Isolated talonavicular arthrodesis in patients with rheumatoid arthritis of the foot and tibialis posterior tendon dysfunction.
BACKGROUND
The foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot deformities include talonavicular joint destruction and tibialis posterior tendon dysfunction, mainly due to its rupture.


METHODS
Between 2002 and 2005 we performed isolated talonavicular arthrodesis in 26 patients; twenty women and six men. Tibialis posterior tendon dysfunction was diagnosed preoperatively by physical examination and by MRI. Talonavicular fusion was achieved via screws in eight patients, memory staples in twelve patients and a combination of screws and memory staples in six cases. The average duration of immobilization after the surgery was four weeks, followed by rehabilitation. Full weight bearing was allowed two to three months after surgery.


RESULTS
The mean age of the group at the time of the surgery was 43.6 years. MRI examination revealed a torn tendon in nine cases with no significant destruction of the talonavicular joint seen on X-rays. Mean of postoperative followup was 4.5 years (3 to 7 years). The mean of AOFAS Hindfoot score improved from 48.2 preoperatively to 88.6 points at the last postoperative followup. Eighteen patients had excellent results (none, mild occasional pain), six patients had moderate pain of the foot and two patients had severe pain in evaluation with the score. Complications included superficial wound infections in two patients and a nonunion developed in one case.


CONCLUSIONS
Early isolated talonavicular arthrodesis provides excellent pain relief and prevents further progression of the foot deformities in patients with rheumatoid arthritis and tibialis posterior tendon dysfunction.
Popelka
Stanislav
S
1st Orthopaedic Clinic, 1St Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. mudr.popelka@volny.cz
Hromádka
Rastislav
R
Vavrík
Pavel
P
Stursa
Pavel
P
Pokorný
David
D
Jahoda
David
D
Sosna
Antonín
A
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D001863:Bone Screws; D002102:Cadaver; D004210:Dissection; D005260:Female; D005413:Flatfoot / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D004204:Joint Dislocations / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D037081:Posterior Tibial Tendon Dysfunction / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012421:Rupture / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013380:Subtalar Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013537:Sutures; D013708:Tendon Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome