Calcaneal stop technique in the treatment of flatfoot in children and adolescents

Abstract

Objective: to evaluate the clinical, functional, and radiographic outcomes of subtalar arthroereisis using the calcaneal stop technique in children and adolescents with Down syndrome, joint hypermobility, and symptomatic flexible flatfoot refractory to conservative treatment. Methods: this retrospective, longitudinal, observational study analyzed medical records and imaging exams of 15 patients (30 feet), aged 8 to 13 years, who underwent the calcaneal stop procedure. Radiographic assessment included the calcaneal pitch angle, and functional evaluation was performed using the physical domain of the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C), comparing pre- and postoperative periods. Paired statistical tests were applied according to data distribution. Results: a significant increase in the postoperative calcaneal pitch angle was observed (22.97° vs. 37.73°; p < 0.001), along with a marked improvement in the OxAFQ-C physical domain scores, with mean values rising from 29.15% to 77.43% (p = 0.002). Conclusions: subtalar arthroereisis using the calcaneal stop technique proved to be an effective and safe intervention, providing meaningful structural correction and functional improvement in the short term, and represents a minimally invasive and promising therapeutic option for symptomatic flexible flatfoot in pediatric patients with Down syndrome.