Arthrodiastasis of the Lateral Column With Medial Fusion: A Retrospective Examination of Medial Double and Lapidus Arthrodeses

Published:December 03, 2014DOI:


      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 (mm3) 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%.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment


        • Ryerson E.W.
        Arthrodesing operations on the feet.
        J Bone Joint Surg Am. 1923; 5: 453-471
        • Goecker R.M.
        • Ruch J.A.
        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 & Wilkins, Philadelphia2001: 1167-1192
        • Knupp M.
        • Stufkens S.A.
        • Hintermann B.
        Triple arthrodesis.
        Foot Ankle Clin. 2011; 16: 61-67
        • Knupp M.
        • Skoog A.
        • Törnkvist H.
        • Ponzer S.
        Triple arthrodesis in rheumatoid arthritis.
        Foot Ankle Int. 2008; 29: 293-297
        • Myerson M.S.
        Triple arthrodesis.
        in: Myerson M.S. Reconstructive Foot and Ankle Surgery: Management of Complications. ed. 2. Elsevier Saunders, Philadelphia2010: 467-490
        • Pell IV, R.F.
        • Myerson M.S.
        • Schon L.C.
        Clinical outcome after primary triple arthrodesis.
        J Bone Joint Surg Am. 2000; 82: 47-57
        • Figgie M.P.
        • O'Malley M.J.
        • Ranawat C.
        • Inglis A.E.
        • Sculco T.P.
        Triple arthrodesis in rheumatoid arthritis.
        Clin Orthop Relat Res. 1993; 292: 250-254
        • Saltzman C.L.
        • Fehrle M.J.
        • Cooper R.R.
        • Spencer E.C.
        • Ponseti I.V.
        Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients.
        J Bone Joint Surg Am. 1999; 81: 1391-1402
        • Wetmore R.S.
        • Drennan J.C.
        Long-term results of triple arthrodesis in Charcot-Marie-Tooth disease.
        J Bone Joint Surg Am. 1989; 71: 417-422
      1. The classic. Arthrodesing operations on the feet: Edwin W. Ryerson, M.D.
        Clin Orthop Relat Res. 1977; 122: 4-9
        • Graves S.C.
        • Mann R.A.
        • Graves K.O.
        Triple arthrodesis in older adults: results after long-term follow-up.
        J Bone Joint Surg Am. 1993; 75: 355-362
        • Angus P.D.
        • Cowell H.R.
        Triple arthrodesis: a critical long-term review.
        J Bone Joint Surg Br. 1986; 68: 260-265
        • Wilson Jr., F.C.
        • Fay G.F.
        • Lamotte P.
        • Williams J.C.
        Triple arthrodesis: a study of the factors affecting fusion after three hundred and one procedures.
        J Bone Joint Surg Am. 1965; 47: 340-348
        • Anand P.
        • Nunley J.A.
        • DeOrio J.K.
        Single-incision medial approach for double arthrodesis of hindfoot in posterior tibialis tendon dysfunction.
        Foot Ankle Int. 2013; 34: 338-344
        • Berlet G.C.
        • Hyer C.F.
        • Scott R.T.
        • Galli M.M.
        The medial double arthrodesis with lateral column sparing and arthrodiastasis: a radiographic and chart review.
        J Foot Ankle Surg. 2015; 54: 441-444
        • Philippot R.
        • Wegrzyn J.
        • Besse J.L.
        Arthrodesis of the subtalar and talonavicular joints through a medial surgical approach: a series of 15 cases.
        Arch Orthop Trauma Surg. 2010; 130: 599-603
        • Weinraub G.M.
        • Schuberth J.M.
        • Lee M.
        • Rush S.
        • Ford L.
        • Neufeld J.
        • Yu J.
        Isolated medial incisional approach to subtalar and talonavicular arthrodesis.
        J Foot Ankle Surg. 2010; 49: 326-330
        • Knupp M.
        • Schuh R.
        • Stufkens S.A.
        • Bolliger L.
        • Hintermann B.
        Subtalar and talonavicular arthrodesis through a single medial approach for the correction of severe planovalgus deformity.
        J Bone Joint Surg Br. 2009; 91: 612-615
        • Kołodziej Ł.
        • Bohatyrewicz A.
        • Budzyński T.
        • Zietek P.
        Subtalar arthrodesis through single medial approach in the treatment of acquired, fixed flatfoot deformity—preliminary report.
        Chir Narzadow Ruchu Ortop Pol. 2009; 74: 220-223
        • Jackson W.F.
        • Tryfonidis M.
        • Cooke P.H.
        • Sharp R.J.
        Arthrodesis of the hindfoot for valgus deformity: an entirely medial approach.
        J Bone Joint Surg Br. 2007; 89: 925-927
        • Lee M.S.
        Medial approach to the severe valgus foot.
        Clin Podiatr Med Surg. 2007; 24: 735-744
        • Myerson M.S.
        • Vora A.M.
        • Jeng C.L.
        The medial approach to triple arthrodesis: indications and technique for management of rigid valgus deformities in high-risk patients.
        J Bone Joint Surg Br. 2005; 87: 369
        • Jeng C.L.
        • Tankson C.J.
        • Myerson M.S.
        The single medial approach to triple arthrodesis: a cadaver study.
        Foot Ankle Int. 2006; 27: 1122-1125
        • Jeng C.L.
        • Vora A.M.
        • Myerson M.S.
        The medial approach to triple arthrodesis: indications and technique for management of rigid valgus deformities in high-risk patients.
        Foot Ankle Clin. 2005; 10: 515-521
      2. Current Procedural Terminology. American Medical Association, Chicago2012
        • Green S.B.
        Design of randomized trials.
        Epidemiol Rev. 2002; 24: 4-11
        • O'Malley M.J.
        • Deland J.T.
        • Lee K.T.
        Selective hindfoot arthrodesis for the treatment of adult acquired flatfoot deformity: an in vitro study.
        Foot Ankle Int. 1995; 16: 411-417
        • Astion D.J.
        • Deland J.T.
        • Otis J.C.
        • Kenneally S.
        Motion of the hindfoot after simulated arthrodesis.
        J Bone Joint Surg Am. 1997; 79: 241-246
        • Leland R.H.
        • Marymont J.V.
        • Trevino S.G.
        • Varner K.E.
        • Noble P.C.
        Calcaneocuboid stability: a clinical and anatomic study.
        Foot Ankle Int. 2001; 22: 880-884
        • Sammarco V.J.
        • Magur E.G.
        • Sammarco G.J.
        • Bagwe M.R.
        Arthrodesis of the subtalar and talonavicular joints for correction of symptomatic hindfoot malalignment.
        Foot Ankle Int. 2006; 27: 661-666
        • Southwell R.B.
        • Sherman F.C.
        Triple arthrodesis: a long-term study with force plate analysis.
        Foot Ankle. 1981; 2: 15-24
        • Amer A.R.
        • Khanfour A.A.
        Arthrodiastasis for late onset Perthes' disease using a simple frame and limited soft tissue release: early results.
        Acta Orthop Belg. 2011; 77: 472-479
        • Hosny G.A.
        • El-Deeb K.
        • Fadel M.
        • Laklouk M.
        Arthrodiastasis of the hip.
        J Pediatr Orthop. 2011; 31: S229-S234
        • Gomez J.A.
        • Matsumoto H.
        • Roye Jr., D.P.
        • Vitale M.G.
        • Hyman J.E.
        • van Bosse H.J.
        • Marangoz S.
        • Sala D.A.
        • Stein M.I.
        • Feldman D.S.
        Articulated hip distraction: a treatment option for femoral head avascular necrosis in adolescence.
        J Pediatr Orthop. 2009; 29: 163-169
        • Kluesner A.J.
        • Wukich D.K.
        Ankle arthrodiastasis.
        Clin Podiatr Med Surg. 2009; 26: 227-244
        • Maxwell S.L.
        • Lappin K.J.
        • Kealey W.D.
        • McDowell B.C.
        • Cosgrove A.P.
        Arthrodiastasis in Perthes' disease: preliminary results.
        J Bone Joint Surg Br. 2004; 86: 244-250
        • Cañadell J.
        • Gonzales F.
        • Barrios R.H.
        • Amillo S.
        Arthrodiastasis for stiff hips in young patients.
        Int Orthop. 1993; 17: 254-258