Abstract
Triple arthrodesis is commonly used to correct complex deformity with hindfoot valgus.
The authors use an isolated medial incisional approach for subtalar and talonavicular
joint arthrodesis to correct hindfoot deformity, including high degrees of hindfoot
valgus. To assess outcomes achieved with this approach, we reviewed the records of
45 patients from the practices of 5 surgeons. Independent variables evaluated included
patient age, primary pathology, use of biologic agents, operative time, time to union,
and complications. The median patient age was 57 years (range, 14-78 years). Pathology
leading to fusion included 27 (60%) posterior tibial tendon dysfunction, 6 (13.3%)
tarsal coalition, 7 (5.5%) degenerative joint disease, 2 (4.4%) rheumatoid arthritis,
and 1 (2.2%) each, with Charcot neuroarthropathy, multiple sclerosis, and poliomyelitis.
Orthobiological materials were used in 27 (60.0%) of the patients. The median duration
of surgery was 87 minutes (range, 65-164 minutes), and the median time to successful
arthrodesis was 8 weeks (range, 6-20 weeks). A complication was observed in 6 (13.3%)
of the patients, including 1 each of the following: painful calcaneal-cuboid joint,
talar fracture, incision dehiscence, poor exposure that required abandonment of the
procedure, elevated first ray, and painful fixation. None of the patients experienced
a nonunion or an adverse event related to the medial neurovascular structures. Based
on our experience with the procedure, the single medial–incision subtalar and talonavicular
joint arthrodesis is a useful alternative to triple arthrodesis for the correction
of hindfoot valgus deformity.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Arthrodesing operations on the feet.J Bone Joint Surg (Am). 1923; 5-A: 453-471
- Treatment of the hollow foot (pes cavus).Am J Orthop Surg. 1913; 2: 341-342
- Triple arthrodesis.in: Banks A.S. Downey M.S. Martin D.E. Miller S.J. McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. ed 3. Lippincott Williams and Wilkins, Philadelphia2001: 1167-1192
- Triple arthrodesis.in: Myerson M.S. Reconstructive Foot and Ankle Surgery. ed 1. Elsevier Saunders, Philadelphia2005
- Selective hindfoot arthrodesis for the treatment of adult acquired flatfoot deformity: an in vitro study.Foot Ankle Int. 1995; 16: 411-417
- Isolated talonavicular arthrodesis for adult onset flatfoot deformity/posterior tibial tendon dysfunction.Clin Podiatr Med Surg. 2007; 24: 745-752
- Financial analysis of anterior cruciate ligament reconstruction at Baylor University Medical Center.Proc Bayl Univ Med Cent. 2000; 13: 327-330
- Motion of the hindfoot after simulated arthrodesis.J Bone Joint Surg (Am). 1997; 79-A: 241-246
- Single medial approach to modified double arthrodesis in rigid flatfoot with lateral deficient skin.Foot Ankle Int. 2009; 30: 21-26
- Arthrodesis of the subtalar and talonavicular joints for correction of symptomatic hindfoot malalignment.Foot Ankle Int. 2006; 27: 661-666
- Triple arthrodesis in rheumatoid arthritis.Foot Ankle Int. 2008; 29: 293-297
- Triple arthrodesis in adults with non-paralytic disease. A minimum of ten-year follow-up study.J Bone Joint Surg (Am). 2004; 86: 2707-2713
- The medial approach to triple arthrodesis: indications and technique for management of rigid valgus deformities in high-risk patients.Foot Ankle Clin N Am. 2005; 10: 515-521
- Financial analysis of anterior cruciate ligament reconstruction at Baylor University Medical Center.Proc Bayl Univ Med Cent. 2000; 13: 327-330
- Adult flatfoot/posterior tibial tendon dysfunction: outcomes analysis of surgical treatment utilizing an algorithmic approach.J Foot Ankle Surg. 2000; 39: 359-364
Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
