• “Collapsing” pes planovalgus or flexible flatfoot is a complex pedal pathological condition with numerous components. In its most significant form, the condition can lead to pain and an inability to walk efficiently.
  • Arthroesis is defined as the limitation of exogenous joint motion without complete arthrodesis or fusion. This procedure, which involves placing a motion blocking implant within the sinus tarsi, has been designed to restrict excessive subtalar joint (STJ) pronation while preserving supination. While arthroesis was originally designed for pediatric flexible flatfoot, many surgeons have expanded the indication for this “implantable orthotic” to adults with or without posterior tibial tendon dysfunction (PTTD).
  • A great advantage for patients is that arthroesis restricts excessive pronation without significantly restricting supination or permanently locking the joint like an arthrodesis would. This is especially true for pediatric patients in whom bony maturation has not occurred.
  • Arthroesis salvages the joint and allows the child to develop more normal osseous and soft tissue structures while the implant maintains the correction.
  • Another advantage is that the procedure is reversible. If the patient experiences pain with the implant, one can remove it. Many surgeons have reported episodes of maintained correction with implant removal although no significant research has been reported in this regard yet.
  • Sinus tarsalgia is by far the most common complication with arthroesis, whether it is due to improper positioning, implant irritation or excessive restriction of the motion of the joint.
  • Researchers have also documented cases of impingements or irritation of the nerve. However, the pain is usually self-limiting and symptoms often successfully resolve with local injections or anti-inflammatories. If symptoms have not resolved, one can remove the implant with relative ease and relieve the pain. Many of the newer implants have more rounded edges and are reported to reduce the frequency of these symptoms.
  • Although implants are generally designed with a suitable biomaterial for long-term wear, fatigue failure may still occur. These implants have to endure a prolonged period of time in the foot with significant repetitive reactive forces on them.
  • Post operative care involves wearing a cam boot for one month to let scar tissue heal around the implant.

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