title: Giannini prosthesis for flatfoot.
abstract: BACKGROUND
  To determine the clinical and radiographic results of arthroereisis using the Giannini endo-orthotic implant for the treatment of pediatric flatfoot deformity, we retrospectively evaluated 37 patients (65 feet).
  
  
  METHODS
  Twenty-two boys and 15 girls were followed for an average of 26.5 months. Their overall average age was 9.4 (range 5 to 14) years. Pain, function, participation in sports activity, and the changes in radiographic measurements taken at 3, 6, and 12 months and then at 1-year intervals were evaluated.
  
  
  RESULTS
  Pain or discomfort decreased from 60% (22 patients) preoperatively to 6% (2 patients) postoperatively. The percentage of normal postoperative footprints was 59% (38 feet) with first-degree flatfoot present in 27 feet (41%). Sports activities were taken up by 19 patients (51%) after surgery. An 8-mm endo-orthotic implant was used in 43 (66%) feet and an Achilles tenotomy was done in 38 feet (59%). The radiographic angles with the greatest degree of correction when compared to preoperative angles were the talar-first metatarsal angle (99%) and the calcaneal-pitch (36%). After placement of the endo-orthotic implant, the talar angle influenced the rest of the radiographic measurements. There was no postoperative deterioration in any of the radiographic angles measured during the monitoring period. Complications occurred in 10.7% of the patients, with postoperative pain being the most frequently reported (6% of patients). There was no infection or local reaction to a foreign body. Removal of the endo-orthotic implant was not done on a routine basis.
  
  
  CONCLUSIONS
  This operative technique respects the anatomical structure of the foot and produces good clinical and radiographic results.
authors.affiliation: Paediatric Orthopaedic Department, Department of Orthopaedic Surgery and Traumatology of the Hospital General Universitario de Alicante, Spain. Gutierrez ped@gva.es
authors.forename: Pedro R
authors.initials: PR
authors.lastname: Gutiérrez
authors.forename: Manuel Herrera
authors.initials: MH
authors.lastname: Lara
mesh_terms: D000125:Achilles Tendon / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005413:Flatfoot / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D019736:Prostheses and Implants; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome