Mid- to long-term outcome of 96 corrective hindfoot fusions in 84 patients with rigid flatfoot deformity.
Talonavicular and subtalar joint fusion through a medial incision (modified triple arthrodesis) has become an increasingly popular technique for treating symptomatic flatfoot deformity caused by posterior tibial tendon dysfunction. The purpose of this study was to look at its clinical and radiological mid- to long-term outcomes, including the rates of recurrent flatfoot deformity, nonunion and avascular necrosis of the dome of the talus. A total of 84 patients (96 feet) with a symptomatic rigid flatfoot deformity caused by posterior tibial tendon dysfunction were treated using a modified triple arthrodesis. The mean age of the patients was 66 years (35 to 85) and the mean follow-up was 4.7 years (1 to 8.3). Both clinical and radiological outcomes were analysed retrospectively. In 86 of the 95 feet (90.5%) for which radiographs were available, there was no loss of correction at final follow-up. In all, 14 feet (14.7%) needed secondary surgery, six for nonunion, two for avascular necrosis, five for progression of the flatfoot deformity and tibiotalar arthritis and one because of symptomatic overcorrection. The mean American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score) at final follow-up was 67 (between 16 and 100) and the mean visual analogue score for pain 2.4 points (between 0 and 10). In conclusion, modified triple arthrodesis provides reliable correction of deformity and a good clinical outcome at mid- to long-term follow-up, with nonunion as the most frequent complication. Avascular necrosis of the talus is a rare but serious complication of this technique.
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
J
J
Röhm
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
L
L
Zwicky
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
T
T
Horn Lang
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
Y
Y
Salentiny
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
B
B
Hintermann
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
M
M
Knupp
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000379:methods; D005260:Female; D005413:Flatfoot / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
flatfoot deformity; hindfoot deformity; posterior tibial tendon dysfunction; subtalar arthrodesis; triple arthrodesis