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A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2008 February;59(1):7-14
The treatment of flatfoot with Giannini’s endo-orthosis
Sabatino C., Fino A., Basso M., Viglierchio P., Zoccolan A., Torasso G.
Dipartimento di Scienze Cliniche e Biologiche Clinica Ortopedica Università degli Studi di Torino Ospedale San Luigi Gonzaga, Orbassano, Torino
Aim. The aim of the study was to assess the alterations in calcaneal valgus and clinical changes that take place following Giannini’s endo-orthotic implant surgery in patients suffering from flatfoot.
Methods. Of 86 patients treated for flat feet at the San Luigi Hospital Orthopedic Clinic in Orbassano (Turin) between 1999 and 2005, 28 patients (50 feet) were selected and treated with Giannini’s endo-orthosis. Mean follow-up was of 18 months; the average age was 9.7 years; subjects suffering from symptomatic flatfoot, posterior tibial tendon insufficiency, retraction of the Achilles tendon, inflammatory diseases, acute post-traumatic tendinosis, flatfoot not accompanied by calcaneal valgus and non reducible, and neuromuscular disorders were excluded from the study. Of the endo-orthoses used, 42 had a diameter of 8 mm, and 8 of 10 mm. All the patients were clinically assessed pre- and post-surgery by measuring the calcaneal valgus angle and using the American Orthopedic Ankle and Foot Society (AOFAS) ankle-hindfoot rating system; the Viladot footprint and Meary’s radiographic axis were also assessed post-operation.
Results. The hindfoot axis in orthostatism was within the norm in all cases (between 5° and 7°): the mean preoperative (one month beforehand) heel valgus value of 12.63° dropped to 5.89° postoperation (18 months afterwards). During the follow-up, 3 months after surgery, a hypercorrection was detected in 4 feet, with an associated supination of the forefoot with spontaneous resolution after a maximum of 6 months postoperation. In 2 cases it was necessary to remove the 10-mm endo-orthosis bilaterally due to intolerance. According to AOFAS rating, the total mean score increased by 25.92 points (+36%), from 72 to 97.92. In 8 cases, first degree flatness remained bilaterally, and radiographically the Meary axis was 170° less in all the patients. All the patients who practised sporting activity before the operation continued to practise it afterwards.
Conclusion. The type of corrective operation used to treat flatfoot has shown good results, both in terms of calcaneal valgus, hindfoot and ankle correction, and in clinical and radiographic terms, with a return to normal daily activity, presenting itself as a valid alternative to corrective flatfoot surgery. Technically the operation is not very demanding and respects anatomical structures, and the screw used is made of reabsorbable material, so no reoperation is necessary for its removal. In two cases - 8% of the total - the implant was removed bilaterally due to intolerance.