Clinical outcomes of subtalar arthroereisis in pediatric flatfoot with or without spring ligament repair

Subtalar arthroereisis (STA) is a commonly used surgical approach for treating pediatric flatfoot. It remains unclear whether STA combined with spring ligament repair surgery is necessary. The purpose of this study was to report the clinical outcomes of STA with or without spring ligament repair and to investigate the impact of spring ligament repair as an adjunctive procedure on treatment outcomes. A retrospective analysis was conducted on the clinical data of 58 patients with pediatric flatfoot admitted to our inpatient center from January 2018 to February 2023. Among them, 25 cases (25 feet) were treated with spring ligament repair combined with STA ((observation group), while 33 cases (33 feet) received STA (control group). Visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores, complications, patient-reported satisfaction, and imaging results (meary angle in the weightbearing lateral view, pitch angle in the weightbearing lateral view, and talonavicular coverage angle in the weightbearing anteroposterior view) were used to describe outcomes. A total of 58 patients were included in the study, with 33 assigned to the subtalar arthroereisis (STA) group and 25 undergoing the combined procedure. Both interventions resulted in clinically meaningful improvements in pain relief and functional outcomes. Visual Analog Scale (VAS) scores improved to 0.12 ± 0.33 in the STA group and 0.28 ± 0.46 in the combined group, with both groups showing statistically significant reductions in pain compared to baseline values (P < .001). Similarly, American Orthopaedic Foot & Ankle Society (AOFAS) scores increased to 95.91 ± 3.02 and 94.84 ± 4.68, respectively, indicating substantial postoperative improvement (P < .001). Radiographic analysis demonstrated that the combined procedure provided superior corrective efficacy. Meary’s angle, talonavicular coverage angle, and calcaneal pitch angle all exhibited significantly greater improvements in the combined group compared to the STA group (all P < .05). High levels of satisfaction were also observed in both treatment groups, with rates of 78.8% and 76.0% for the STA and combined groups, respectively. Among the combined and STA subgroups in pediatric flatfoot, the combined subgroup demonstrated superior imaging measurements, yet similar clinical scores. We believe that the improvement from an imaging perspective is more significant and may offer greater long-term clinical benefits. Level III, retrospective comparative study.