Title: Arthrodesis of the Hindfoot for Valgus Deformity; an Entirely Medial Approach
Authors: W.F.M. Jackson, M. Tryfonidis, P.H.Cooke, R.J.Sharp
Source: Journal of Bone and Joint Surgery (Britain) , 89-B: 925-927, 2007
PODIATRIC RELEVANCE:
It is well established that the traditional lateral approach to triple arthrodesis to correct valgus carries the risk of postoperative sequelae including wound dehiscence and delayed healing. The goal of this study presented in this article was to correct a fixed valgus hindfoot deformity by triple arthrodesis via an entirely medial approach to determine whether this approach reduces the risks inherent to a lateral approach.
METHODS:
This is a prospective study performed over 11 months and involved 8 patients, aged 56-78 years,
with fixed valgus hindfoot deformity for which lateral approach was considered unsuitable.
Four cases presented with rheumatoid arthritis, 2 with diabetic Charcot neuroarthropathy and 2 with primary degenerative arthritis. If a medial ulcer was present, it was excised and accomodated. The medial incision was placed 8cm distal to the tip of the medial malleolus, centered over the talonavicular joint. The technique was performed according to the technique described by Myerson. Postoperatively, patients were placed in a short leg cast and were non-weightbearing for 6 weeks and then were weightbearing in a short leg cast for an additional 6 weeks.
Wound status was assessed at 2, 6 and 12 weeks. Radiographic evaluation was performed with pre- and postoperative weightbearing anteroposterior (AP) ankle views to measure the angle between the axis of the tibia and a line between the center of the subtalar joint and the axis of the calcaneus. Evidence of union was defined by painfree weightbearing with no changes in the position of the foot, and radiographically by the presence of bony consolidation.
RESULTS:
The authors found no wound complications and reported good correction that allowed
for shoe accommodation in 8 subjects. The mean fixed preop valgus deformity was 58.8° (45°-66°) and the mean postop was 13.6° (7°-23°).
COMMENTS:
The results seen here are promising; however, the need for a statistically larger
study group cannot be overemphasized. This will better provide the evidence that supports
the use of a medial approach. In addition, the authors’ evaluation methods were a bit subjective and did not utilize any standard measurement parameters such as AOFAS or ACFAS hindfoot scales. However, if this technique gains greater acceptance, it may reduce the morbidity associated with this procedure.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.