Return to sport after subtalar arthroeresis for flexible pediatric flatfoot: a systematic review of the literature

INTRODUCTION: Subtalar arthroeresis (SA) is a widespread surgical option for treating flexible flatfoot, nevertheless there is great heterogeneity in the postoperative protocol, particularly as concern the time to return to sport activities. Aim of this systematic review was to research the time to return to sport after SA, possible complications related to sport resumption timing and restrictions in sport activities. EVIDENCE ACQUISITION: A literature search of Cochrane Library, CINAHL, EMBASE, MEDLINE, PUBMED and GOOGLE SCHOLAR databases was performed in December 2022 according to PRISMA guidelines. Quality of the studies was assessed using the Methodological Index for Non-randomized Studies Score. Sport activities were classified as low or high impact according to Clifford Classification. A statistical analysis between different times to return to sport and complication rates was performed. The search identified 253 studies. Six of these met the inclusion criteria, for a total of 679 flexible flatfeet. EVIDENCE SYNTHESIS: Faster return to low and high-impact activity was correlated to a significant higher implant removal rate. Metallic devices were also linked to a higher implant removal rate. Over 97% of the patients were able to return to sport within six months after surgery, and 80% of the patients were capable to practice an high-impact sport after surgery. CONCLUSIONS: After SA, most of the patients can safely return to sport without particular restrictions within six months. Faster return to low and high-impact activities was related to a higher implant removal rate, however different implant characteristics and related postoperative protocols may have influenced these data.