{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:21Z","timestamp":1787755521900,"version":"build-2784847793"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pediatric flexible flatfoot (FFF) is a common condition characterized by the collapse of the medial longitudinal arch, which can lead to pain and functional impairment in a subset of patients. Subtalar arthroereisis (AR) is a minimally invasive procedure that corrects FFF by limiting excessive pronation of the subtalar joint. Two main techniques exist: endosinotarsal AR, which involves placing an implant in the sinus tarsi, and exosinotarsal AR, which uses a screw external to the sinus tarsi. This systematic review and meta-analysis compares the clinical outcomes and complication rates of these 2 techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted in Scopus, Web of Science, and PubMed. Only comparative clinical studies comparing endosinotarsal and exosinotarsal AR in pediatric patients with FFF were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 6 studies involving 791 feet were analyzed. The exosinotarsal group showed a statistically significant improvement in talocalcaneal (Kite) angle (mean difference = \u22121.14; p = 0.04), although the difference may not be clinically significant. Calcaneal pitch angle analysis revealed no significant difference, but sensitivity analysis favored the exosinotarsal technique when 1 study was excluded (mean difference = \u22122.21; p = 0.004). Postoperative pain was reported with higher rates in the exosinotarsal group, as well as screw breakage, while the endosinotarsal group had higher rates of implant dislocation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Both techniques effectively treat pediatric FFF, but exosinotarsal AR may offer better structural correction. However, it may be associated with higher rates of pain that tend to recede after 6 months from the operation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.rvw.24.00178","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T14:00:56Z","timestamp":1735653656000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Endosinotarsal vs. Exosinotarsal Subtalar Arthroereisis in Treating Pediatric Flexible Flat Feet"],"prefix":"10.2106","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7705-0335","authenticated-orcid":false,"given":"Ahmed O.","family":"Sabry","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Cairo University, Cairo, Egypt"},{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8234-1557","authenticated-orcid":false,"given":"Mohamed K.A.","family":"Genedy","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7112-0952","authenticated-orcid":false,"given":"M.","family":"Hennidi","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4657-0272","authenticated-orcid":false,"given":"Mohamed A.","family":"Shebl","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4458-3846","authenticated-orcid":false,"given":"Ahmed","family":"Zaky","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cairo University, Cairo, Egypt"},{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0039-2603","authenticated-orcid":false,"given":"Osama E.M.","family":"Selim","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2990-5962","authenticated-orcid":false,"given":"Menna A.","family":"Shebl","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3601-7843","authenticated-orcid":false,"given":"Mohamed T.G.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4830-4067","authenticated-orcid":false,"given":"Osama","family":"Almohani","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4070-8907","authenticated-orcid":false,"given":"Merna","family":"Arid","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Network, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0112-4147","authenticated-orcid":false,"given":"Amr 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