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Bakaes Y, Gonzalez T, Hardin JW, Jackson JB. Comparison of the Acute Postoperative Complications Between Isolated Talonavicular Versus Talonavicular and Subtalar (Double) Arthrodesis in Flatfoot Deformity. Foot Ankle Spec 2024:19386400231221711. [PMID: 38185852 DOI: 10.1177/19386400231221711] [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] [Indexed: 01/09/2024]
Abstract
BACKGROUND Both isolated talonavicular arthrodesis and talonavicular and subtalar (such as double) arthrodesis can be effective treatments for adult-acquired flatfoot deformity (AAFD) with good success rates, but double arthrodesis has become more commonly performed in recent years. The purpose of this study is to evaluate whether isolated talonavicular versus talonavicular and subtalar arthrodesis led to significantly different 30-day postoperative complication rates in patients with AAFD. METHODS We performed a retrospective review to identify a large cohort of adult patients with the diagnosis of AAFD or posterior tibial tendon deformity (PTTD) who underwent isolated talonavicular or talonavicular and subtalar arthrodesis between 2006 and 2020 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). To investigate whether there was a difference in complication rate between the 2 surgical cohorts, we estimated logistic regression models and log-binomial models on each of the outcomes while also adjusting for sex and age. RESULTS We found that there was no significant difference in the rate of major complications (P = .567) or readmissions (P = .567) between patients who underwent isolated talonavicular versus talonavicular and subtalar arthrodesis for AAFD. However, there was a significantly higher rate of minor complications in patients who underwent isolated talonavicular arthrodesis when compared with patients who underwent talonavicular and subtalar arthrodesis (P = .009). CONCLUSION This study found that there was no increased risk of 30-day postoperative complications or readmissions with talonavicular and subtalar arthrodesis when compared with isolated talonavicular arthrodesis for AAFD. In addition, there was no increased risk of major complications for talonavicular and subtalar arthrodesis when compared with isolated talonavicular arthrodesis, and isolated talonavicular arthrodesis actually carried a higher risk of minor complications for this surgical cohort. This may provide valuable information for surgeons considering surgical treatment for a particular case of AAFD. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yianni Bakaes
- University of South Carolina School of Medicine Columbia, Columbia, South Carolina
| | - Tyler Gonzalez
- Department of Orthopaedics, University of South Carolina, Columbia, South Carolina
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - J Benjamin Jackson
- Department of Orthopaedics, University of South Carolina, Columbia, South Carolina
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Gauthier C, Bakaes Y, Martinez M, Hardin J, Gonzalez T, Jackson JB. Retrospective Review of Complications and Revision Rates Between Isolated Talonavicular vs Talonavicular and Subtalar (Double) Arthrodesis vs Triple Arthrodesis. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241231559. [PMID: 38405386 PMCID: PMC10893835 DOI: 10.1177/24730114241231559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Background Hindfoot fusion procedures are common for the treatment of end-stage arthritis or deformity. Surgical treatments for these conditions include talonavicular joint (single) arthrodesis, talonavicular and subtalar (double) arthrodesis, or talonavicular, subtalar, and calcaneocuboid (triple) arthrodesis. This study evaluated the complication rate, revision surgery rate, and hardware removal rate for those treated with either single, double, or triple arthrodesis. Methods A retrospective review was conducted for patients who underwent single (Current Procedural Terminology [CPT] code 28740), double (CPT 28725 and 28740), or triple (CPT 28715) arthrodesis to treat hindfoot arthritis/deformity (International Classification of Diseases, Ninth Revision [ICD-9] code: 734, International Classification of Diseases, Tenth Revision [ICD-10] codes: M76821, M76822, and M76829) from 2005 to 2022 using the South Carolina Revenue and Fiscal Affairs databank. Data collected included demographics, comorbidities, procedure data, and postoperative outcomes within 1 year of principal surgery. Student t test, chi-squared test, and multivariable logistic regression analysis were utilized during data analysis. Results A total of 433 patients were identified, with 248 undergoing single arthrodesis, 67 undergoing double arthrodesis, and 118 undergoing triple arthrodesis. There was no significant difference between single, double, and triple arthrodesis in the rate of complications, hardware removals, revision surgeries, or 30-day readmission when controlling for confounding variables. However, a decrease in Charlson Comorbidity Index (CCI) was found to be predictive of an increase in the revision surgery rate (OR = 0.46, 95% CI 0.22-0.85, P = .02). Conclusion We found no difference in the rate of complications, hardware removals, or revision surgeries in those undergoing single, double, or triple arthrodesis. Surprisingly we found that a lower Charlson Comorbidity Index, indicating a healthier patient had a significant relationship with a higher rate of revision surgery. Further study including radiographic indications for surgery or the impact of overall health status on revision surgery rates may further elucidate the other components of this relationship. Level of Evidence Level III, cohort study.
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Affiliation(s)
- Chase Gauthier
- Department of Orthopedic Surgery, Prisma Health, Columbia, SC, USA
| | - Yianni Bakaes
- Department of Orthopedic Surgery, Prisma Health, Columbia, SC, USA
| | - Matthew Martinez
- Department of Orthopedic Surgery, Prisma Health, Columbia, SC, USA
| | - James Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Tyler Gonzalez
- Department of Orthopedic Surgery, Prisma Health, Columbia, SC, USA
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Sy E, Sorensen MD. Medial Double Arthrodesis Through Single Approach. Clin Podiatr Med Surg 2023; 40:623-632. [PMID: 37716741 DOI: 10.1016/j.cpm.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Triple arthrodesis is a time-tested procedure toward primary salvage in the context of posterior tibial tendon dysfunction, symptomatic rigid and severe hindfoot malalignment, end-stage degenerative and posttraumatic arthritis, and sequelae of paralytic diseases. Today, the indication for hindfoot arthrodesis is applied to correct painful deformities and arthritic joints, such as advanced cases of adult-acquired flatfoot secondary to ligament collapse and insufficiency of the posterior tibial tendon. Although the triple arthrodesis is an effective and reliable outcome procedure, the popularity of a medial double arthrodesis has increased.
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Affiliation(s)
- Edgar Sy
- Weil Foot & Ankle Institute, Chicago, IL, USA.
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4
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Madi NS, Fletcher AN, Easley ME. Double and Triple Tarsal Fusions in the Severe Rigid Flatfoot Deformity. Foot Ankle Clin 2022; 27:805-818. [PMID: 36368798 DOI: 10.1016/j.fcl.2022.08.003] [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] [Indexed: 11/09/2022]
Abstract
A flatfoot deformity is a multiplanar foot deformity characterized by forefoot abduction and supination and hindfoot valgus. With progressive pathology, a rigid deformity may develop. In the setting of a rigid deformity, the appropriate procedure to use is not without controversy. The extent of joints to involve in the arthrodesis depends on the ability to obtain a plantigrade foot. Both double and triple arthrodesis have been suggested. Care must be taken to avoid lateral column shortening and loss of foot reduction when fusing the CC joint. The concerns about lateral skin breakdown led some surgeons to describe a single medial incision for a triple or modified double arthrodesis. The necessity of bone grafting has been controversial. Implant selection is essential to achieve solid stabilization of the arthrodesis sites. To decrease the risk of overcorrection and malunion, the surgeon should be familiar with the hindfoot biomechanics and generate, based on the clinical examination and imaging, a meticulous preoperative plan to address and balance both the soft tissue and bony deformity.
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Affiliation(s)
- Naji S Madi
- Foot & Ankle Surgery, Department of Orthopaedic Surgery, West Virginia University, Morgantown, WV, USA.
| | - Amanda N Fletcher
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
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5
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Cates NK, Mayer A, Tenley J, Wynes J, Tefera E, Steinberg JS, Kim PJ, Weinraub GM. Double Versus Triple Arthrodesis Fusion Rates: A Systematic Review. J Foot Ankle Surg 2022; 61:907-913. [PMID: 35221217 DOI: 10.1053/j.jfas.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Hindfoot arthrodesis is often required for end-staged deformities, such as posterior tibial tendon dysfunction, osteoarthritis, or rheumatoid arthritis. Although the need for hindfoot arthrodesis is generally accepted in severe deformities, there is a debate whether a double or triple arthrodesis should be performed. The aim of our systematic review is to review the fusion rates and mean time to fusion in double and triple arthrodesis. A total of 184 articles were identified using the keyword search through the database of articles published from 2005 to 2017. After review by 3 physicians, a total of 13 articles met the eligibility criteria. The reason for double or triple arthrodesis within the studies were posterior tibial tendon dysfunction, tarsal coalition, degenerative joint disease, osteoarthritis, rheumatoid arthritis, Charcot Marie Tooth, Multiple Sclerosis, Polio, neuromuscular disorder, cerebral palsy, acrodystrophic neuropathy, clubfoot, post-traumatic, and seronegative arthropathy (spondyloarthritis). Within these 13 studies, there were a total of 343 (6-95) subjects extremities operated on. The overall fusion rate for double arthrodesis was 91.75% (289/315) compared to 92.86% (26/28) triple arthrodesis fusion rate, p value .8370. The mean time to fusion for double arthrodesis was 17.96 ± 7.96 weeks compared to 16.70 ± 8.18 weeks for triple arthrodesis, p value = .8133. There are risks associated with triple arthrodesis including increased surgical times, lateral wound complications, residual deformity, surgical costs and peri-articular arthritis. Given the benefits of double arthrodesis over triple arthrodesis and the nearly equivalent fusion rates and time to fusion, double arthrodesis is an effective alternative to triple arthrodesis. The authors of this systematic review recommend double arthrodesis as the hindfoot fusion procedure of choice.
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Affiliation(s)
- Nicole K Cates
- Fellowship Trained Foot and Ankle Surgeon, Hand & Microsurgery Medical Group, San Francisco, CA.
| | - Alissa Mayer
- Resident Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jonathan Tenley
- Resident Physician, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jacob Wynes
- Asistant Professor, Fellowship Program Director, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Eshetu Tefera
- Department of Biostatistician and Biomedical Informatics, MedStar Health Research Institute, Washington, DC
| | - John S Steinberg
- Co-Director of the Center for Wound Healing and Director of Podiatric Residency Training Program, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Paul J Kim
- Professor, Attending Physician, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Glenn M Weinraub
- Attending Physician, Department of Orthopaedics, Kaiser Permanente, San Leandro, CA
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MacDonald A, Anderson M, Soin S, Brodell JD, Flemister AS, Ketz JP. Single Medial vs 2-Incision Approach for Double Hindfoot Arthrodesis: Is There a Difference in Joint Preparation? Foot Ankle Int 2021; 42:1068-1073. [PMID: 34121477 DOI: 10.1177/10711007211001030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Double hindfoot arthrodesis is a reliable treatment option in lower extremity deformity and arthritis. Single (medial) and 2-incision techniques have been described. The purpose of this study was to evaluate the extent of cartilage debrided in each approach and to evaluate the competency of the deltoid ligament. METHODS Eight matched pairs of cadaveric specimens were acquired. One limb from each pair was randomly assigned to the single medial incision and the other to the 2-incision technique. Stress radiographs were obtained prior to dissection to evaluate for valgus tibiotalar tilt. The talonavicular and subtalar articular surfaces were denuded of cartilage and the joints disarticulated. The percentage of cartilage debrided was determined using ImageJ software. Postoperative tibiotalar tilt was measured with a technique and threshold previously described by our group. The intraclass correlation coefficient was calculated to determine inter- and intraobserver reliability. RESULTS The single medial incision demonstrated significantly less cartilage denuded than the 2-incision technique at the talar head (61.1% ± 20.4% vs 88.1% ± 6.1%, P < .001), and the posterior facets of the talus (53.5% ± 7.6% vs 73.6% ± 7.0%, P < .001) and calcaneus (55.3% ± 16.5% vs 81.0% ± 7.4%, P = .001). Overall, 75% of specimens that underwent a single medial incision approach demonstrated increased valgus tibiotalar tilt postdissection, whereas none that underwent the 2-incision technique developed increased tibiotalar tilt (P < .01). The average tibiotalar tilt among these specimens was 4.6 ± 1.3 degrees (range 2.5-5.7 degrees). For all measurements, the intraclass correlation coefficient was greater than 0.8. CONCLUSION The posterior facet of the subtalar joint and talar head are at risk of subtotal debridement, as well as increased tibiotalar tilt with the single medial incision technique. Adequate debridement may require greater soft tissue dissection, possibly at the expense of medial ankle stability. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Ashlee MacDonald
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
| | | | - Sandeep Soin
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
| | - James D Brodell
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Adolph S Flemister
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
| | - John P Ketz
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
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7
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Double hindfoot arthrodesis using a single-incision medial approach in the correction of adult-acquired flatfoot deformity: a case series. INTERNATIONAL ORTHOPAEDICS 2021; 45:2375-2381. [PMID: 33963886 DOI: 10.1007/s00264-021-05057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hindfoot arthrodesis is used in patients with advanced-stage acquired flatfoot, usually associated with degenerative joint disease. The objective of the present study was to evaluate the clinical and radiographic results of hindfoot arthrodesis using the single-incision medial approach. METHODS A case series of 18 consecutive patients undergoing surgical correction between 2015 and 2018 with hindfoot arthrodesis using the medial approach was evaluated. The clinical assessment used the visual analog pain scale, AOFAS hindfoot score, SF-36, and foot function index. Radiographs and personal satisfaction criteria were also analyzed. RESULTS All radiographic parameters evaluated showed a significant improvement (p < .05), except the calcaneal pitch. Pain decreased by 5.1 points (p < .001), and the mean final AOFAS score was 72.6. In three feet, a new surgery was required. Two feet developed talar necrosis. None of the cases presented surgical wound dehiscence, and two presented with superficial infection, which was resolved with the use of oral antibiotics. CONCLUSION Double arthrodesis (subtalar and talonavicular) to correct adult-acquired valgus flatfoot using a medial approach has a low risk of soft tissue complications and presents satisfactory functional results. Avascular necrosis is a serious complication that was present in 11% of cases.
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8
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Fadle AA, El-Adly W, Attia AK, Mohamed MM, Mohamadean A, Osman AE. Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts. INTERNATIONAL ORTHOPAEDICS 2021; 45:2219-2229. [PMID: 33895880 PMCID: PMC8494666 DOI: 10.1007/s00264-021-05041-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
Purpose The study aims to prospectively compare double and triple arthrodesis in terms of functional outcomes and deformity correction. To the best of our knowledge, this is the first prospective comparative study in the literature to date. Methods This is a prospective comparative cohort study carried out between May 2017 and May 2019. The study was approved by the IRB at Assiut University and done according to the Helsinki declaration. Patients with AAFD stage III aged between 15 and 40 years old were assigned to double arthrodesis or triple arthrodesis. The groups were prospectively followed for one year. Primary outcomes were union rates, AOFAS scores, and radiological parameters of deformity correction on AP and lateral plain radiographs. Secondary outcomes were operative time, time to union, and complications. The double arthrodesis was done through the medial approach, while the triple arthrodesis was done through dual medial and lateral approaches. The post-operative protocol was standardized for both groups. Results A total of twenty-three patients matched the inclusion criteria and provided their consent to participate in the study. Thirteen (all males) patients underwent double arthrodesis, while ten (nine males and one female) patients underwent triple arthrodesis. The mean age for double and triple arthrodesis was 20.15 ± 5.63 and 25.10 ± 8.36 years, respectively, and the mean follow-up lengths were 12.46 and 12.9 months, respectively. There were no statistically significant differences between both groups in age, gender, laterality, or duration of follow-up. There were no statistically significant differences between both groups in AOFAS hindfoot scores or radiographic parameters. All patients were available for the final follow-up evaluation. All patients in both groups achieved union by four months post-operatively. The mean time to union in the double and triple arthrodesis groups was 3.39 ± 0.65 vs. 3.31 ± 0.6 months, respectively, with no statistically significant differences (p = 0.77). The mean operative time was significantly shorter in the double arthrodesis group than the triple arthrodesis group, 55.77 ± 15.18 vs. 91.6 ± 24.14 min (p < 0.001), respectively. Both double and triple arthrodesis groups had a statistically significant improvement of the mean AOFAS hindfoot score post-operatively (71.46 ± 7.77 vs. 88.38 ± 3.66, p < 0.001) and (66.9 ± 7.69 vs. 85 ± 5.83, p < 0.001), respectively. In the double arthrodesis group, the mean calcaneal pitch angle increased from 11.46° pre-operatively to 19.34° (MD = 8.45°, p < 0.001). The mean Meary’s angle improved from − 4.19 to 2.9° (MD = 7.32°, p < 0.001). Hibbs angle had a mean reduction of 6.45° post-operatively (p = 0.069). In the triple arthrodesis group, the mean calcaneal pitch angle improved from 10.06° pre-operatively to 17.49° post-operatively (MD = 7.12°, p < 0.001). The mean Meary’s angle improved from − 4.72 to 2.29° (MD = 7.09°, p < 0.001). The mean Hibbs angle decreased from 153.07 to 142.32° (MD = 10.54°, p < 0.001). The double vs. triple arthrodesis groups had no statistically significant differences in AOFAS hindfoot score improvement (16.92 vs. 19.1, p = 0.44), respectively. The two groups had no statistically significant differences in the magnitude of correction of all the radiographic parameters. Conclusion Double arthrodesis is an equally reliable surgical option for AAFD stage III for achieving union, improving the functional outcomes, and deformity correction as triple arthrodesis with a significantly shorter operative time in the former. The authors recommend double arthrodesis if the calcaneocuboid joint is unaffected.
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Affiliation(s)
- Amr A. Fadle
- Orthopedic Department, Assiut University, Assiut, Egypt
| | - Wael El-Adly
- Orthopedic Department, Assiut University, Assiut, Egypt
| | - Ahmed Khalil Attia
- Orthopedic Surgery Department, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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9
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Gelenkerhaltende operative Korrektur der fortgeschrittenen flexiblen Planovalgusdeformität des erwachsenen Fußes. DER ORTHOPADE 2020; 49:976-984. [DOI: 10.1007/s00132-020-03987-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Abstract
In the case of a rigid flatfoot deformity, joint-preserving techniques like soft-tissue balancing and osteotomies do not achieve acceptable results. This is the indication for arthrodesis. The selection of the arthrodesis depends on the amount of deformity, localisation of the rigidity and the general health status of the patient. Isolated arthrodesis can be combined with soft-tissue reconstructions. It is functionally advantageous to preserve as many joints as possible.
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11
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Erard MAJUE, Sheean MAJAJ, Sangeorzan BJ. Triple Arthrodesis for Adult-Acquired Flatfoot Deformity. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419849609. [PMID: 35097328 PMCID: PMC8500395 DOI: 10.1177/2473011419849609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Originally described as a means to address fixed deformities or uncontrolled movement of the hindfoot observed in paralytic foot deformities, triple arthrodesis has evolved into a powerful procedure for the correction of a variety of foot deformities. Over the past decade, multiple advances have been made with respect to diagnostic imaging, fixation options, bone graft substitutes, and postoperative regimens. While this operation requires experience and skill to execute, when properly performed, it allows for correction of deformity and a plantigrade and ideally pain-free foot for ambulation. The purpose of this review is to highlight advances in the procedure and its application to the rigid planovalgus foot. Level of Evidence: Level V, review.
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Affiliation(s)
- MAJ Uma E. Erard
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - MAJ Andrew J. Sheean
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
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12
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So E, Reb CW, Larson DR, Hyer CF. Medial Double Arthrodesis: Technique Guide and Tips. J Foot Ankle Surg 2018; 57:364-369. [PMID: 29254850 DOI: 10.1053/j.jfas.2017.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 02/03/2023]
Abstract
The triple arthrodesis procedure remains the historical standard to treat complex hindfoot pathology. However, in recent data, the medial double arthrodesis has been documented to provide similar benefit with decreased complication rates compared with the triple arthrodesis. Therefore, increased interest in this procedure for the treatment of complex hindfoot pathologies has ensued. We describe the technical components of the medial double arthrodesis.
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Affiliation(s)
- Eric So
- Resident, Grant Medical Center, Columbus, OH
| | - Christopher W Reb
- Orthopedic Surgeon, Assistant Professor, Division of Foot and Ankle Surgery, Department of Orthopaedics and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL
| | - David R Larson
- Fellowship-Trained Foot and Ankle Surgeon, Integrated Orthopedics, Phoenix, AZ
| | - Christopher F Hyer
- Fellowship Co-Director, Fellowship-Trained Foot and Ankle Surgeon, Foot and Ankle Center, Westerville, OH.
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Abstract
Surgical access to the subtalar joint is required in a plethora of pathologic conditions of the hindfoot. The conventional lateral approach can give excellent access to subtalar joint; however, in hindfoot valgus deformities, there can be unacceptable risks of wound problems and incomplete deformity corrections. The medial approach offers good access to the subtalar joint with an increasing evidence base for its use, especially with double fusions in pes planus deformities. The authors review the current evidence in the use of the medial approach for the subtalar joint.
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Affiliation(s)
- James Widnall
- Trauma and Orthopaedic Department, Aintree University Hospital, Lower Lane, Liverpool, L9 7AL, UK
| | - Lyndon Mason
- Trauma and Orthopaedic Department, Aintree University Hospital, Liverpool University, Liverpool, UK
| | - Andrew Molloy
- Trauma and Orthopaedic Department, Aintree University Hospital, Liverpool University, Liverpool, UK.
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14
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Safety of dorsolateral talonavicular joint fixation in modified double arthrodesis: an anatomic study. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Stapleton JJ, Zgonis T. Hindfoot Arthrodesis for the Elective and Posttraumatic Foot Deformity. Clin Podiatr Med Surg 2017; 34:339-346. [PMID: 28576193 DOI: 10.1016/j.cpm.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Triple (talonavicular, subtalar, and calcaneocuboid) joint arthrodesis and most recently double (talonavicular and subtalar) joint arthrodesis have been well proposed in the literature for surgical repair of the elective, posttraumatic, and/or neuropathic hindfoot deformities. The articulation of the hindfoot with the ankle and midfoot is multiaxial, and arthrodesis of these joints can significantly alter the lower extremity biomechanical manifestations by providing anatomic correction and alignment. This article reviews the indications and preoperative planning for some of the most common procedures to address the hindfoot deformity.
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Affiliation(s)
- John J Stapleton
- Foot and Ankle Surgery, Lehigh Valley Hospital, 1250 South Cedar Crest Boulevard, Suite 110, Allentown, PA 18103, USA; Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Thomas Zgonis
- Division of Podiatric Medicine and Surgery, Department of Orthopaedics, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC 7776, San Antonio, TX 78229, USA
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16
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Schuberth JM, Christensen JC, Seidenstricker CL. Total Ankle Replacement with Severe Valgus Deformity: Technique and Surgical Strategy. J Foot Ankle Surg 2017; 56:618-627. [PMID: 28268144 DOI: 10.1053/j.jfas.2017.01.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Indexed: 02/03/2023]
Abstract
Correction of severe valgus deformity of the foot and ankle with ankle replacement is challenging. We describe the controversies and specific issues of surgical management and provide a detailed surgical strategy for management of this common deformity. A reliable technique for deltoid reconstruction is also described and illustrated in detail.
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Affiliation(s)
- John M Schuberth
- Chief, Foot and Ankle Surgery, Department of Orthopedic Surgery, Kaiser Foundation Hospital, San Francisco, CA.
| | - Jeff C Christensen
- Attending Surgeon, Division of Podiatric Surgery, Department of Orthopedic, Swedish Medical Center-First Hill Campus, Seattle, WA
| | - Chad L Seidenstricker
- Third-Year Resident, Division of Podiatric Surgery, Department of Orthopedic, Swedish Medical Center-First Hill Campus, Seattle, WA
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Dodd A, Daniels TR. Injectable Recombinant Human Platelet-derived Growth Factor in Collagen Carrier for Hindfoot Fusion. Foot Ankle Clin 2016; 21:777-791. [PMID: 27871411 DOI: 10.1016/j.fcl.2016.07.013] [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] [Indexed: 02/02/2023]
Abstract
Arthrodesis of the hindfoot is a common procedure for degenerative joint disease and/or severe deformity. Nonunion is a common complication from this procedure, causing an increased burden to the patient and health care system, often resulting in the need for revision surgery. Recombinant human platelet-derived growth factor (rhPDGF) has been shown to be a safe and effective tool to enhance arthrodesis rates in hindfoot surgery while avoiding the potential morbidity of bone grafting. This article provides a review of the role of rhPDGF in hindfoot fusions, and the surgical technique for performing an rhPDGF enhanced double-arthrodesis through a medial approach.
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Affiliation(s)
- Andrew Dodd
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario M5C 1R6, Canada
| | - Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario M5C 1R6, Canada.
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Burrus MT, Werner BC, Carr JB, Perumal V, Park JS. Increased Failure Rate of Modified Double Arthrodesis Compared With Triple Arthrodesis for Rigid Pes Planovalgus. J Foot Ankle Surg 2016; 55:1169-1174. [PMID: 27614822 DOI: 10.1053/j.jfas.2016.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Indexed: 02/03/2023]
Abstract
For rigid pes planovalgus deformities, modified double and triple arthrodeses have had high union rates and subjective outcomes reported. Increased rates of talonavicular nonunions after modified double arthrodesis have led to concern regarding this procedure. A retrospective medical record review was performed of patients who had undergone either a modified double (n = 9) or triple (n = 7) arthrodesis for stage 3 pes planovalgus deformity. Radiographs were reviewed for hindfoot alignment, bony union, and hardware failure. Data from questionnaires, including the Foot and Ankle Ability Measure and the Foot and Ankle Outcome Score, were obtained. No significant differences were found between the cohorts in terms of preoperative radiographic parameters or patient characteristics. The modified double arthrodesis cohort demonstrated a nonunion rate of 44% (4 of 9), but the triple arthrodesis cohort had a 0% (0 of 7) nonunion rate (p = .042). The Foot and Ankle Ability Measure activities of daily living, Foot and Ankle Outcome Score activities of daily living, and Foot and Ankle Outcome Score quality of life scores were significantly worse for the modified double arthrodesis than for the triple arthrodesis group. For patients with stage 3 pes planovalgus, modified double arthrodesis resulted in significantly greater rates of nonunion and incomplete union, with significantly inferior subjective outcome scores compared with triple arthrodesis for the same indication.
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Affiliation(s)
- M Tyrrell Burrus
- Resident Physician, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
| | - Brian C Werner
- Resident Physician, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - James B Carr
- Resident Physician, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Venkat Perumal
- Assistant Professor, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Joseph S Park
- Assistant Professor, Division Head, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
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Seybold JD, Coetzee JC. Primary Triple Arthrodesis for Management of Rigid Flatfoot Deformity. JBJS Essent Surg Tech 2016; 6:e29. [PMID: 30233922 DOI: 10.2106/jbjs.st.16.00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Primary triple arthrodesis is a powerful and reliable procedure for stabilizing and correcting painful rigid flatfoot deformities with a low rate of complications. Indications & Contraindications Step 1 Preoperative Planning Pay careful attention to the history, physical examination, and weight-bearing radiographic studies as they are critical for selecting patients who will benefit from a triple arthrodesis. Step 2 Room Setup and Patient Positioning Position the patient supine on the operating table with the toes pointing straight up to the ceiling. Step 3 Incisions and Exposure For a standard triple arthrodesis, use 2 incisions: a lateral sinus tarsi incision, which allows exposure of the subtalar joint, CC joint, and lateral aspect of the TN joint, and a medial incision, which provides exposure of the TN joint. Step 4 Joint Preparation Ensure that joint preparation is thorough as this is critical for the success of any hindfoot arthrodesis. Step 5 Reduction of Deformity Reduce the TN joint first, followed by the subtalar joint, restoring a plantigrade foot and approximately 5° of hindfoot valgus alignment. Step 6 Joint Fixation Perform rigid fixation of the subtalar joint first, followed by fixation of the TN and CC joints. Step 7 Accessory Procedures Accessory procedures are often required in addition to the triple arthrodesis to ensure that appropriate hindfoot alignment and a plantigrade foot are achieved. Step 8 Wound Closure Perform a staged wound closure, taking care to maximize soft-tissue coverage over the involved hindfoot joints. Step 9 Postoperative Care Ensure that the patient follows strict non-weight-bearing precautions in the immediate postoperative period to limit micromotion at the arthrodesis sites and allow for timely fusion. Results In one of the largest published series of patients managed with triple arthrodesis (111 patients), Pell et al. reported a union rate of 98% at a minimum follow-up of 2 years, with 91% of patients indicating that they would be willing to repeat the procedure under similar circumstances4. Pitfalls & Challenges
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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.
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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
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Knupp M, Zwicky L, Lang TH, Röhm J, Hintermann B. Medial approach to the subtalar joint: anatomy, indications, technique tips. Foot Ankle Clin 2015; 20:311-8. [PMID: 26043246 DOI: 10.1016/j.fcl.2015.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The medial approach to the subtalar joint allows good visualization of the articular surfaces. Compared with the lateral approach, advantages are found particularly in flatfoot correction, in which the single-incision technique can be used for corrective fusions of rigid flatfoot deformity. Union rates are comparable with the traditional lateral approach; however, wound healing problems occur less frequently. Avascular necrosis of the talus is a rare but serious complication, although frequency seems to be independent of the approach chosen. Clinical studies showed no increased morbidity when comparing the medial to the lateral approach.
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Affiliation(s)
- Markus Knupp
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland.
| | - Lukas Zwicky
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Tamara Horn Lang
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Julian Röhm
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Beat Hintermann
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
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DeVries JG, Scharer B. Hindfoot Deformity Corrected With Double Versus Triple Arthrodesis: Radiographic Comparison. J Foot Ankle Surg 2015; 54:424-7. [PMID: 25432460 DOI: 10.1053/j.jfas.2014.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Indexed: 02/03/2023]
Abstract
Hindfoot fusion is capable of correcting hindfoot deformities. Typically, this has been done through triple arthrodesis. Recently, there has been some discussion of a double arthrodesis, sparing the calcaneocuboid joint. We compared the radiographic corrective ability of these 2 fusion techniques. A retrospective radiographic review was performed of 20 consecutive triple arthrodeses (triple) and 20 consecutive talonavicular and subtalar arthrodesis with calcaneocuboid preservation (double). Additional midfoot arthrodesis or osteotomy was performed as needed in each group. The preoperative measurements were compared to those from standing weightbearing films after fusion postoperatively. The angular measurements included the anteroposterior and lateral talar–first metatarsal line (Meary's and Simmons) and the anteroposterior and lateral talocalcaneal angle. Both groups demonstrated a statistically significant reduction in deformity and a return to more normal radiographic findings after arthrodesis (p < .05). The 2 groups did not differ statistically in preoperative deformity or correction obtained (p > .05). Traditionally, triple arthrodesis has been advocated for significant hindfoot deformity that is irreducible. Recent studies have questioned the need for inclusion of the calcaneocuboid joint in the arthrodesis, in particular, in a pronated, valgus-type foot. In addition, others have advocated a strictly medial approach to hindfoot fusion, necessarily avoiding the calcaneocuboid joint. Our findings agree with the assertion that hindfoot deformity can be adequately and reliably corrected through hindfoot arthrodesis whether or not the calcaneocuboid joint is included.
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Zhou B, Tang K, Hardy M. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review. J Orthop Surg Res 2014; 9:129. [PMID: 25499625 PMCID: PMC4276075 DOI: 10.1186/s13018-014-0129-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 11/24/2014] [Indexed: 01/28/2023] Open
Abstract
Talocalcaneal coalition often leads to a flatfoot deformity in children. Previous reports have uncovered many aspects of tarsal coalition and flatfoot respectively, including the etiology, clinical presentation, and diagnostic imaging, as well as treatment. However, the optimum surgical procedure for talocalcaneal coalition combined with flatfoot has not been definitively determined. The nonconformity of treatment options is due to our incomplete knowledge of biomechanics, diagnosis, and indication of treatment for talocalcaneal coalition with flatfoot. The objectives of this review are to provide an overview of the current knowledge about etiology, biomechanics, classification, diagnosis, and treatment options for talocalcaneal coalitions with flatfoot and highlight its therapies in children.
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Affiliation(s)
- Binghua Zhou
- Department of Orthopedic Surgery, Third Military Medical University Affiliated Southwest Hospital, Gaotanyan Str. 30, Chongqing, 400038, People's Republic of China.
| | - Kanglai Tang
- Department of Orthopedic Surgery, Third Military Medical University Affiliated Southwest Hospital, Gaotanyan Str. 30, Chongqing, 400038, People's Republic of China.
| | - Mark Hardy
- Department of Foot & Ankle Surgery, HealthSpan Physicians Group, 10 Severance Circle, Cleveland Heights, OH, 44118, USA.
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Galli MM, Protzman NM, Brigido SA. Arthrodiastasis of the lateral column with medial fusion: a retrospective examination of medial double and Lapidus arthrodeses. J Foot Ankle Surg 2014; 54:412-6. [PMID: 25481723 DOI: 10.1053/j.jfas.2014.09.013] [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: 06/27/2013] [Indexed: 02/03/2023]
Abstract
Arthrodiastasis of the calcaneocuboid joint after medial double arthrodesis has been described, but the extent remains unreported. We present our comparative findings after medial double and Lapidus fusion on the effects of the calcaneocuboid joint. Adults undergoing medial column fusion with internal fixation and a minimal clinical and radiographic follow-up period of 3 months were included. Subjects were excluded for Charcot deformity, previous arthrodesis surgery, and history of calcaneocuboid joint trauma or surgery. Although 52 patients were identified, 32 (mean age 56.69 ± 12.56 years; 11 males) met the study criteria (15 medial double and 17 Lapidus procedures). The height of the calcaneocuboid joint on the lateral radiograph and width of the calcaneocuboid joint on the anteroposterior radiograph were measured postoperatively and fixed, given the overlap often noted preoperatively in flatfoot deformities. The joint depth was measured at 3 points and averaged both preoperatively and postoperatively on lateral and anteroposterior radiographs. The volume of the calcaneocuboid joint (mm(3)) was the primary endpoint. Medial column fusion elicited a statistically significant mean increase of 32% in calcaneocuboid joint diastasis (p < .001). The percent change in diastasis volume was statistically different between the medial double (61.90% ± 40.59%) and the Lapidus (5.71% ± 14.84%, p < .001) fusion procedures. These results confirmed our hypothesis that arthrodesis of the more proximal medial column joints would produce greater lateral column arthrodiastasis. Adding to the published data, medial double arthrodesis increased the volume of the calcaneocuboid joint by 62%.
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Affiliation(s)
- Melissa M Galli
- Fellow, Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA
| | | | - Stephen A Brigido
- Fellowship Director, Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA.
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Camus D, Launay F, Guillaume JM, Viehweger E, Bollini G, Jouve JL. Proximal migration of fibular malleolus during tibial lengthening despite syndesmotic screw fixation: a series of 22 cases. Orthop Traumatol Surg Res 2014; 100:637-40. [PMID: 25201280 DOI: 10.1016/j.otsr.2014.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 05/18/2014] [Accepted: 06/13/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION During tibial lengthening procedures, it is recommended to prevent fibular malleolus proximal migration using a distal tibiofibular syndesmotic screw, which is removed at 6 months. We have observed proximal migrations of the fibular malleolus despite placement of this syndesmotic screw. OBJECTIVE The objective of this study was to demonstrate this migration and to study the influence of two factors that may favor its occurrence: positioning of the syndesmotic screw and union of the fibula at the time of removal. HYPOTHESIS An unhealed fibula at the time the distal tibiofibular syndesmotic screw is removed and its tricortical position promote the proximal migration of the fibular malleolus. MATERIAL AND METHODS This was a retrospective, single-center, analytical study that included 22 lengthening procedures in 18 patients from 5 to 17 years of age who had undergone tibial lengthening and presented a preoperative continuous fibula. The position of the fibular malleolus, union of the fibula, and the tri- or quadricortical position of the screw were assessed based on four successive x-rays. RESULTS Tricortical positioning of the syndesmotic screw was significantly associated with proximal migration of the fibular malleolus during lengthening (P=0.0248<0.05). However, there was no significant relation between an unhealed fibula and proximal migration of the fibular malleolus when the screw was removed (P=0.164>0.05). DISCUSSION Proximal migration of the fibular malleolus during lengthening is promoted by placing a non-quadricortical syndesmotic screw. Quadricortical positioning of the screw should be recommended. Migration of the fibular malleolus after ablation of the syndesmotic screw seems to be related to absence of fibular union but this series was too small to demonstrate this clearly. LEVEL OF EVIDENCE Level IV: Retrospective study.
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Affiliation(s)
- D Camus
- Hôpital Timone-Enfant, 6, rue Jean-de-Bernardy, 13000 Marseille, France.
| | - F Launay
- Hôpital Timone-Enfant, 6, rue Jean-de-Bernardy, 13000 Marseille, France
| | - J-M Guillaume
- Hôpital Timone-Enfant, 6, rue Jean-de-Bernardy, 13000 Marseille, France
| | - E Viehweger
- Hôpital Timone-Enfant, 6, rue Jean-de-Bernardy, 13000 Marseille, France
| | - G Bollini
- Hôpital Timone-Enfant, 6, rue Jean-de-Bernardy, 13000 Marseille, France
| | - J-L Jouve
- Hôpital Timone-Enfant, 6, rue Jean-de-Bernardy, 13000 Marseille, France
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Catanzariti AR, Adeleke AT. Double arthrodesis through a medial approach for end-stage adult-acquired flatfoot. Clin Podiatr Med Surg 2014; 31:435-44. [PMID: 24980932 DOI: 10.1016/j.cpm.2014.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Triple arthrodesis has traditionally been the procedure of choice for end-stage adult-acquired flatfoot. The results have been universally good, and it has proven to be dependable and predictable. Nonetheless, complications have been reported following triple arthrodesis in certain patients. Selective arthrodesis of the talonavicular joint and subtalar joint through a single medial approach has been developed as an alternative. The authors especially prefer this procedure with severe transverse plane deformity and often choose this approach as an alternative to triple arthrodesis in high-risk patients, including those patients with diabetes mellitus, rheumatoid arthritis, long-term steroid use, and the elderly.
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Affiliation(s)
- Alan R Catanzariti
- Division of Foot & Ankle Surgery, West Penn Hospital, 4800 Friendship Avenue, N1, Pittsburgh, PA 15224, USA.
| | - Adebola T Adeleke
- Division of Foot & Ankle Surgery, West Penn Hospital, 4800 Friendship Avenue, N1, Pittsburgh, PA 15224, USA
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Abstract
Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations.
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Affiliation(s)
- Ettore Vulcano
- Foot and Ankle Department, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA,
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