Monestier L, Riva G, Latiff M, Marciandi L, Bozzi E, Pelozzi A, Pautasso A, Pilato G, Surace MF, D'Angelo F. Pediatric flexible flatfoot: Does obesity influence the outcomes of arthroereisis? World J Orthop 2024; 15(9): 850-857 [PMID: 39318489 DOI: 10.5312/wjo.v15.i9.850]
Corresponding Author of This Article
Luca Monestier, MD, Division of Orthopedics and Traumatology, ASST Sette Laghi, Viale L Borri 57, Varese 21100, Lombardy, Italy. dottlucamonestier@outlook.it
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Sep 18, 2024; 15(9): 850-857 Published online Sep 18, 2024. doi: 10.5312/wjo.v15.i9.850
Pediatric flexible flatfoot: Does obesity influence the outcomes of arthroereisis?
Luca Monestier, Giacomo Riva, Mahfuz Latiff, Luca Marciandi, Elisa Bozzi, Alessandra Pelozzi, Andrea Pautasso, Giorgio Pilato, Michele Francesco Surace, Fabio D'Angelo
Luca Monestier, Giacomo Riva, Mahfuz Latiff, Luca Marciandi, Andrea Pautasso, Giorgio Pilato, Fabio D'Angelo, Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese 21100, Lombardy, Italy
Elisa Bozzi, Alessandra Pelozzi, Residency Program in Orthopedics and Trauma, Department of Biotechnologies and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
Giorgio Pilato, Michele Francesco Surace, Fabio D'Angelo, Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Lombardy, Italy
Michele Francesco Surace, Division of Orthopedics and Traumatology, Ospedale di Cittiglio, ASST Sette Laghi, Varese 21100, Lombardy, Italy
Author contributions: Monestier L and Riva G were the patients’ surgeons; Monestier L, Pelozzi A, Bozzi E, Latiff M and Marciandi L reviewed the literature and contributed to manuscript drafting; Latiff M and Pautasso A analyzed the imaging findings; Surace MF, Pilato G, D'Angelo F, Monestier L and Riva G were responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Institutional review board statement: In compliance with Italian law, we are not required to ask for Ethic Committee approval for this type of study.
Informed consent statement: Regular informed consent was obtained from all patients. Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Luca Monestier, MD, Division of Orthopedics and Traumatology, ASST Sette Laghi, Viale L Borri 57, Varese 21100, Lombardy, Italy. dottlucamonestier@outlook.it
Received: April 29, 2024 Revised: July 24, 2024 Accepted: August 13, 2024 Published online: September 18, 2024 Processing time: 136 Days and 3.3 Hours
Abstract
BACKGROUND
Childhood obesity has emerged in the last decades as an important public health problem worldwide. Although relationships between obesity and flatfoot have been shown, no studies have investigated the influence of obesity on arthroereisis outcomes.
AIM
To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants.
METHODS
This retrospective study included one hundred and sixty-nine pediatric patients (10-14 years old) who underwent subtalar arthroereisis (PEEK PitStop® device) for severe flexible flatfoot. Exclusion criteria were additional procedures, revision of previous corrective surgeries, rigid flatfoot with severe deformity, and neurological or post-traumatic flatfoot. Preoperative/postoperative European Foot and Ankle Society (EFAS) and visual analogue scale (VAS) scores were determined; radiographic assessment was conducted on weight-bearing foot X-rays: Kite angle, first metatarsal-talus angle, Meary angle, calcaneal pitch angle and lateral talo-calcaneal angle were analyzed.
RESULTS
EFAS and VAS scores improved post-operatively in the whole population. Only seven cases with complications were reported. Radiographic assessment revealed an improvement in all angles. Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes: Relationships were reported between BMI and postoperative EFAS/VAS scores, postoperative calcaneal pitch angle, Kite angle, Meary angle and talo-first metatarsal angle.
CONCLUSION
Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children, obesity significantly influences clinical and radiographic outcomes of arthroereisis, and obese children tend to perceive more pain and discomfort.
Core Tip: Childhood obesity has emerged in the last decades as an important public health problem worldwide. It has been demonstrated that pediatric flatfoot is also related to obesity, showing a two-fold higher risk compared to normal weight children. While the relationship between obesity and flatfoot has been well established, only a few studies have reported the relationships between childhood obesity and arthroereisis outcomes and no studies have assessed the outcomes of self-locking implants and obesity. The aim of the present study is to evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants.
