Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 2

A Review of the Effectiveness of Arthroereisis Implant in Adults with Acquired Flatfoot Deformity

Paolo Ceccarini1, Rosario Petruccelli1*, Marco Corzani2, Lorenzo Maria Di Giacomo1, Giuseppe Rinonapoli1, Pierluigi Antinolfi1 and Auro Caraffa1

1SM Misericordia Hospital Orthopaedic and Traumatology Department, University of Perugia, Italy
2Villa Maria Private Hospital, Rimini, Italy

*Corresponding Author: Rosario Petruccelli, SM Misericordia Hospital Orthopaedic and Traumatology Department, University of Perugia, Italy.

Received: November 09, 2021; Published: January 25, 2022


The role of arthroereisis in adult flatfoot has been debated for years. Arthroereisis procedures were originally designed for the treatment of pediatric deformities, that is: correction of the flatfoot while preserving foot function, subtalar joint locking device into the sinus tarsi or tarsal canal. The purpose of this study was to review the literature on arthroereisis implants in adults. The literature was reviewed from 2003 to 2019. 13 articles were included in the study. Most were level 4 evidence. Over all outcomes were good, but the overall study quality was poor. The authors recommend further studies in the topic. Methods: In January 2020 a topical review of the PubMed/MEDLINE, EMBASE database was conducted. This review identified 13 studies focusing on the use of arthroereisis in adults with flatfoot, for a total of 456 feet in 431 patients, with a mean age of 46.3 years and median follow-up of 35 months. Results:: The current evidence for the treatment is limited to retrospective case series. The clinical results are encouraging but the removal of the implant remains controversial. Conclusion: The degree of recommendation in adults is level IV. There is no consensus related to what kind of implant should be indicated. Finally, to definitively validate the success of arthroereisis procedure prospective and comparative studies are indispensable.

Keywords: Adult-acquired Flatfoot Deformity; Arthroereisis; Flexible Flatfoot; Posterior Tibial Tendon


  1. Bluman E., et al. “Posterior tibial tendon rupture: a refined classification system”. Foot and Ankle Clinics of North America 12 (2007): 233-249.
  2. Deland JT. “Adult - Acquired flatfoot deformity”. Journal of the American Academy of Orthopaedic Surgeons 16 (2008): 399-406.
  3. Myerson MS. “Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon”. Instructional Course Lectures 46 (1997): 393-405.
  4. Needleman RL. “A surgical approach for flexible flatfeet in adults including a subtalar arthroereisis with the MBA sinus tarsi implant”. Foot and Ankle International (2006).
  5. Ortiz CA., et al. “Arthroereisis: What Have We Learned?”. Foot and Ankle Clinics3 (2018): 415-434.
  6. Pinney SJ and Lin SS. “Current concept review: acquired adult flatfoot deformity”. Foot and Ankle International 27 (2006): 66-75.
  7. Bernasconi A., et al. “The role of arthroereisis of the subtalar joint for flatfoot in children and adults”. EFORT Open Review11 (2017): 438-446.
  8. Arangio GA and Salathe EP. “A biomechanical analysis of posterior tibial tendon dysfunction, medial displacement calcaneal osteotomy and flexor digitorum longus transfer in adult acquired flat foot”. Clinical Biomechanics (Bristol, Avon)4 (2009): 385-390.
  9. Moher D., et al. “Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement”. PLoS Medicine 6 (2009): e123-e130.
  10. Wright JG., et al. “Grades of recommendation”. Journal of Bone and Joint Surgery 9 (2005): 1909-1910.
  11. Whiting PF., et al. “QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies”. Annals of Internal Medicine8 (2011): 529-536.
  12. Adelman VR., et al. “Radiographic evaluation of endoscopic gastrocnemius recession, subtalar joint arthroereisis, and flexor tendon transfer for surgical correction of stage II posterior tibial tendon dysfunction: a pilot study”. Journal of Foot and Ankle Surgery5 (2008): 400-408.
  13. Baker JR., et al. “Retrospective analysis of the survivability of absorbable versus nonabsorbable subtalar joint arthroereisis implants”. Foot and Ankle Specialist1 (2013): 36-44.
  14. Ceccarini P., et al. “The arthroereisis procedure in adult flexible flatfoot grade IIA due to insufficiency of posterior tibial tendon”. Foot and Ankle Surgery4 (2018): 359-364.
  15. Cook EA., et al. “Identifying risk factors in subtalar arthroereisis explantation: a propensity-matched analysis”. Journal of Foot and Ankle Surgery4 (2011): 395-401.
  16. Lu W., et al. “The arthroereisis procedure in adult flexible flatfoot grade IIA due to insufficiency of posterior tibial tendon”. Foot and Ankle Surgery2 (2018): 171.
  17. Ozan F., et al. “Symptomatic flexible flatfoot in adults: subtalar arthroereisis”. Therapeutics and Clinical Risk Management 11 (2015): 1597-602.
  18. Saxena A and Patel R. “Medial Displacement Calcaneal Osteotomy: A Comparison of Screw Versus Locking Plate Fixation”. Journal of Foot and Ankle Surgery6 (2016): 1164-1168.
  19. Saxena A., et al. “Subtalar Arthroereisis Implant Removal in Adults: A Prospective Study of 100 Patients”. Journal of Foot and Ankle Surgery3 (2016): 500-503.
  20. Viladot R., et al. “Subtalar arthroereisis for posterior tibial tendon dysfunction: a preliminary report”. Foot and Ankle International8 (2003): 600-606.
  21. Viladot Voegeli A., et al. “Results of subtalar arthroereisis for posterior tibial tendon dysfunction stage IIA1. Based on 35 patients”. Foot and Ankle Surgery1 (2018): 28-33.
  22. Yasui Y., et al. “Use of the arthroereisis screw with tendoscopic delivered platelet-rich plasma for early stage adult acquired flatfoot deformity”. International Orthopaedics2 (2017): 315-321.
  23. Zhu Y and Xu XY. “Treatment of Stage II Adult Acquired Flatfoot Deformity With Subtalar Arthroereises”. Foot and Ankle Specialist3 (2015): 194-202.
  24. Kitaoka HB., et al. “Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes”. Foot and Ankle International 15 (1994): 349-353.
  25. Richter M., et al. “A new foot and ankle outcome score: questionnaire based, subjective, Visual-Analogue-Scale, validate and computerized”. Foot and Ankle Surgery4 (2006): 191-199.
  26. Wong DW., et al. “Biomechanical consequences of subtalar joint arthroereisis in treating posterior tibial tendon dysfunction: a theoretical analysis using finite element analysis”. Computer Methods in Biomechanics and Biomedical Engineering 14 (2017): 1525-1532.
  27. Grant WP., et al. “Beaming the columns for Charcot diabetic foot reconstruction: a retrospective analysis”. Journal of Foot and Ankle Surgery2 (2011): 182-189.
  28. Brancheau SP., et al. “An analysis of outcomes after use of the Maxwell-Brancheau Arthroereisis implant”. Journal of Foot and Ankle Surgery1 (2012): 3-8.
  29. Chang TJ and Lee J. “Subtalar joint arthroereisis in adult-acquired flatfoot and posterior tibial tendon dysfunction”. Clinics in Podiatric Medicine and Surgery4 (2007): 687-697.
  30. Corpuz M., et al. “Fracture of the talus as a complication of subtalar arthroereisis”. Journal of Foot and Ankle Surgery1 (2012): 91-94.
  31. Dellon AL., et al. “Sinus tarsi denervation: clinical results”. Journal of the American Podiatric Medical Association 2 (2005): 108-113.
  32. Fernández de Retana P., et al. “Is there a role for subtalar arthroereisis in the management of adult acquired flatfoot?”. Foot and Ankle Clinics2 (2012): 271-281.
  33. Flynn J., et al. “Bridle procedure combined with a subtalar implant: a case series and review of the literature”. Foot and Ankle Specialist1 (2015): 29-35.
  34. Garras DN., et al. “Outcome of modified Kidner procedure with subtalar arthroereisis for painful accessory navicular associated with planovalgus deformity”. Foot and Ankle International11 (2012): 934-939.
  35. Lui TH. “Endoscopic assisted posterior tibial tendon reconstruction for stage 2 posterior tibial tendon insufficiency”. Knee Surgery, Sports Traumatology, Arthroscopy 10 (2007): 1228-1234.
  36. Schon LC. “Subtalar arthroereisis: a new exploration of an old concept”. Foot and Ankle Clinics 12 (2007): 329-339.
  37. Shah NS., et al. “Subtalar Arthroereisis Survey: The Current Practice Patterns of Members of the AOFAS”. Foot and Ankle Specialist3 (2013): 180-185.
  38. Soomekh DJ and Baravarian B. “Pediatric and adult flatfoot reconstruction: subtalar arthroereisis versus realignment osteotomy surgical options”. Clinics in Podiatric Medicine and Surgery4 (2006): 695-708.
  39. Walley KC., et al. “Short- to Mid-Term Outcomes Following the Use of an Arthroereisis Implant as an Adjunct for Correction of Flexible, Acquired Flatfoot Deformity in Adults”. Foot and Ankle Specialist2 (2019): 122-130.
  40. Xu J., et al. “Comparison of Extraosseous Talotarsal Stabilization Implants in a Stage II Adult-Acquired Flatfoot Model: A Finite Element Analysis”. Journal of Foot and Ankle Surgery5 (2017): 1058-1064.
  41. Yen-Douangmala D., et al. “Subtalar arthroereisis and its role in pediatric and adult population”. Clinics in Podiatric Medicine and Surgery3 (2012): 383-390.


Citation: Rosario Petruccelli., et al. “A Review of the Effectiveness of Arthroereisis Implant in Adults with Acquired Flatfoot Deformity". Acta Scientific Orthopaedics 5.2 (2022): 25-34.


Copyright: © 2022 Rosario Petruccelli., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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