The Viladot implant in flatfooted children

In 1991, Viladot(1) described an implant for the treatment of painless flat feet in children. This was inserted through a double approach to allow the talus to function while limiting its ability to slide off the calcaneus. Th e wineglass shaped prosthesis was inserted into the sinus tarsi with a tibi alis posterior advancement and soft tissue correction to allow the foot to adopt a neutral position. This is in keeping with other procedures describe d for the correction of flatfoot, Viladot reported excellent results in 234 feet operated on in such a manner using clinical, radiological and photopo dographic parameters. In Sheffield, over three years, 22 implants were inse rted for similar painless flatfeet in children. The results were assessed u sing clinical, radiological and pedobarographic parameters. Viladot was able to demonstrate an improvement in all cases, clinically, ra diologically and photopodographically with little or no discomfort and a re turn to preoperative levels of activity including sport, We found that in a ll cases, postoperative pain was a major feature which limited activity in all but 2 feet and which reduced the ability to take part in sport and othe r preoperative pastimes, Unlike Viladot, we were unable to demonstrate cons istent improvements radiologically, Pedobarographically, the loading of the first metatarsal head remained unchanged and the centre of pressure was co rrected in only 14%.