Subtalar Extra-articular Screw Arthroereisis (SESA)

Subtalar extra-articular screw arthroereisis (SESA) is a minimally invasive surgical procedure that was developed in Europe over the past several decades and is now being investigated as a potential treatment option for flexible flatfoot in children in the United States. SESA is a procedure that aims to correct flatfoot with a less invasive approach than traditional foot reconstruction surgery. Boston Children's Hospital is one of the key centers in the U.S. studying and offering this innovative treatment option.

Flexible flatfoot is a condition in which the arch of the foot collapses when a person stands or walks. In most cases, flexible flatfoot doesn't require treatment or can be managed with conservative options like physical therapy and orthotics (shoe inserts). However, for some children and teens, flexible flatfoot can cause significant pain and limit their ability to participate in activities.

SESA involves placing a small screw outside the subtalar joint (the joint below the ankle) to help stimulate the calf and foot muscles to better support the arch of the foot. The screw is typically removed after a few years, once the muscles and ligaments in the foot have adapted to the corrected position. In early studies, the screw has been typically removed within three years.

Some children with flexible flatfoot also have a tight Achilles tendon. If this is the case, the surgeon can lengthen the tendon when they perform the SESA operation.

Children are usually able to walk without crutches in less than a week after SESA surgery. Children who also have their Achilles tendon lengthened during the operation typically wear a walking cast for a month before transitioning to a boot and physical therapy. Most children can return to sports within a couple of months. After SESA surgery, the foot may feel achy while the muscles in the foot adjust to having an arch. This is normal and the discomfort usually goes away within a couple of months.

SESA is not yet the standard of care for flexible flatfoot and may not be appropriate for all children. If your child is experiencing pain or limitations due to flatfoot, it's important to consult with a pediatric orthopedic specialist to discuss all available treatment options, including conservative treatments and surgical options like SESA or foot reconstruction. Some children and adolescents may not be eligible for SESA if they have certain conditions, or their skeleton is more like an adult skeleton. This is why consulting with a pediatric orthopedic surgeon is important.

• SESA is a minimally invasive surgical alternative to traditional foot reconstruction.
• SESA is a newer procedure, and long-term outcomes are still being studied.
• SESA may be an option for children with painful flexible flatfoot who have not responded to conservative treatments.
• A pediatric orthopedic specialist can help determine if SESA is the right treatment option for your child.

Important note: SESA is an investigational procedure. Its long-term effectiveness and safety are still being evaluated. Boston Children's Hospital is committed to advancing the understanding of this new technique through ongoing research and clinical studies.