Treating Paediatric Flat Foot with Arthroeresis Plugs

Ankle osteoarthritis is a condition that causes pain and stiffness in the ankle joint. Traditional treatments like joint fusion can limit mobility. An alternative procedure called ankle distraction arthroplasty has been gaining some traction, but how well does it hold up in the long term? 

A recent study by Greenfield et al. (2019) investigated this very question. They conducted a survival analysis of ankle distraction arthroplasty for ankle osteoarthritis. Their findings suggest that this procedure may be a viable option for some patients. 

Key takeaways from the study: 

  • Ankle distraction arthroplasty showed promising results, with an 84% survival rate at 5 years. This is better than some previously reported outcomes. 
  • The study also identified factors that can influence the success of the procedure. Avascular necrosis of the talus (bone death) was associated with a lower survival rate. Additionally, sex may play a role, with the study suggesting potential gender differences in long-term outcomes. 

What this means for patients: 

Ankle distraction arthroplasty offers a potential option for preserving joint mobility in patients with ankle osteoarthritis. This study provides valuable data for surgeons and patients to consider when making treatment decisions. 

Important to note: 

  • This was a retrospective study, meaning researchers analyzed past data. More robust research designs are needed to confirm these findings. 
  • The study involved a relatively small group of patients. Larger studies are necessary to draw more definitive conclusions. 

Overall, this research suggests that ankle distraction arthroplasty may be a valuable tool for treating ankle osteoarthritis. However, more research is needed to solidify its place as a standard treatment option. 

ReferenceGreenfield, S., Matta, K. M., McCoy, T. H., Rozbruch, S. R., & Fragomen, A. (2019). Ankle distraction arthroplasty for ankle osteoarthritis: a survival analysis. Strategies in trauma and limb reconstruction, 14(2), 65.,and%2037%25%20within%205%20years


This blog is for informational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional to discuss your individual treatment options.

Image Credit: Podiatry Today

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Article Authors: Gordon Slater| Tandose Sambo 

Paediatric flatfoot is common in children, and normally heals on its own as children grow, develop and become more active in their early childhood. Flatfoot is defined by the absence of the arch at the base of the leg. Babies are normally born with padded feet, so the arch tends to be absent. Otherwise however, with a flexor motion strengthened and via physical activity the arch will become more prevalent with time. By the time children are at the age of eight, the condition will have alleviated. If you notice any unusual appearances in your child’s feet, do consult with your podiatrist or your paediatric orthopaedic surgeon. Via a series of diagnostics algorithms outlined below, the root cause of the problem will be identified, and the appropriate treatment plan can be developed. Treatment is either via exterior intervention, or via minimally invasive procedures such as Subtalar Arthroereisis.

Symptoms of Paediatric Flatfoot

Paediatric Flatfoot is a common condition in children. While not a contributor to deformities in children, it affects appropriate weight management in children. With sagging of the medial arch and the heel valgus as its main identifiers, in many patients they may develop complications later in life that will affect their mobility. With minimal symptoms in the majority of the population, some children do experience pain in their feet, and ultimately find themselves limiting their physical activity due to the pain they experience after the sporting event. Symptoms of paediatric flatfoot include: 

  1. Pain in the bottom of the leg, which spreads to the ankle regions. 
  2. Lateral motion in the heels. The heels will vere outwards. 

Consultation with your paediatric orthopaedic surgeon will facilitate an appropriate diagnosis of the condition. Usually, a series of decisions are made by your specialist. The following diagram represents that outcome: 

Image reference: NIH

With the various action steps that are taken by your specialists, there are a series of possibilities that determine the path that will be taken by your foot and ankle surgical specialist. After detailed analysis and observations, the ideal path for your child’s progression will be determined. 

Treatment of Paediatric Flatfoot

The minor cases of paediatric flatfoot that require treatment,often utilize the processes of either orthotic devices that are custom made to fit the feet or surgical procedures such as Subtalar Arthroereisis plugs. The process of arthroereisis is based on the concept of Greek root meaning “ to press a thing against”. This process is a means via which the ankle joint can be propped by an implement, much as identified in the image above. The arthroereisis procedure aims to achieve the following: 

  1. Control the motion at the subtalar joint 
  2. Facilitate range of motion (3-5) degree allowance
  3. Preserve the joint

Orthopaedic surgeons have been utilising surgical treatments for paediatric flat foot for many years. It has proven to be successful in children. If you’re a concerned parent, then talk through the above decision matrix with your orthopaedic surgeon to determine what path of action is best for you. 


  1. Pediatric Flatfoot:
  2. Flatfoot in Children:
  3. Pediatric Flexible Flatfeet:

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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