A flatfoot deformity in skeletally mature patients, now commonly described as a progressive collapsing foot deformity (PCFD), is a complex, multifactorial condition. Subtalar arthroereisis is a joint-preserving procedure designed to limit pathological subtalar pronation. While previously primarily used in paediatric patients, it has been increasingly used in adult PCFD reconstruction. The aim of this review was to evaluate the current evidence regarding the types of implants, the biomechanics, indications, complications, and clinical outcomes of the use of subtalar arthroereisis in adults. It has been suggested in biomechanical studies that the use of a subtalar arthroereisis can reduce medial column load and improve multiplanar correction. However, clinical outcomes depend on the correct sizing and positioning of the implant. Although subtalar arthroereises have been reported as a standalone procedure in a few studies, there remains too little information to allow guidance as to the correct indications for their use. It has more commonly been used as an adjunct in PCFD reconstruction, and improvements in radiological abduction of the mid- and forefoot have been reported in these studies without necessarily improving patient-reported outcomes. Comparative studies in which subtalar arthroereisis has been used as an alternative to lateral column lengthening in patients with significant forefoot abduction suggest similar radiological and clinical improvements. Sinus tarsi pain is the most frequent complication of subtalar arthroereisis, with rates of implant removal of between 6% and 48%. Most studies report that the correction of the deformity is maintained after removal of the implant. Thus, its role seems mainly to allow adjunctive bony and soft-tissue procedures to heal in the early postoperative period. Removal of the implant results in symptomatic improvement in between 62% and 100% of patients, suggesting that sinus tarsi pain may not be solely due to irritation associated with the implant. Overall, it appears that the use of a subtalar arthroereisis can further improve the correction of forefoot and midfoot abduction when used as an adjunct to other froms of surgery, and may have a role in the treatment of the class B component of flexible PCFD or as an alternative to lateral column lengthening. The evidence for its use in patients who undergo surgery for PCFD, however, remains of low quality, lacking a standardized PCFD-based classification; future prospective comparative trials are needed to clarify the indications, cost-effectiveness, and long-term outcomes. Cite this article: Bone Joint J 2026;108-B(3):407–415.
Loizou et al. (Sun,) studied this question.