1
|
Talo-navicular and calcaneo-cuboid fusion with PEEK H-pode™ vs. Titanium Maxlock™ locking plates: Comparison of functional and radiographic outcomes. Orthop Traumatol Surg Res 2023; 109:103343. [PMID: 35660079 DOI: 10.1016/j.otsr.2022.103343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Locking plates are increasingly used to achieve hindfoot fusion. The objective of this study was to compare hindfoot fusion outcomes with the PEEK H-pode™ (Biotech™) locking plate and the titanium Maxlock™ (Tornier-Wright™) locking plate. HYPOTHESIS A polyetheretherketone (PEEK) H-pode™ locking plate provides similar fusion rates to a titanium Maxlock™ locking plate for talo-navicular and calcaneo-cuboid arthrodesis. METHODS We conducted a retrospective comparative study in 39 patients (including 21 [54%] with pes planovalgus and 11 [28%] with neurological equinovarus deformities) who underwent talo-navicular and/or calcaneo-cuboid fusion, usually combined with subtalar fusion. The first 17 patients (January 2014-February 2016) were managed with Maxlock™ locking plates and the next 22 patients (March 2016-August 2018) with H-pode™ locking plates. These two cohorts of consecutive patients were comparable regarding age, sex distribution, body mass index, and comorbidities. At last follow-up more than 1year after surgery, we compared functional scores, pain intensity, and fusion assessed by radiographs and computed tomography (CT) (threshold set at 33%). RESULTS Mean follow-up was 42months (range: 34-63months) in the Maxlock™ group and 25months (range: 12-36months) in the H-pode™ group. At last follow-up, the two groups were not significantly different for the mean values of the American Orthopedic Foot & Ankle Society score, European Foot & Ankle Society score, and visual analogue scale pain score. Neither were the two groups significantly different for talo-navicular and calcaneo-cuboid fusion by CT. In the Maxlock™ group, we found non-significant trends towards a higher proportion of patients with talo-navicular nonunion (18% vs. 5% in the H-pode™ group) and weaker talo-navicular fusion in patients with pes planovalgus (60.8% vs. 82.0%, respectively). Radiographic results overestimated the fusion rates. DISCUSSION Talo-navicular and calcaneo-cuboid fusion was not significantly different with H-pode™ and Maxlock™ locking plates. CT was more accurate than standard radiography to assess fusion. These results underline the usefulness of PEEK locking plates for talo-navicular and calcaneo-cuboid fusion; moreover, the radiolucency of PEEK facilitates the interpretation of radiographs. LEVEL OF EVIDENCE IV.
Collapse
|
2
|
Lui TH. Synovitis of the Tarsal Canal: An Uncommon Cause of Lateral Heel Pain After Triple Arthrodesis. J Foot Ankle Surg 2017; 56:255-257. [PMID: 28231962 DOI: 10.1053/j.jfas.2016.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Indexed: 02/03/2023]
Abstract
Lateral heel pain after triple arthrodesis can have numerous causes, including nonunion of the fusion site, hindfoot malalignment, degenerative arthritis in adjacent joints, and deep infection. We present a case of lateral heel pain after triple arthrodesis due to synovitis of the tarsal canal that was successfully treated with anterior subtalar arthroscopy.
Collapse
Affiliation(s)
- Tun Hing Lui
- Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, New Territories, Hong Kong Special Administrative Region, China.
| |
Collapse
|
3
|
Aarts CAM, Heesterbeek PJC, Jaspers PEM, Stegeman M, Louwerens JWK. Does osteoarthritis of the ankle joint progress after triple arthrodesis? A midterm prospective outcome study. Foot Ankle Surg 2016; 22:265-269. [PMID: 27810026 DOI: 10.1016/j.fas.2015.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 10/13/2015] [Accepted: 11/19/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Debate exists regarding the effect of triple fusion on the development of osteoarthritis (OA) of the ankle joint. The midterm outcome after triple arthrodesis and the prevalence of OA following triple arthrodesis are reported in this study. The role of alignment in the development of OA was investigated. METHODS Seventy five patients (87 feet) were evaluated in 2003 and of these, 48 patients (55 feet) were available for second evaluation in 2008. X-rays of the ankles and feet were made prior to surgery, in 2003 and in 2008, and the level of osteoarthritis (OA) was graded with the Kellgren and Lawrence score. Of all postoperative X-rays, the AP and lateral talo first metatarsal angle X-rays were compared. Also, standardized digital photos were made to assess the geometry/alignment. The Foot Function Index (FFI) and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were completed. In order to investigate the role of the underlying alignment on the aggravation of ankle osteoarthritis, patients were divided into a 'varus' and a 'valgus' group based on the indication for surgery. RESULTS The outcome scores (AOFAS and FFI) after triple arthrodesis remained stable in the present 7.5-year follow-up study. An important increase of OA of the ankle was not established, 58% of the patients showed no aggravation, 31% one-grade and 2% two-grade increase of OA. A trend was found (P=.063) towards aggravation of OA of the ankle in patients of the varus group with the highest medial arches (persistent cavovarus deformity). CONCLUSION This study reports minor, not statistically significant, changes of the ankle joint following triple arthrodesis after 7.5 years. Clinical outcome remained stable in time. Clinical relevance It seems that triple arthrodesis as such does not lead to major osteoarthritis of the ankle, given that adequate alignment of the hindfoot is achieved. LEVEL OF EVIDENCE Level II, retrospective study.
Collapse
Affiliation(s)
- Chris A M Aarts
- Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, the Netherlands.
| | | | - Perry E M Jaspers
- Department of Orthopaedics, Bernhoven Ziekenhuis, Uden, the Netherlands
| | - Mark Stegeman
- Department of Orthopaedics, Maartenskliniek Woerden, Woerden, the Netherlands
| | | |
Collapse
|
4
|
Hahn T, Carl HD, Jendrissek A, Brem M, Swoboda B, Rummel P, Pauser J. Assessment of plantar pressure in hindfoot relief shoes of different designs. J Am Podiatr Med Assoc 2016; 104:19-23. [PMID: 24504572 DOI: 10.7547/0003-0538-104.1.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although there are several different concepts of hindfoot relief footwear, there are no studies on the extent of pressure reduction to be achieved by this footwear. Therefore, we sought to evaluate the reduction in plantar pressure to be achieved with two different hindfoot relief shoes. METHODS Ten healthy volunteers performed three trials at a self-selected speed. Peak pressure values in mass-produced shoes (normal gait) were considered as 100% and were compared with measurements in two differently designed hindfoot relief shoes. Foot portions were defined as heel (0%-15% of total insole length), hindfoot (16%-30%), midfoot (31%-60%), and forefoot (61%-100%). RESULTS Heel and hindfoot peak pressures were significantly reduced in both shoes compared with normal gait (P < .05), but the extent of peak pressure reduction under the heel and hindfoot varied significantly between the tested shoes. Midfoot peak pressure was not significantly reduced in tested shoes compared with baseline (P > .05) but differed significantly between the two shoes. Forefoot peak pressure was significantly reduced with one of the tested shoes (to a median 73% baseline; P = .004) but not with the other (median, 88% baseline). CONCLUSIONS Hindfoot relief shoes leave a considerable amount of peak pressure, predominantly under the hindfoot. The extent of peak pressure reduction for the heel and the hindfoot varies between different hindfoot relief shoes. Depending on the affected foot area, the kind of hindfoot relief shoe should be carefully chosen.
Collapse
Affiliation(s)
- Thomas Hahn
- Division of Orthopaedic Rheumatology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | | | | | |
Collapse
|
5
|
Genc Y, Gultekin A, Duymus TM, Mutlu S, Mutlu H, Komur B. Pedobarography in the Assessment of Postoperative Calcaneal Fracture Pressure With Gait. J Foot Ankle Surg 2015; 55:99-105. [PMID: 26364236 DOI: 10.1053/j.jfas.2015.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to evaluate the benefits and importance of pedobarography in the diagnosis and treatment of plantar pressure changes in the postoperative follow-up of calcaneus fractures treated with open reduction and internal fixation. The 28 patients included 23 males (82%) and 5 females (18%). The clinical evaluation was performed using the American Orthopaedic Foot and Ankle Society hindfoot scoring system. The Böhler and Gissane angles were measured on the preoperative and postoperative radiographs. In the postoperative follow-up period (mean ± standard deviation 22.25 ± 10.8 months), all the patients underwent analysis with a dynamic pedobarogram. Because the arch index of the operated feet was 29.73% and that of the nonoperated feet was 28.94%, a similar slightly low arch was seen in both feet (p = .078). When the plantar surface maximum pressures were evaluated, a significant reduction was seen in the operated feet in the second, third, fourth, and fifth metatarsals and the medial hindfoot (p < .05). Displaced intra-articular calcaneus fractures resulted in a significant reduction in maximum pressure of the second, third, fourth, and fifth metatarsals and the medial hindfoot. Also, the hindfoot pressure was lateralized. Pedobarography is a simple and useful method for the diagnosis of plantar pressure changes occurring postoperatively.
Collapse
Affiliation(s)
- Yasin Genc
- Orthopaedic Surgeon, Department of Orthopaedics, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Alper Gultekin
- Orthopaedic Surgeon, Department of Orthopaedics, Kocaeli Derince Training and Research Hospital, Istanbul, Turkey
| | - Tahir Mutlu Duymus
- Orthopaedic Surgeon, Department of Orthopaedics, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Serhat Mutlu
- Orthopaedic Surgeon, Department of Orthopaedics, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey.
| | - Harun Mutlu
- Orthopaedic Surgeon, Department of Orthopaedics, Taksim Training and Research Hospital, Istanbul, Turkey
| | - Baran Komur
- Orthopaedic Surgeon, Department of Orthopaedics, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
6
|
Röhm J, Zwicky L, Horn Lang T, Salentiny Y, Hintermann B, Knupp M. Mid- to long-term outcome of 96 corrective hindfoot fusions in 84 patients with rigid flatfoot deformity. Bone Joint J 2015; 97-B:668-74. [PMID: 25922462 DOI: 10.1302/0301-620x.97b5.35063] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Talonavicular and subtalar joint fusion through a medial incision (modified triple arthrodesis) has become an increasingly popular technique for treating symptomatic flatfoot deformity caused by posterior tibial tendon dysfunction. The purpose of this study was to look at its clinical and radiological mid- to long-term outcomes, including the rates of recurrent flatfoot deformity, nonunion and avascular necrosis of the dome of the talus. A total of 84 patients (96 feet) with a symptomatic rigid flatfoot deformity caused by posterior tibial tendon dysfunction were treated using a modified triple arthrodesis. The mean age of the patients was 66 years (35 to 85) and the mean follow-up was 4.7 years (1 to 8.3). Both clinical and radiological outcomes were analysed retrospectively. In 86 of the 95 feet (90.5%) for which radiographs were available, there was no loss of correction at final follow-up. In all, 14 feet (14.7%) needed secondary surgery, six for nonunion, two for avascular necrosis, five for progression of the flatfoot deformity and tibiotalar arthritis and one because of symptomatic overcorrection. The mean American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score) at final follow-up was 67 (between 16 and 100) and the mean visual analogue score for pain 2.4 points (between 0 and 10). In conclusion, modified triple arthrodesis provides reliable correction of deformity and a good clinical outcome at mid- to long-term follow-up, with nonunion as the most frequent complication. Avascular necrosis of the talus is a rare but serious complication of this technique.
Collapse
Affiliation(s)
- J Röhm
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - L Zwicky
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - T Horn Lang
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - Y Salentiny
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - B Hintermann
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - M Knupp
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| |
Collapse
|
7
|
Schaefer A, Hotfiel T, Pauser J, Swoboda B, Carl HD. Incompliance of total hip arthroplasty (THA) patients to limited weight bearing. Arch Orthop Trauma Surg 2015; 135:265-269. [PMID: 25527185 DOI: 10.1007/s00402-014-2134-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Limited weight bearing of the lower extremity is a commonly applied procedure in orthopedic rehabilitation following trauma surgery and joint replacement. The compliance of patients with limited weight bearing after cementless total hip arthroplasty has not yet been surveyed using sensor-loaded insoles. The objective of this study was to investigate foot loadings in patients after THA under the assumption of limited weight bearing. METHODS Peak pressures for the hindfoot, midfoot and forefoot were obtained from 14 patients (10 women, 4 men, age 63 ± 12 years, height 172 ± 9 cm, weight 92 ± 20 kg, BMI 31 ± 6 kg/m(2)) by means of dynamic pedobarography, with full weight bearing preoperatively (baseline) and at 8-10 days after cementless total hip arthroplasty, walking again on even floor, and also walking upstairs and downstairs with a restriction of weight bearing to 10 % body weight, taught by an experienced physiotherapist with a bathroom scale. RESULTS Foot loadings with limited weight bearing on even floor remained up to 88 % from full weight bearing preoperatively. Walking upstairs and downstairs under the same condition was approximately equal to a bisection of peak pressures from full weight bearing. CONCLUSIONS Patients following cementless do not comply with limited weight bearing when they are trained by the use of a bathroom scale.
Collapse
Affiliation(s)
- Anja Schaefer
- Division of Orthopedic Rheumatology, University of Erlangen-Nuremberg, Rathsberger Strasse 57, 91054, Erlangen, Germany
| | - Thilo Hotfiel
- Division of Orthopedic Rheumatology, University of Erlangen-Nuremberg, Rathsberger Strasse 57, 91054, Erlangen, Germany
| | - Johannes Pauser
- Division of Orthopedic Rheumatology, University of Erlangen-Nuremberg, Rathsberger Strasse 57, 91054, Erlangen, Germany
| | - Bernd Swoboda
- Division of Orthopedic Rheumatology, University of Erlangen-Nuremberg, Rathsberger Strasse 57, 91054, Erlangen, Germany
| | - Hans-Dieter Carl
- Division of Orthopedic Rheumatology, University of Erlangen-Nuremberg, Rathsberger Strasse 57, 91054, Erlangen, Germany.
| |
Collapse
|
8
|
Moore BE, Wingert NC, Irgit KS, Gaffney CJ, Cush GJ. Single-incision lateral approach for triple arthrodesis. Foot Ankle Int 2014; 35:896-902. [PMID: 25005551 DOI: 10.1177/1071100714539658] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Triple arthrodesis is a powerful hindfoot corrective procedure involving fusion of the talonavicular (TN), calcaneocuboid (CC), and subtalar (ST) joints. A 2-incision approach, a single-incision medial triple arthrodesis, and a single-incision medial double arthrodesis are well described. We present a single-incision lateral approach to triple arthrodesis. METHODS We retrospectively reviewed 70 patients who underwent triple arthrodesis at our institution from 2007 to 2011. Patients had either double-incision (n = 33) or single-incision lateral (n = 37) triple arthrodesis. A single surgeon performed all procedures. The most common diagnosis was stage III planovalgus deformity. Deformity correction, union rate, time of surgery, complications, wound healing, reoperations, and pre- and postoperative visual analog scale (VAS) pain scores were analyzed for both groups. RESULTS There were no statistical differences in deformity correction, wound healing, complications, reoperations, or improvement in VAS pain scores. Operation time was significantly shorter in the single-incision lateral group (86 minutes vs 95 minutes, P = .0395). There was no difference in union rates with regard to the TN, ST, or CC joints. Five patients had radiographic nonunions of the CC joint between both groups. CONCLUSIONS This is the first study that presents outcomes of a single lateral approach for triple arthrodesis. The single-incision approach was faster. The low rate of symptomatic nonunions suggests that fusion of the CC joint may not be important in symptomatic relief or deformity correction. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
|
9
|
Schuh R, Salzberger F, Wanivenhaus AH, Funovics PT, Windhager R, Trnka HJ. Kinematic changes in patients with double arthrodesis of the hindfoot for realignment of planovalgus deformity. J Orthop Res 2013. [PMID: 23192937 DOI: 10.1002/jor.22269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Double fusion (i.e., fusion of the subtalar and talonavicular joint) represents a modification of triple arthrodesis preserving integrity of the calcaneocuboidal joint. Our aims were (1) to evaluate dynamic plantar pressure distribution in patients undergoing double arthrodesis, (2) to obtain a comparison of kinematic changes to healthy feet, (3) to evaluate the influence of radiographic alignment, and (4) to assess functional outcome. Sixteen feet (14 patients) treated by double fusion due to fixed planovalgus deformity were included. Dynamic plantar pressure distribution was assessed using a capacitive pressure platform. Results were compared with a demographically matched control group. Clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) score and radiographic assessment included measurement of talometatarsal, calcaneal pitch, and talocalcaneal (TC) angle on lateral radiographs. Significant differences in plantar pressure distribution were found for maximum force of the hindfoot, midfoot, and big toe region: While the hindfoot and hallux represented decreased load in the double arthrodesis patients, load increased in the midfoot region compared with healthy controls. The lateral talus-first metatarsal-angle increased from -16.3° to -8.2°, and the TC angle decreased from 41.3° to 35.8° (p < 0.05). The pre- and post-operative AOFAS score increased from 37 points (SD, 16.3) to 70 points (SD, 16.7). These results revealed that double arthrodesis represents a reliable method for correction of planovalgus deformity. Compared with healthy feet, force transmission of the midfoot is increased whereas push-off force decreases.
Collapse
Affiliation(s)
- Reinhard Schuh
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
10
|
Munoz MA, Augoyard R, Canovas F. Surgical treatment of hindfoot inflammatory diseases: 107 arthrodesis. Orthop Traumatol Surg Res 2012; 98:S85-90. [PMID: 22939106 DOI: 10.1016/j.otsr.2012.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/29/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In rheumatoid diseases, hindfoot arthrodesis abolishes pain and corrects deformity. The choice between selective and double arthrodesis depends on whether the hindfoot malalignment is fixed or not. Indications for surgery are well codified. The various types of arthrodesis have never been assessed together on a large series. We here report a series that is substantial in numbers and in follow-up. MATERIALS AND METHODS A continuous single-center retrospective study included patients with native hindfoot inflammatory disease treated by arthrodesis between 1996 and 2009. RESULTS Around 80% of patients were followed up, for a mean 7 years. Fifty-four isolated talonavicular arthrodeses, 14 talocalcaneal arthrodeses and 39 double arthrodeses were performed. 96% of patients had rheumatoid arthritis and 4% spondylarthritis. 62% were completely pain-free at follow-up. The satisfaction rate was 91% and mean AOFAS score 70%. 6% of patients showed symptomatic non-union, mainly associated with talonavicular arthrodesis. In 22% of double arthrodeses and 11% of talonavicular arthrodeses, ankle status required surgical revision. In double arthrodesis, there was no correlation between hindfoot deviation and secondary deterioration in ankle status. Talocalcaneal arthrodesis was associated with radiologic hindfoot varus, both preoperatively and at follow-up. DISCUSSION Non-union was the main complication in talonavicular arthrodesis. The rate of secondary ankle surgery was significantly elevated in double arthrodesis. These findings support Suckel's cadaver studies, which, in 2007, reported early deterioration in ankle status in double arthrodesis, due to mechanical overloading. Talocalcaneal arthrodesis proved reliable and simple, free of major complications and with a 100% satisfaction rate. CONCLUSION Double arthrodesis showed the greatest benefit in terms of restoring foot architecture, but was associated with a higher rate of deterioration in ankle status. Preventive double arthrodesis is not recommended in case of isolated arthritis with reducible hindfoot malalignment.
Collapse
Affiliation(s)
- M A Munoz
- Hip, Knee and Foot Surgery Medical Unit, Lapeyronie University Hospital (Montpellier-1 University), 271, avenue Doyen-Gaston-Giraud, 34000 Montpellier, France.
| | | | | | | |
Collapse
|
11
|
Abstract
The traditional surgical treatment for adults with a rigid, arthritic flatfoot is a dual-incision triple arthrodesis. Over time, this procedure has proved to be reliable and reproducible in obtaining successful deformity correction through fusion and good clinical results. However, the traditional dual-incision triple arthrodesis is not without shortcomings. Early complications include lateral wound problems, malunion, and nonunion. Long-term follow-up of patients after a triple arthrodesis has shown that many develop adjacent joint arthritis at the ankle or midfoot. This particular problem should be considered an expected consequence, rather than a failure of the procedure. Although the indications for and surgical techniques used in triple arthrodesis have evolved and improved with time (predictably improving results in the intermediate term), the triple arthrodesis should be regarded as a salvage procedure. Certain measures can be taken by the surgeon to avoid some problems. If patients are at risk for lateral wound complications, the arthrodesis could be performed through a single medial incision. However, this can make some aspects of the CC fusion more difficult. Implants would have to be inserted percutaneously, which prevents the surgeon from using either staples or plates. If a patient were to need a lateral column lengthening through a CC distraction fusion, this would not be possible medially. If either the ST or CC joints have minimal degenerative changes, they could be spared through a double or modified double arthrodesis, respectively. Although these procedures that deviate from the traditional triple arthrodesis offer promise, further study is required to better define their role in treatment of the rigid, arthritic AAFD. Triple arthrodesis is, by no means, a simple surgery. It requires preoperative planning, meticulous preparation of bony surfaces, cognizance of hindfoot positioning, and rigidity of fixation. The procedure also requires enough experience on the part of the operating surgeon to anticipate postoperative problems and provide modifications in traditional technique for certain patients.
Collapse
|
12
|
Pauser J, Jendrissek A, Brem M, Gelse K, Swoboda B, Carl HD. Foot loading with an ankle-foot orthosis: the accuracy of an integrated physical strain trainer. INTERNATIONAL ORTHOPAEDICS 2012; 36:1411-5. [PMID: 22358175 DOI: 10.1007/s00264-012-1501-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/17/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the value of a built-in physical strain trainer for the monitoring of partial weight bearing with an ankle-foot orthosis. METHODS 12 healthy volunteers were asked to perform three trials. Plantar peak pressure values from normal gait (trial one) were defined as 100% (baseline). The following trials were performed with the Vacoped® dynamic vacuum ankle orthosis worn in a neutral position with full weight bearing (trial two) and a restriction to 10% body weight (BW) (trial three), as monitored with an integrated physical strain trainer. Peak plantar pressure values were obtained using the pedar® X system. RESULTS Peak pressure values were statistically significantly reduced wearing the Vacoped® shoe with full weight bearing for the hindfoot to 68% of the baseline (normal gait) and for the midfoot and forefoot to 83% and 60%, respectively. Limited weight bearing with 10% BW as controlled by physical strain trainer further reduced plantar peak pressure values for the hindfoot to 19%, for the midfoot to 43% of the baseline and the forefoot to 22% of the baseline. CONCLUSIONS The Vacoped® vacuum ankle orthosis significantly reduces plantar peak pressure. The integrated physical strain trainer seems unsuitable to monitor a limitation to 10% BW adequately for the total foot. The concept of controlling partial weight bearing with the hindfoot-addressing device within the orthosis seems debatable but may be useful when the hindfoot in particular must be off-loaded.
Collapse
Affiliation(s)
- Johannes Pauser
- Division of Orthopedic Rheumatology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | | | |
Collapse
|
13
|
Inaccuracy of a physical strain trainer for the monitoring of partial weight bearing. Arch Phys Med Rehabil 2011; 92:1847-51. [PMID: 21840501 DOI: 10.1016/j.apmr.2011.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/08/2011] [Accepted: 06/10/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the use of a physical strain trainer for the monitoring of partial weight bearing. DESIGN Case series with healthy volunteers. SETTING Orthopedic clinic. PARTICIPANTS Healthy volunteers (N=10) with no history of foot complaints. INTERVENTIONS Volunteers were taught to limit weight bearing to 10% body weight (BW) and 50% BW, monitored by a physical strain trainer. MAIN OUTCOME MEASURES The parameters peak pressure, maximum force, force-time integral, and pressure-time integral were assessed by dynamic pedobarography when volunteers walked with full BW (condition 1), 50% BW (condition 2), and 10% BW (condition 3). RESULTS With 10% BW (condition 3), forces with normative gait (condition 1) were statistically significantly reduced under the hindfoot where the physical strain trainer is placed. All pedobarographic parameters were, however, exceeded when the total foot was measured. A limitation to 10% BW with the physical strain trainer (condition 3) was equal to a bisection of peak pressure and maximum force for the total foot with normative gait (condition 1). Halved BW (condition 2) left a remaining mean 82% of peak pressure and mean 59% of maximum force from full BW (condition 1). CONCLUSIONS The concept of controlling partial weight bearing with the hindfoot-addressing device does not represent complete foot loading. Such devices may be preferably applied in cases when the hindfoot in particular must be off-loaded. Other training devices (eg, biofeedback soles) that monitor forces of the total foot have to be used to control partial weight bearing of the lower limb accurately.
Collapse
|
14
|
Schuh R, Hofstaetter JG, Hofstaetter SG, Adams SB, Kristen KH, Trnka HJ. Plantar pressure distribution after tibiotalar arthrodesis. Clin Biomech (Bristol, Avon) 2011; 26:620-5. [PMID: 21392869 DOI: 10.1016/j.clinbiomech.2011.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Arthrodesis is a well-established treatment option for end-stage osteoarthritis of the ankle. Osteoarthritis of the ankle can alter plantar pressure distribution. However, surprisingly little is known about the effect of ankle arthrodesis to alter plantar pressure distribution. The purpose of this study was to determine plantar pressure distribution in a selected group of patients with unilateral arthrodesis of the ankle joint. METHODS 20 patients with an average age of 60 years who underwent isolated unilateral ankle arthrodesis using a 3-crossed screw technique by a single surgeon were included. After a mean of 25 months (range 12-75 months) post surgery plantar pressure distribution was determined in five regions of the foot. The outcome was evaluated clinically, using the American Orthopaedic Foot and Ankle Society hindfoot score, as well as radiographically. The contralateral normal foot was used as a control. FINDINGS Comparing the foot that underwent tibiotalar arthrodesis to the contralateral normal foot, differences were found in the peak pressure and maximum force in the toe region and the lateral midfoot region. In addition, a decrease in the contact time in the forefoot region and a decrease of the contact area in the toe region of the operated foot were identified. The other regions did not show a significant difference. The mean American Orthopaedic Foot and Ankle Society score of the operated leg was 79 (range 46-92) at the last follow up, and the mean fixation angle of the arthrodesis on lateral weight bearing radiographs was 90° (range 86°-100°). INTERPRETATION Our results indicate that arthrodesis of the ankle joint can provide high levels of function with minimal changes in the plantar pressure distribution.
Collapse
Affiliation(s)
- Reinhard Schuh
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria.
| | | | | | | | | | | |
Collapse
|