Subtalar Arthroereisis with Endorthesis in Adult-acquired Flatfoot: Classification of the Postoperative Rehabilitation Phases

Abstract

Flatfoot is a biomechanical condition in which the medial longitudinal arch collapses, causing flattening of the foot towards the ground. In adult-acquired flatfoot, the subtalar joint has a greater range of motion than a normal foot, and multiple factors can cause the onset of this condition. Subtalar arthroereisis with endorthesis is a surgical procedure by which an implant is positioned in the sinus tarsi depression in order to limit the excessive pronation of the subtalar joint. Subtalar arthroereisis is often associated with adjunctive procedures. A period of three weeks of non-weight bearing is recommended after surgery and additional protection is achieved as the load is increased. In order to be able to discuss the postoperative course, it is useful to be able to classify it. Basically, the classification proposed in this paper is a practical/theoretical instrument which seeks to contribute to a better understanding and achievement of the aims and outcome desired at each stage described. Postoperative rehabilitation must be oriented to both protect the surgical site and to enhance foot mobility. We have proposed a classification of the rehabilitative pathway after subtalar arthroereisis with endorthesis based on our experience, also considering the related literature. Furthermore, we provide a synthetic description of the surgery, and the rehabilitation techniques are discussed. The ultimate goal of the rehabilitation project is centered on obtaining the physical condition closest to that required for the daily activity of the healthy population with the aim of returning to full recovery after surgery. To this end, a certain degree of multiprofessional cooperation is always recommended in order to ensure patient safety and obtain the best results.