To satisfy my husband's request, I took my 9 year old son to a foot and ankle specialist to get an opinion on his "flat feet". My son has never complained of pain of any kind. This was just to "check it out". The first doctor indicated he was too far gone for shoe inserts/plates to help in any way and highly suggested the procedure "subtalar arthroereisis". This procedure involves a small incision for insertion of a titanium stent to be placed into the sinus tarsi of the foot. He mentioned recovery was within 3 weeks, then have the other foot done. Of course, I took him to another specialist for a second opinion, this time asking the doctor to please look at my 11 year old son as well. This doctor also suggested the surgical procedure for both of them. Have you heard of this procedure? If so, do you know the success rate/benefits? Is this highly recommended for this age group? Is it possible for the titanium stent to get logged somewhere else in the body? Are there other options, in your opinion, to consider before surgery? Any information/advice you could offer is greatly appreciated. We are very apprehensive to voluntarily place foreign objects in both of our sons feet. Thank you so much.
Flatfoot (hyperpronation and flattening-out of the longitudinal arch) (also known as pes planus or pes planovalgus) is a common deformity among children and adults. Another cause of flatfoot can be attributed to posterior tibial tendon dysfunction. Conservative treatments to relieve pain from the foot and leg associated with flatfoot include orthotics, stretching exercises, and medication (e.g., non-steroidal anti-inflammatory drugs). Corticosteroid injections continue to be controversial.
The Subtalar MBA implant was cleared by the FDA via a 510(k) premarket notification in 1996. It is an "internal orthotic" designed for correction of pediatric pes valgus and adult posterior tibial dysfunction deformity. There are five different MBA implant sizes: 6, 8, 9, 10, and 12 mm in diameter. The implant is a soft-threaded titanium device that is inserted into the sinus tars. It aims to restore the arch by blocking the anterior and inferior displacement of the talus and by preventing the foot from pronating; thus allowing normal subtalar joint motion. Tissue grows normally around the implant and aids in holding it in place. In adults, ancillary procedures may be performed simultaneously (e.g., an Achilles tendon lengthening if an equines deformity is present). The patient can ambulate the day after surgery in a Cam Walker for approximately 3 weeks. Thereafter, regular shoes can be worn with an ankle brace for an additional 2 to 3 weeks.
For further information you can contact Prof Schon LC. Department of Orthopaedic Surgery, 3333 North Calvert Street, Suite 400, The Union Memorial Hospital, Baltimore 21218, MD, USA.
Surgical treatment of painless flexible flat feet is a crime and product of pure capitalistic mentality! Especially in 9 or 11yr old kids!
Medial arch will fully form till the end of growth, intrinsic feet muscles will strengthen and feet will finally adopt "natural" form.
Surgical treatment should be considered ONLY if there is subluxation of navicular bone, complete medialisation of footprint, rupture of tibialis posterior tendon or some other foot pathology which should anyway exclude flexible flat feet as diagnosis. If pain is present when walking or activity, then diagnosis is definitely NOT flexible flat feet, and further investigation should be done.
Flat feet are our adaptation to urbanization, asphalt and shoes, not necessarily a pathology. let your kids play barefoot on pebble beach, or grasp small objects with feet as a physical treatment but in a manner of game, not as an obligation and in 5 years your kids will be grateful for not being stigmatized with orthopedic shoes, insoles or surgical treatment. Its a waste of time and money!
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