DOUBLE ARTHRODESIS THROUGH A SINGLE MEDIAL INCISION APPROACH FOR FLATFOOT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YUGuangrong , YUTao , YANGYunfeng , LIBing , ZHUHui , CHENKai , ZHANGMingzhu , ZHAOYouguang

Department of Orthopedics, Affiliated Tongji Hospital of Tongji University, Shanghai, 200065, P. R. China;

Corresponding author：

YUGuangrong, Email: yuguangrong@hotmail.com

Keywords：

Flatfoot deformity; Double arthrodesis; Subtalar joint; Talonavicular joint; Posterior tibial tendon

DOI：

10.7507/1002-1892.20140286

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Objective To investigate the effectiveness of double arthrodesis to correct flatfoot deformity with pes valgus. Methods Between May 2009 and May 2012, 12 patients with flatfoot deformity and pes valgus were treated using subtalar and talonavicular joints arthrodesis through a single medial incision approach. There were 5 males and 7 females with an average age of 53.3 years (range, 21-78 years), including 5 left feet and 7 right feet. Of them, 11 cases had posterior tibial tendon dysfunctions; 6 cases were at Johnson-Strom stageⅢ, 5 cases at stageⅡ(c); and 1 case had tarsal coal ition. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 48.75±3.46 and 6.08±1.14, respectively. Results The mean operation time was 85.6 minutes (range, 65-125 minutes). Eleven patients were followed up for 19.4 months on average (range, 13-30 months). All of the cases obtained primary healing of incision, with no complication of infection and nerve or blood vessel injury. X-ray film showed that the mean time of bone union was 9.8 weeks (range, 7-18 weeks); no bone nonunion occurred. No loosening or breakage of internal fixation was observed. Pain occurred at the calcaneal-cuboid joint (1 case) and at fixation site (1 case), and was relieved after symptomatic treatment. The mean AOFAS score and VAS score were significantly increased to 81.36±2.98 and 0.72±0.11 respectively, showing significant differences when compared with preoperative scores (t=19.946, P=0.000; t=16.288, P=0.000). Conclusion Subtalar and talonavicular joints arthrodesis by a single medial incision approach is a useful alternative to tri ple arthrodesis for the correction of flatfoot deformity with pes valgus

Citation： YUGuangrong, YUTao, YANGYunfeng, LIBing, ZHUHui, CHENKai, ZHANGMingzhu, ZHAOYouguang. DOUBLE ARTHRODESIS THROUGH A SINGLE MEDIAL INCISION APPROACH FOR FLATFOOT. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(11): 1321-1324. doi: 10.7507/1002-1892.20140286 Copy

1.	O'Malley MJ, Deland JT, Lee KT. Selective hindfoot arthrodesis for the treatment of adult acquired flatfoot deformity:an in vitro study. Foot Ankle Int, 1995, 16(7):411-417.
2.	Weinraub GM, Heilala MA. Isolated talonavicular arthrodesis for adult onset flatfoot deformity/posterior tibial tendon dysfunction. Clin Podiatr Med Surg, 2007, 24(4):745-752, ix.
3.	Bonsell S. Financial analysis of anterior cruciate ligament reconstruction at Baylor University Medical Center. Proc (Bayl Univ Med Cent), 2000, 13(4):327-330.
4.	Jeng CL, Vora AM, Myerson MS. The medial approach to tri ple arthrodesis. Indications and technique for management of rigid valgus deformities in high-risk patients. Foot Ankle Clin, 2005, 10(3):515-521, vi-vii.
5.	De Wachter J, Markus K, Hintermann B. Double-hindfoot arthrodesis through a single medial approach. Tech Foot Ankle Surg, 2007, 6(4): 237-242.
6.	Sammarco VJ, Magur EG, Sammarco GJ, et al. Arthrodesis of the subtalar and talonavicular joints for correction of symptomatic hindfoot malalignment. Foot Ankle Int, 2006, 27(9):661-666.
7.	Goecker RM. Tri ple arthrodesis//AS Banks MSD, DE Martin SJM, eds. McGlamry's comprehensive textbook of foot and ankle surgery. Philadelphia: Li ppincott Williams and Wilkins, 2001:1167-1192.
8.	Savory KM, Wülker N, Stukenborg C, et al. Biomechanics of the hindfoot joints in response to degenerative hindfoot arthrodeses. Clin Biomech (Bristol, Avon), 1998, 13(1):62-70.
9.	Gérard Y, Chelius P. Block of the movement of the subastragalar joint by astragalo-scaphoid arthrodesis. Rev Chir Orthop Reparatrice Appar Mot, 1986, 72 Suppl 2:104-108.
10.	Harper MC, Tisdel CL. Talonavicular arthrodesis for the painful adult acquired flatfoot. Foot Ankle Int, 1996, 17(11):658-661.
11.	Castro MD, Coetzee JC. Surgical treatment of gradeⅢposterior tibial tendon insufficiency. Single and double arthrodesis. Tech Foot Ankle Surg, 2003, 2(4):232-236.
12.	Knupp M, Schuh R, Stufkens SA, et al. Subtalar and talonavicular arthrodesis through a single medial approach for the correction of severe planovalgus deformity. J Bone Joint Surg (Br), 2009, 91(5):612-615.
13.	Philippot R, Wegrzyn J, Besse JL. Arthrodesis of the subtalar and talonavicular joints through a medial surgical approach:a series of 15 cases. Arch Orthop Trauma Surg, 2010, 130(5):599-603.
14.	Astion DJ, Deland JT, Otis JC, et al. Motion of the hindfoot after simulated arthrodesis. J Bone Joint Surg (Am), 1997, 79(2):241-246.

1. O'Malley MJ, Deland JT, Lee KT. Selective hindfoot arthrodesis for the treatment of adult acquired flatfoot deformity:an in vitro study. Foot Ankle Int, 1995, 16(7):411-417.
2. Weinraub GM, Heilala MA. Isolated talonavicular arthrodesis for adult onset flatfoot deformity/posterior tibial tendon dysfunction. Clin Podiatr Med Surg, 2007, 24(4):745-752, ix.
3. Bonsell S. Financial analysis of anterior cruciate ligament reconstruction at Baylor University Medical Center. Proc (Bayl Univ Med Cent), 2000, 13(4):327-330.
4. Jeng CL, Vora AM, Myerson MS. The medial approach to tri ple arthrodesis. Indications and technique for management of rigid valgus deformities in high-risk patients. Foot Ankle Clin, 2005, 10(3):515-521, vi-vii.
5. De Wachter J, Markus K, Hintermann B. Double-hindfoot arthrodesis through a single medial approach. Tech Foot Ankle Surg, 2007, 6(4): 237-242.
6. Sammarco VJ, Magur EG, Sammarco GJ, et al. Arthrodesis of the subtalar and talonavicular joints for correction of symptomatic hindfoot malalignment. Foot Ankle Int, 2006, 27(9):661-666.
7. Goecker RM. Tri ple arthrodesis//AS Banks MSD, DE Martin SJM, eds. McGlamry's comprehensive textbook of foot and ankle surgery. Philadelphia: Li ppincott Williams and Wilkins, 2001:1167-1192.
8. Savory KM, Wülker N, Stukenborg C, et al. Biomechanics of the hindfoot joints in response to degenerative hindfoot arthrodeses. Clin Biomech (Bristol, Avon), 1998, 13(1):62-70.
9. Gérard Y, Chelius P. Block of the movement of the subastragalar joint by astragalo-scaphoid arthrodesis. Rev Chir Orthop Reparatrice Appar Mot, 1986, 72 Suppl 2:104-108.
10. Harper MC, Tisdel CL. Talonavicular arthrodesis for the painful adult acquired flatfoot. Foot Ankle Int, 1996, 17(11):658-661.
11. Castro MD, Coetzee JC. Surgical treatment of gradeⅢposterior tibial tendon insufficiency. Single and double arthrodesis. Tech Foot Ankle Surg, 2003, 2(4):232-236.
12. Knupp M, Schuh R, Stufkens SA, et al. Subtalar and talonavicular arthrodesis through a single medial approach for the correction of severe planovalgus deformity. J Bone Joint Surg (Br), 2009, 91(5):612-615.
13. Philippot R, Wegrzyn J, Besse JL. Arthrodesis of the subtalar and talonavicular joints through a medial surgical approach:a series of 15 cases. Arch Orthop Trauma Surg, 2010, 130(5):599-603.
14. Astion DJ, Deland JT, Otis JC, et al. Motion of the hindfoot after simulated arthrodesis. J Bone Joint Surg (Am), 1997, 79(2):241-246.

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