ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Orthopedics
This article is part of the Research TopicFractures and Deformities of the Extremities in Children and Adolescents: Etiology, Diagnosis, and Treatment: 2025View all 16 articles
Plantar pressure distribution during gait cycle after subtalar arthroereisis in adolescent flexible flatfoot
Provisionally accepted
- 1Huashan Hospital, Fudan University, Shanghai, China
- 2Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, Shanghai Municipality, China
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Background: Flexible flatfoot is a common deformity in adolescents. Subtalar arthroereisis (STA) can reduce excessive pronation by placing an implant in the subtalar joint. Although widely used, few studies have investigated postoperative plantar pressure and lower-limb muscle activation patterns within the first 3–6 months after STA. Methods: Twenty adolescents with flexible flatfoot who underwent STA were prospectively enrolled. The plantar surface was divided into eight regions. Average standing pressure and peak pressure during the gait cycle were measured preoperatively and at three months postoperatively. Surface electromyography (sEMG) of the tibialis anterior (TA), peroneus longus (PL), and medial gastrocnemius (MG) was recorded during a single gait cycle. Results: All patients could walk in shoes three months postoperatively. During standing, pressures on the lesser toes, lateral forefoot, and lateral midfoot increased significantly (p < 0.05), whereas those on the hallux, medial forefoot, medial midfoot, medial hindfoot, and lateral hindfoot decreased (p < 0.05). During gait, peak pressures increased significantly in the lesser toes, lateral forefoot, lateral midfoot, and lateral hindfoot, but decreased in the hallux and medial plantar regions (all p < 0.05). The maximum lateral displacement of the center of pressure (COP) decreased from 3.81 ± 0.56 cm to 3.59 ± 0.41 cm, and longitudinal displacement from 21.07 ± 3.96 cm to 19.37 ± 3.08 cm (p < 0.05), indicating a lateral COP shift. Postoperatively, the peak activation percentage of TA and MG decreased, while that of PL increased. Similarly, the activation integral of TA and MG decreased and that of PL increased (all p < 0.05). Conclusion: Three months after STA, plantar pressure shifted laterally, accompanied by altered muscle activation patterns—reduced TA and MG activity with compensatory PL activation. These biomechanical and neuromuscular adaptations may contribute to early postoperative plantar discomfort or peroneal spasm. Monitoring plantar pressure and muscle activation during the early recovery phase is therefore recommended to guide rehabilitation and prevent complications.
Keywords: Subtalar arthroereisis, Flexible flatfoot, surface electromyography, Plantar pressure, Postoperative follow-up
Received: 25 Apr 2025; Accepted: 30 Oct 2025.
Copyright: © 2025 Xiong, Chen, Ru, Zhang, Huang, Wang and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xin Ma, maxin@sjtu.edu.cn
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