Arthroereisis For

Flat Foot
Cristian Ortiz, MD
Clinica U de Los Andes

Historic perspective Most of us saw that even though a good simptoms was
achieved in several patients, some did not obtained good
The word arthroereisis comes from “arthros” (joint) and “ereisis” anatomical correction and several showed lost of the implant
(support) , which nally means support for the joint. position.

NORMAL
1: Normal space between
the anterior lateral body of
the talus and calcaneus

2: Angle of Gissane

The rst description of a such a technique was published in

1946 by Chambers using a bone block in exible at feet in
adolescents.

It became more popular after Grice described in 1952 his

technique of an extra-articular arthrodesis of the subtalar joint
for the correction of paralytic at feet in children.

More recently, in 1970, it was Lelievre who describe the bone

block without arthrodesis in the correction of at feet.

A few year later (1977) Subotnick described the silicone implant

for the sinus tarsi. Figs: Shows loss of position of an arthoereisis of the sinus tarsi. The latest
advances in implant development more towards a tarsal canal implant that
Several implants were described for the sinus tarsi being “ the seems to produce better correction with less loss of positions compared with
implants in the sinus tarsi.
cup of Viladot “ (Kalix) being by far the most popular one. He
reported 99% of successful results in 234 children.

The technique for exible at feet in children and adolescents

How does it work?
becames popular in Europe, from where it spread out to the rest
Although there is no consensus about how or why it works, it
of the world, but interestingly enough it did not became
makes sense than since in blocks eversion and produces at the
popular in the United States until the last 20 years.
same time some sort of lengthening of the lateral column. By
this mechanism the implant produces correction in three
Myerson reported good results in 23 children but mentioned
planes, improving the arch, hindfoot valgus and abduction.
the need of removal in about 10% of cases without loss of
correction in follow up.
In some children´s hospitals a variation of the technique

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 Arthroereisis For Flat Foot
Cristian Ortiz, MD

became very popular because it was cheap and showed good For many years the major indication for arthroereisis was
results (“calcaneo stop”). In this technique a simple screw was exible at feet in children. But several authors noted good
inserted in the calcaneus leaving a prominent head facing the results with low morbidity and star ted to use it as
lateral process of the talus, so it could block eversion. A similar complementary technique in adult. So, some reports showed
technique has been describe using the screw in the lateral arthroereisis in combination with medial soft tissue
process of the talus instead of the calcaneus. reconstruction, medializing calcaneal osteotomy, tendon
tranfers, etc.

Some authors like Fernandez de Retana recommends

arthoereisis in adult with exible at feet.

Since morbidity related to the implant has been shown to be

mild, indication has been extended for more patient without a
clear limit in age.

Surgical technique:

Patient is in prone position. Local anesthesia and sedation is

enough for most patients.

A 2 centimeters transverse incision is made in the sinus tarsi.

Correct orientation of this canal is proved with a Ø1.8 Rounded
K Wire and its position check with X-rays.

A Cannulated Probe can be used to dilate the tarsal canal.

Then size of the implant is tested so it is able to be positioned in

the tarsal canal with its lateral part at the level of the lateral neck
of the talus. Then the implant is screwed in double checking the
nal position with X-rays.

Fig: “Calcaneo stop technique”.

Indications

Classical surgical indication for painful at feet that did not

respond to conservative treatment includes

1- Soft tissues: Tendon transfers, medial ligaments

reconstruction, achilles tendon lengthening, etc;

2- Osteotomies: calcaneal , lateral column lengthening, cotton,

etc; and

3- Arthrodesis triple and double.

Arthrodesis has been classically restricted for patient with

closed growth physis, and the other techniques have been used
in different combinations depending on patients conditions
and surgeons preferences.

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 Arthroereisis For Flat Foot
Cristian Ortiz, MD

Results

There is no level one evidence to prove how good this

technique is, but general experience among authors show that
indication is growing.

It has low morbidity with mild pain that typically forces the
patient to walk on the lateral side of the foot for a few days or
weeks. We allow them walk freely as tolerated and advice them
that they may go back to sports between 3 to 6 months and that
they might need implant removal if pain persist at the insertion
area.
Fig: Surgical technique showing small incision during implant insertion.
It has been interesting to see that patients do not seem to loose
correction in case of removal.

Fig: shows intraop X-rays insertion of ARTROM GMREIS arthroereisis screw.

Figs: preop pictures showing valgus, at arch and abduction.

Fig: shows intraop X-ray of ARTROM GMREIS arthroereisis screw in tarsal canal. Fig: post op pictures of the same patient showing correction.
Images cordially provided by Mohamed Albaqali, MD.

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 Arthroereisis For Flat Foot
Cristian Ortiz, MD

IMPLANTS

Code Description Qty Colour

241-70-12 Artrom – Arthroereisis Screw Ø7.0 mm 02

241-90-14 Artrom – Arthroereisis Screw Ø9.0 mm 02

241-100-14 Artrom – Arthroereisis Screw Ø10.0 mm 02

241-110-16 Artrom – Arthroereisis Screw Ø11.0 mm 02

241-120-16 Artrom – Arthroereisis Screw Ø12.0 mm 02

Fig : X-ray with tarsal canal implant in good position.

Summary

Arthroereisis has shown excellent results with minimal

morbidity, explaining why so many surgeons are using it more
and more with very happy patients.

Cristian Ortiz, MD

INSTRUMENTALS

Code Description Qty Colour

241-32 Ø1.8 x 310 mm Rounded K Wire 10

241-200 Artrom Cannulated Driver 01

241-300 Artrom Cannulated Probe 01

241-7012-T Artrom Cannulated Trial Ø7.0 mm 01

241-9014-T Artrom Cannulated Trial Ø9.0 mm 01

241-10014-T Artrom Cannulated Trial Ø10.0 mm 01

241-11016-T Artrom Cannulated Trial Ø11.0 mm 01

241-12016-T Artrom Cannulated Trial Ø12.0 mm 01

241-1000 Artrom Implants and Instruments Tray 01

References:
Chambers EF. An operation for the correction of exible at feet of adolescents. WestJ Surg Obstet Gynecol 1946;54:603–4.

Grice DS. An extra-articular arthrodesis of the subastragalar joint for correction of paralytic at feet in Children. J Bone Joint Surg Am 1952;34:927–40

Lelievre J. The valgus foot: current concepts and correction. Clin Orthop 1970;70:43–55.

Zaret DI, Myerson MS. Arthroereisis of the subtalar joint. Foot Ankle Clin North Am 2003;8:605–17

Needleman RL. Current topic review: subtalar arthroereisis for correction of exible atfoot. Foot Ankle Int 2005;26:336–46

Subotnick S. The subtalar joint lateral extra-articular arthroereisis: a follow-up report.J Am Podiatry Assoc 1977;32:27–33.

Arangio GA, Reinert KL, Salathe EP. A biomechanical model of the effect of subtalar arthroereisis on the adult exible at foot. Clin Biomech 2004;19:847–52.

Is There a Role for Subtalar Arthroereisis in the Management of Adult Acquired Flatfoot? Pablo Fernández de Retana, MDa,, Fernando Álvarez, MDGustavo Bacca, FAC 2012

The Calcaneo-Stop Procedure F.G. Usuelli, MD*, U. Al eri Montrasio, MD. FAC 2012

Magnan B, Baldrighi C, Papadia D. Flatfeet: comparison of surgical techniques.Result of study group into retrograde endorthesis with calcaneus-stop. Ital J Pediatr Orthop 1997;13:28–33.

Schon LC. Subtalar arthroereisis: a new exploration of an old concept. Foot Ankle Clin North Am 2007;12:329–39,

GMReis Educational Resources - Technical Report TR006 - Rev. 00 4-4