Title: Isolated Medial Column Stabilization Improves Alignment in Adult-acquired Flatfoot
Authors: Greisberg J, Assal M, Hansen ST, Sangeorzan BJ
Source: Clinical Orthopedics and Related Research 435: 197-202, 2005
PODIATRIC RELEVANCE:
Realignment and arthrodesis of the medial naviculocuneiform and first tarsometatarsal joints can be performed to correct alignment and relieve symptoms in some patients with painful, adult-acquired flatfoot deformity. The purpose of this article was to discuss the results of a study undertaken to assess the ability of isolated medial column arthrodesis in improving hindfoot alignment and in correcting radiographic parameters of overall foot structure in acquired flatfoot.
METHODS:
A retrospective review of 19 patients that had undergone arthrodesis of the naviculocuneiform and/or tarsometatarsal joints between 1998 and 2001 for treatment of painful acquired flatfoot deformity. The surgical procedures were performed by one of two experienced foot and ankle surgeons. A painful flatfoot with clinical deformity and evidence of naviculocuneiform sag and/or tarsometatarsal joint subluxation on radiographic evaluation were the indicators for surgery. Before the surgery, standardized weightbearing radiographs were obtained. On the lateral views, arch height was assessed by measuring talometatarsal angle and calcaneal pitch. On the AP views, talonavicular subluxation was measured, representing hindfoot abduction in the axial plane. The same parameters were measured on weightbearing radiographs taken postoperatively. All measurements were made by two experienced foot and ankle surgeons. The surgeons were blinded to each other's observations. An inter-observer correlation coefficient was calculated for each measurement. The initial value for each measurement was compared with the final value using Student's paired t test, with a p<0.05 considered significant.
RESULTS:
Good correlation was found between the observers with respect to radiographic parameters pre- and postoperatively. The inter-observer correlation coefficient was 0.87 for the lateral talometatarsal angle, 0.62 for the improvement in calcaneal pitch, and 0.57 for the improvement in talonavicular coverage. From preoperative to postoperative, all the radiographic measurements were found to be significantly improved. Improvement in arch height was indicated by a decrease in measured arch sag combined with an increase in calcaneal pitch. On the AP views, talonavicular coverage increased, suggesting improvement in abduction of the foot. The results of the medial column realignment resulted in an improvement of hindfoot alignment in the axial plane.
COMMENTS:
Isolated medial column stabilization procedures performed in patients with painful, adult-acquired flatfoot deformity can result in an increase in medial arch height and an increase in talonavicular coverage, suggesting improved hindfoot alignment. Patients who are carefully chosen can benefit from isolated medial column stabilization procedures. It proves to be a useful surgical treatment for flatfoot deformity by providing correction without the sacrifice of essential joints. The procedures are only appropriate for patients with a collapse of the medial arch through the naviculocuneiform and/or the tarsometatarsal joints. Although the patient population in this study was low, the results proved that in the correct patient, the procedure could improve a painful flatfoot deformity as observed through measured changes in specific radiographic parameters.
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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.