title: Radiographic correction of stage III posterior tibial tendon dysfunction with a modified triple arthrodesis.
abstract: BACKGROUND
  The literature supports fusion as the surgical treatment of choice for stage III posterior tibial tendon dysfunction (PTTD). The present study reports the radiographic correction following a modified triple arthrodesis (fusions of the subtalar, talonavicular, and first tarsometatarsal joints) in patients with stage III PTTD.
  
  
  METHODS
  An institutional review board-approved retrospective study was performed to assess the radiographic outcome of a modified triple arthrodesis in 21 patients (22 feet). Pre- and postoperative weight-bearing radiographs were reviewed in a blinded fashion by clinicians of varying levels of training. The talo-first metatarsal, talocalcaneal, and talonavicular coverage angles were measured on anteroposterior views. On lateral views, the talo-first metatarsal (Meary's), talocalcaneal, calcaneal pitch, and talar declination angles and the medial cuneiform to floor distance were measured. Statistical analysis was performed to compare pre- and postoperative measurements, assess the degree of correction, and determine interobserver reliability of the radiographic measurements.
  
  
  RESULTS
  All measurements improved significantly after treatment with a modified triple arthrodesis (P ≤ .001). The medial cuneiform to floor distance (0.910), talonavicular coverage angle (0.896), and lateral talo-first metatarsal angle (0.873) were the most reproducible between observers. Postoperatively, 100% of feet were corrected to normal medial cuneiform to floor distance and talonavicular coverage angle, and 90.9% were corrected to a normal lateral talo-first metatarsal angle.
  
  
  CONCLUSIONS
  The modified triple arthrodesis resulted in a reliable and reproducible correction of the deformity seen in rigid stage III PTTD.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Department of Orthopaedic Surgery & Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Siddhant K
authors.initials: SK
authors.lastname: Mehta
authors.forename: R Bradley
authors.initials: RB
authors.lastname: Kellum
authors.forename: George H
authors.initials: GH
authors.lastname: Robertson
authors.forename: Allen Ryves
authors.initials: AR
authors.lastname: Moore
authors.forename: Scott A
authors.initials: SA
authors.lastname: Wingerter
authors.forename: Thom A
authors.initials: TA
authors.lastname: Tarquinio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000379:methods*; D005260:Female; D005529:Foot Bones / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging; D008875:Middle Aged; D037081:Posterior Tibial Tendon Dysfunction / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D013639:Tarsal Bones / Q000000981:diagnostic imaging; D016896:Treatment Outcome
keywords: modified triple arthrodesis; posterior tibial tendon dysfunction; radiographic correction; stage III PTTD; tendon disorders