Focus of the Report: This report assesses subtalar arthroereisis (SA) for treating adults with symptomatic flatfoot (FF) deformity that does not respond to conservative measures and negatively impacts the patient’s ability to function in activities of daily living.

Technology Description: SA involves limitation of subtalar joint pronation by surgical placement of an implant into the sinus tarsi that prevents abnormal rotation of the tarsus. It shifts loads from the medial to lateral column and decreases the movement of the talonavicular joint compared with a flattened foot without the implant. Correction is achieved by stimulation of proprioceptive foot receptors, allowing active inversion of the foot and normal subtalar joint motion while blocking excessive pronation. Surgery is performed with locoregional or general anesthesia and the implant may be removed after correction. SA is performed with a variety of devices either alone or in conjunction with adjunct procedures such as medializing calcaneal osteotomy, flexor digitorum longus or flexor hallucis longus tendon transfer, lateral column lengthening, and gastrocnemius recession or Achilles tendon lengthening.

Controversy: The stage of adult-acquired FF deformity (AAFD) and symptoms at diagnosis are the main determinants of how the condition is managed and the appropriate treatment options. It is generally accepted that symptomatic FF, rigid FF, progressive FF, or withdrawal from physical activity due to FF merit detailed evaluation and accurate diagnosis. When conservative measures fail to produce symptomatic relief, surgical management may be indicated with several options available, such as soft tissue plication, tendon lengthening, osteotomy, and SA.

Key Questions:

  • Does SA provide long-term correction of AAFD, reduce symptoms, and increase functionality?

  • How does SA compare with other well-established surgical approaches such as joint fusions and osteotomies?

  • Is SA safe in adults with FF deformity?

  • Have definitive patient selection criteria for the use of SA in the treatment of AAFD been established?

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