Risk Factors of Subtalar Arthroereisis for Progressive Collapsing Foot Deformity: A Retrospective Analysis of 236 Cases

Abstract

Purpose: Although subtalar arthroereisis (SA) with HyProCure is increasingly utilized for progressive collapsing foot deformity (PCFD), evidence regarding risk factors for complications remains limited. This study aimed to analyze the influencing factors and correlations of sinus tarsi pain and implant removal in PCFD patients after SA utilizing the HyProCure device.

Methods: A retrospective study was conducted involving 223 patients (236 ft) diagnosed with PCFD who underwent SA from June 2015 to June 2023. General data and surgical data such as patient gender, age, body mass index (BMI), surgical side, any adjunctive surgeries, length of stay, HyProCure size, and HyProCure depth were collected. Complications were also recorded. Statistical analysis included normality assessment, inter-group comparisons (t-tests for normal quantitative data, Mann–Whitney U for non-normal data, and chi-square for categorical variables). Spearman correlation analyzed factors associated with sinus tarsi pain and implant removal. Binary logistic regression identified risk factors.

Results: From 2015 to 2023, a total of 60 cases with sinus tarsi pain, with an incidence rate of 25.42%. Spearman correlation analysis showed that sinus tarsi pain was positively correlated with BMI (r = 0.159, p = 0.014), length of stay (r = 0.165, p = 0.011), and HyProCure depth (r = 0.501, p < 0.01). HyProCure removal was positively correlated with HyProCure depth (r = 0.521, p < 0.01) and sinus tarsi pain (r = 0.700, p < 0.01). In the analysis of sinus tarsi pain, the primary risk factor in patients with PCFD was identified as length of stay (OR = 1.456, 95% CI 1.113–1.904) and HyProCure depth (OR = 2.156, 95% CI 1.690–2.750), both of which were statistically significant (p < 0.05). Among the cases of sinus tarsi pain, 36 patients underwent HyProCure removal, leading to an incidence rate of 15.25%. Regarding the removal of HyProCure, the primary risk factor identified was HyProCure depth (OR = 2.531, 95% CI 1.849–3.463), which was statistically significant (p < 0.05). In particular, no significant correlation was observed between HyProCure size and sinus tarsi pain or implant removal (p > 0.05).

Conclusion: In patients with PCFD, length of stay was correlated with the incidence of sinus tarsi pain. Additionally, HyProCure depth was linked to both the incidence of sinus tarsi pain and HyProCure removal. Our research suggests that the prognosis is better for PCFD patients with a shorter length of stay and a reduced HyProCure depth.

Level of Evidence: Level III, Retrospective Comparative Study.

Keywords

HyProCure / prognosis / progressive collapsing foot deformity / subtalar arthroereisis

References

[1] C. Y. K. Tang, K. H. Ng, and J. Lai, “Adult Flatfoot,” BMJ (Clinical Research Ed.) 368 (2020): m295.

[2] C. Biz, G. Baldin, C. Cappelletto, et al., “Isolated Medial Subtalar Joint Dislocation During Sports Activities: A Systematic Review of the Literature With Individual Participant Data Analysis,” Osteology 1, no. 1 (2021): 48-61.

[3] C. Biz, A. Ruaro, A. Giai Via, J. Torrent, G. Papa, and P. Ruggieri, “Conservative Management of Isolated Medial Subtalar Joint Dislocations in Volleyball Players: A Report of Three Cases and Literature Review,” Journal of Sports Medicine and Physical Fitness 59, no. 10 (2019): 1739-1746.

[4] M. S. Myerson, D. B. Thordarson, J. E. Johnson, et al., “Classification and Nomenclature: Progressive Collapsing Foot Deformity,” Foot & Ankle International 41 (2020): 1271-1276.

[5] J. B. Jackson, M. J. Pacana, and T. A. Gonzalez, “Adult Acquired Flatfoot Deformity,” Journal of the American Academy of Orthopaedic Surgeons 30 (2022): e6-e16.

[6] C. Biz, M. Cerchiaro, F. Mori, et al., “Flatfoot Over the Centuries: The Background of Current Conservative and Operative Treatments,” International Orthopaedics 47, no. 9 (2023): 2357-2368.

[7] Ł. Kołodziej, D. Ciechanowicz, M. Wójtowicz, et al., “Prospective, Long-Term Functional Outcomes of Extra-Osseous Talotarsal Stabilization (EOTTS) Using HyProCure in Adult Patients With Talotarsal Joint Instability: Assessment of Physical Activity and Patient Satisfaction,” JCM 12 (2023): 4872.

[8] P. S. Agnew, J. D. Foster, J. Chariton, et al., “Clinical Outcomes Following Treatment of Recurrent Talotarsal Joint Dislocation Using a Type II Extraosseous Talotarsal Stabilization Implant—A Long-Term Follow-Up Study,” Journal of Foot and Ankle Surgery 62 (2023): 877-882.

[9] M. E. Graham, N. T. Jawrani, A. Chikka, and R. J. Rogers, “Surgical Treatment of Hyperpronation Using an Extraosseous Talotarsal Stabilization Device: Radiographic Outcomes in 70 Adult Patients,” Journal of Foot and Ankle Surgery 51 (2012): 548-555.

[10] P. Fernández de Retana, F. Álvarez, and G. Bacca, “Is There a Role for Subtalar Arthroereisis in the Management of Adult Acquired Flatfoot?,” Foot and Ankle Clinics 17 (2012): 271-281.

[11] W.-M. Chen, S.-J. Lee, and P. V. S. Lee, “Plantar Pressure Relief Under the Metatarsal Heads: Therapeutic Insole Design Using Three-Dimensional Finite Element Model of the Foot,” Journal of Biomechanics 48 (2015): 659-665.

[12] J. J. McCormick and J. E. Johnson, “Medial Column Procedures in the Correction of Adult Acquired Flatfoot Deformity,” Foot and Ankle Clinics 17 (2012): 283-298.

[13] H. Kubo, C. Lipp, M. Hufeland, et al., “Outcome After Subtalar Screw Arthroereisis in Children With Flexible Flatfoot Depends on Time of Treatment: Midterm Results of 95 Cases,” Journal of Orthopaedic Science 25 (2020): 497-502.

[14] A. Saxena, A. G. Via, N. Maffulli, and H. Chiu, “Subtalar Arthroereisis Implant Removal in Adults: A Prospective Study of 100 Patients,” Journal of Foot and Ankle Surgery 55 (2016): 500-503.

[15] C. Chen, J. Jiang, S. Fu, et al., “HyProCure for Pediatric Flexible Flatfoot: What Affects the Outcome,” Frontiers in Pediatrics 10 (2022): 857458.

[16] S. Wang, L. Chen, J. Yu, et al., “Mid-Term Results of Subtalar Arthroereisis With Talar-Fit Implant in Pediatric Flexible Flatfoot and Identifying the Effects of Adjunctive Procedures and Risk Factors for Sinus Tarsi Pain,” Orthopaedic Surgery 13 (2021): 175-184.

[17] C.-H. Hsieh, C.-C. Lee, T.-H. Tseng, K. W. Wu, J. F. Chang, and T. M. Wang, “Body Weight Effects on Extra-Osseous Subtalar Arthroereisis,” JCM 8 (2019): 1273.

[18] C. Faldini, A. Mazzotti, A. Panciera, et al., “Patient-Perceived Outcomes After Subtalar Arthroereisis With Bioabsorbable Implants for Flexible Flatfoot in Growing Age: A 4-Year Follow-Up Study,” European Journal of Orthopaedic Surgery and Traumatology 28 (2018): 707-712.

[19] E. A. Cook, J. J. Cook, and P. Basile, “Identifying Risk Factors in Subtalar Arthroereisis Explantation: A Propensity-Matched Analysis,” Journal of Foot and Ankle Surgery 50 (2011): 395-401.

[20] C. Biz, B. Hoxhaj, R. Aldegheri, and C. Iacobellis, “Minimally Invasive Surgery for Tibiotalocalcaneal Arthrodesis Using a Retrograde Intramedullary Nail: Preliminary Results of an Innovative Modified Technique,” Journal of Foot and Ankle Surgery 55, no. 6 (2016): 1130-1138.

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