Presentation
Minimal subtalar motion and persistent pain at the sinus tarsi from outcomes of subtalar arthrorereisis (STA-PEG) with absorbable endorthesis.
Patient Data
Rx left foot
Cylindrical morphology surgical defect of the anterior process of the calcaneus with sclerotic and regular margins in outcomes of STA-peg implant used for the treatment of painful deformity of flexible flat foot.
MRI of the left foot without contrast
There is modest joint effusion with pathological hypointense tissue in the sinus tarsi. The head of the calcaneal screw causes impingement, synovitis and erosion of the posterolateral talus. Moderate bone marrow edema at the base of the last four metatarsals, in the cuboid, laterally, and in the calcaneus.
Surgical report
Removal of resorbable sub-talar endorthesis.
Histological examination
Material received: removal of resorbable sub-talar endorthesis.
Foreign body synovitis with granulomatous giant cell reaction to refractile polyethelene debris.
Case Discussion
There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse of the arch. Other characteristics include toe drift, in which the toes and front part of the foot point outward. The heel tilts toward the outside, and the ankle appears to turn in. The term “flexible” means that while the foot is flat when standing (weight-bearing), the arch returns when not standing. Subtalar arthroereisis (STA) is a minimally invasive and reversible surgery to correct symptomatic flexible flatfoot in children. STA is reversible, maintaining the motion of the subtalar joint during and after treatment. For this treatment, self-locking, absorbable, or non-absorbable devices implanted in the sinus tarsi acting as a plug as well as impact-blocking subtalar extraarticular screw arthroereises can be applied. Foreign body synovitis with extensive granulomatous giant cell reaction to polyethylene debris is a complication of subtalar arthroereisis. Subsequently, the implant was removed with good pain relief.
Radiographer: TSRM Fabio Imola
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