SLR - November 2009 - David H. Simon
Reference:
Turriago, C., Arbelaez, M., Becerra, L. (2009). Talonavicular joint arthrodesis for treatment of pes planus valgus in older children and adolescents with cerebral palsy. Journal of Child Orthopedics, 3, 179-183.
Scientific Literature Review
Reviewed By: David H. Simon DPM
Residency Program: YNHH PMS36 Podiatric Surgical Residency Program
Podiatric Relevance:
Prior to this paper there were no clinical reports regarding the use of an isolated talonavicular joint fusion in the pediatric patient for a spastic flat foot secondary to cerebral palsy.
Methods:
59 feet were included within this retrospective study. The average patient age was 13.9 years and the average follow-up time was 40 months. 35% had previous foot surgical intervention prior to this procedure. 27% of the sample patients also underwent concomitant lower extremity procedures. Data was obtained from clinical history, pre and post operative weight-bearing x-rays, and gait parameters from a computerized gait analysis (Ariel dynamics and BTS). Weight bearing x-ray angles that were measured included the AP and lateral 1st metatarsal-talus angle, and the AP and lateral talo-calcaneal angle. A single 3 cm medial based incision was utilized at the talo-navicular joint. Articular cartilage was resected with use of oscillating saw and curettage. Rigid internal fixation was performed with either 3.0 mm steinmann pin or a 4.5 mm cannulated cortical screw.
Results:
All feet had midtarsal hypermobility preoperatively; none had this post-operatively. The surgeons neglected to diagnose preoperative ankle valgus deformities 10 % of the time leading to a residual hindfoot valgus deformity. 87.5% of the patients were satisfied with the surgical correction while no patients were unsatisfied. No significant changes were seen in the gait parameters after undergoing this surgical intervention. Although there was an 11.8% rate of pseudo arthrosis of the fusion site and 85% of those feet were fixated with a percutaneous steinmann pin, there was no statistical significance of this finding.
Conclusion:
This article showed evidence that isolated talo-navicular fusions in children with a spastic flat foot secondary to cerebral palsy have good short term outcomes with reduction of deformities commonly associated with pes valgus. Although the authors admit that their follow-up is short (40 months), this article indicates that isolated TN fusions are a viable option to consider instead of more extensive double or triple arthrodesis procedures.