adjuncts in arthroereisis for the correction of pediatric pes planovalgus:a radiographic retrospective study. J Foot Ankle Surg, 2008, 47(5):385-391.
38.	Nelson SC, Haycock DM, Little ER. Flexible flatfoot treatment with arthroereisis:radiographic improvement and child health survey analysis. J Foot Ankle Surg, 2004, 43(3):144-155.

1. Fabry G. Clinical practice. Static, axial, and rotational deformities of the lower extremities in children. Eur J Pediatr, 2010, 169(5):529-534.
2. Harris EJ, Vanore JV, Thomas JL, et al. Diagnosis and treatment of pediatric flatfoot. J Foot Ankle Surg, 2004, 43(6):341-373.
3. Lin CJ, Lai KA, Kuan TS, et al. Correlating factors and clinical significance of flexible flatfoot in preschool children. J Pediatr Orthop, 2001, 21(3):378-382.
4. Evans AM, Rome K. A Cochrane review of the evidence for nonsurgical interventions for flexible pediatric flat feet. Eur J Phys Rehab Med, 2011, 47(1):69-89.
5. Abolarin T, Aiyegbusi A, Tella A, et al. Predictive factors for flatfoot:The role of age and footwear in children in urban and rural communities in South West Nigeria. Foot (Edinb), 2011, 21(4):188-192.
6. Labovitz JM. The algorithmic approach to pediatric flexible pes planovalgus. Clin Podiatr Med Surg, 2006, 23(1):57-76.
7. Kwon JY, Myerson MS. Management of the flexible flat foot in the child:a focus on the use of osteotomies for correction. Foot Ankle Clin, 2010, 15(2):309-322.
8. De Pellegrin M, Moharamzadeh D, Strobl WM, et al. Subtalar extraarticular screw arthroereisis (SESA) for the treatment of flexible flatfoot in children. J Child Orthop, 2014, 8(6):479-487.
9. Jerosch J, Schunck J, Abdel-Aziz H. The stop screw technique-a simple and reliable method in treating flexible flatfoot in children. Foot Ankle Surg, 2009, 15(4):174-178.
10. Bandholm T, Boysen L, Haugaard S, et al. Foot medial longitudinalarch deformation during quiet standing and gait in subjects with medial tibial stress syndrome. J Foot Ankle Surg, 2008, 47(2):89-95.
11. Shultz SJ, Nguyen AD, Levine BJ. The relationship between lower extremity alignment characteristics and anterior knee joint laxity. Sports Health, 2009, 1(1):54-60.
12. Bowman GD. New concepts in orthotic management of the adult hyperpronated foot:preliminary findings. J Prosthet Orthot, 1997, 9(2):77-81.
13. Sobel E, Levitz SJ, Caselli MA. Orthoses in the treatment of rearfoot problems. J Am Podiatr Med Assoc, 1999, 89(5):220-233.
14. Butler MT. Tibialis posterior dysfunction. Aus J Podiatr Med, 2003, 37:35-42.
15. Zaw H, Calder JD. Operative management options for symptomatic flexible adult acquired flatfoot deformity:a review. Knee Surg Sports Traumatol Arthrosc, 2010, 18(2):135-142.
16. Wenger DR, Leach J. Foot deformities in infants and children. Pediatr Clin North Am, 1986, 33(6):1411-1427.
17. Jane MacKenzie A, Rome K, Evans AM. The efficacy of nonsurgical interventions for pediatric flexible flat foot:a critical review. J Pediatr Orthop, 2012, 32(8):830-834.
18. Catanzariti AR, Mendicino RW, Saltrick KR, et al. Subtalar joint arthrodesis. J Am Podiatr Med Assoc, 2005, 95(1):34-41.
19. Easley ME, Trnka HJ, Schon LC, et al. Isolated subtalar arthrodesis. J Bone Joint Surg (Am), 2000, 82(5):613-624.
20. Vora AM, Tien TR, Parks BG, et al. Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer. J Bone Joint Surg (Am), 2006, 88(8):1726-1734.
21. Addante JB, Chin MW, Loomis JC, et al. Subtalar joint arthroereisis with SILASTIC silicone sphere:a retrospective study. J Foot Surg, 1992, 31(1):47-51.
22. Graham ME, Jawrani NT, Chikka A. Extraosseous talotarsal stabilization using HyProCure^® in adults:a 5-year retrospective follow-up. J Foot Ankle Surg, 2012, 51(1):23-29.
23. Graham ME, Parikh R, Goel V, et al. Stabilization of joint forces of the subtalar complex via HyProCure sinus tarsi stent. J Am Podiatr Med Assoc, 2011, 101(5):390-399.
24. Graham ME, Jawrani NT, Goel VK. Evaluating plantar fascia strain in hyperpronating cadaveric feet following an extra-osseous talotarsal stabilization procedure. J Foot Ankle Surg, 2011, 50(6): 682-686.
25. Graham ME, Jawrani NT, Goel VK. Effect of extra-osseous talotarsal stabilization on posterior tibial nerve strain in hyperpronating feet:a cadaveric evaluation. J Foot Ankle Surg, 2011, 50(6):672-675.
26. Graham ME, Jawrani NT, Goel VK. Effect of extra-osseous talotarsal stabilization on posterior tibial tendon strain in hyperpronating feet. J Foot Ankle Surg, 2011, 50(6):676-681.
27. Graham ME, Jawrani NT. Extraosseous talotarsal stabilization devices:a new classification system. J Foot Ankle Surg, 2012, 51(5): 613-619.
28. Crawford AH, Kucharzyk D, Roy DR, et al. Subtalar stabilization of planovalgus foot by stable arthroereisis in young children who have neuromuscular problems. J Bone Joint Surg (Am), 1990, 72(6):840-845.
29. Yagerman SE, Cross MB, Positano R, et al. Evaluation and treatment of symptomatic pes planus. Curr Opin Pediatr, 2011, 23(1):60-67.
30. Herrera-Soto JA. Pediatric foot and ankle disorders. Curr Opin Orthop, 2004, 15(6):417-422.
31. Carranza A, Gimeno V, Gomez JA, et al. Giannini's prosthesis in the treatment of juvenile flatfoot. J Foot Ankle Surg, 2000, 6:11-17.
32. Bohay DR, Anderson JG. Stage IV posterior tibial tendon insufficiency:the tilted ankle. Foot Ankle Clin, 2003, 8(3):619-636.
33. Harris EJ. The natural history and pathophysiology of flexible flatfoot. Clin Pod Med Surg, 2012, 27(1):1-23.
34. Graham ME, Chikka A, Jones PC. Validation of the talar-second metatarsal angle as a standard measurement for radiographic evaluation. J Am Podiatr Med Assoc, 2011, 101(6):475-483.
35. Graham ME, Jawrani NT, Chikka A, et al. Surgical treatment of hyperpronation using an extraosseous talotarsal stabilization device: radiographic outcomes in 70 adult patients. J Foot Ankle Surg, 2012, 51(5):548-555.
36. Forg P, Feldman K, Flake E, et al. Flake-Austin modification of the STA-Peg arthroereisis:a retrospective study. J Am Podiatr Med Assoc, 2001, 91(8):394-405.
37. Cicchinelli LD, Pascual Huerta J, García Carmona FJ, et al. Analysis of gastrocnemius recession and medial column procedures as adjuncts in arthroereisis for the correction of pediatric pes planovalgus:a radiographic retrospective study. J Foot Ankle Surg, 2008, 47(5):385-391.
38. Nelson SC, Haycock DM, Little ER. Flexible flatfoot treatment with arthroereisis:radiographic improvement and child health survey analysis. J Foot Ankle Surg, 2004, 43(3):144-155.

Chinese Journal of Reparative and Reconstructive Surgery

SHORT-TERM EFFECTIVENESS OF Hyprocure SUBTALAR STABILIZATION IN TREATMENT OF ADOLESCENT FLEXIBLE FLATFOOT

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