Evaluation of the calcaneo-stop procedure with FIT-CS for the surgical treatment of juvenile flatfoot

Abstract Purpose Flexible flatfoot is one of the most common paediatric foot deformities. Although most cases remain asymptomatic, a subset of patients develop persistent pain and functional limitations requiring surgical treatment. This study evaluated the medium-term clinical, functional, and radiographic outcomes of Calcaneo-stop arthroereisis in children with symptomatic flexible flatfoot. Methods A retrospective analysis of prospectively collected data was performed on consecutive pediatric patients who underwent Calcaneo-stop arthroereisis between January 2018 and December 2022. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Score, the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C), and the Catania Flatfoot Score (CTF). Radiographic outcomes included Kite's and Costa-Bertani angles. Patients were evaluated preoperatively and at one and three year follow-up. Repeated-measures ANOVA with Bonferroni-adjusted post-hoc comparisons was used. Results A total of 121 consecutive patients (218 treated feet) completed a minimum follow-up of three years. The AOFAS score improved from 44.99 ± 10.59 preoperatively to 92.46 ± 8.78 at final follow-up ( p < 0.001). Similar improvements were observed for the OxAFQ-C and CTF scores, together with significant correction of Kite's angle (30.38° to 24.02°) and Costa-Bertani angle (155.95° to 123.22°) (all p < 0.001). No significant differences were observed between the first and third postoperative year. The overall complication rate was 7.4%, with only two patients requiring revision surgery because of implant screw breakage. Conclusion Calcaneo-stop arthroereisis provided significant and sustained clinical, functional, and radiographic improvement at a minimum follow-up of three years. Clinical and radiographic correction remained stable after the first postoperative year, while the procedure demonstrated a low complication rate, supporting its use as a safe and effective surgical option for carefully selected pediatric patients.