Revision of failed triple arthrodesis with an opening-closing wedge osteotomy of the midfoot.
BACKGROUND
This investigation reviewed the clinical and radiographic results of a biplanar opening-closing wedge osteotomy of the midfoot to revise failed triple arthrodeses with severe rocker-bottom deformity. Five cases were reviewed to determine if this osteotomy corrects the rocker-bottom deformity, improves function and provides satisfaction to the patient.


METHODS
American Orthopaedic Foot and Ankle Society (AOFAS) clinical ratings scores obtained before and after the procedure were compared to assess the functional outcome. The patients' satisfaction with their results of surgery was also determined. Three parameters of foot alignment were measured from preoperative and postoperative anteroposterior and lateral weightbearing radiographs to assess the correction of the rocker-bottom deformity and the effect of the osteotomy on valgus tilting of the talus was evaluated with weightbearing views of the ankle.


RESULTS
All clinical and radiographic measures of outcome significantly improved at a mean follow-up of 18 months (range, 13-32 months). The mean clinical rating score increased from 33 +/- 14 points (range, 14-49 points) to 70 +/- 11 points (range, 62-87 points) after the surgery (p < or = .05). Every patient was satisfied with the result and would repeat the procedure under the same circumstances. All four measures of foot and ankle alignment demonstrated significant correction after surgery.


CONCLUSIONS
The osteotomy effectively realigned the rocker-bottom deformity. The procedure normalized the angular relationships of the foot by correction of the abduction and dorsiflexion deformities of the midfoot and valgus deformity of the hindfoot. The reduction in pain, increased functional capacity, and ability to wear conventional shoes, achieved without any major complication, account for the improved clinical rating scores and high rate of the satisfaction observed with this procedure.
Department of Surgery, Section of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA. btoolan@surgery.bsd.uchicago.edu
Brian C
BC
Toolan
D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005413:Flatfoot / Q000601:surgery*; D005529:Foot Bones / Q000601:surgery*; D005531:Foot Deformities, Acquired / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure