Summary

To analyze the clinical outcomes of triple arthrodesis with osteotomy for the treatment of Stage IIB and Stage III adult-acquired flatfoot deformity.

Abstract

Purpose

To analyze the clinical outcomes of triple arthrodesis with osteotomy for the treatment of Stage IIB and Stage III adult-acquired flatfoot deformity. Methods The authors have reviewed 10 cases adult-acquired flatfoot, including 3 cases of stage IIB adult-acquired flatfoot and 7cases of stage III adult-acquired flatfoot, which were treated by triple arthrodesis with osteotomy, which includes the subtalar joints (STJ), talonavicular joints (TNJ), and calcaneocuboid joints (CCJ). The combined medial and lateral incision were used to obtain adequate exposure to the CCJ, STJ, and TNJs. The cartilage of the CCJ, STJ, and TNJs then were completely denuded of all cartilage, and osteotomied to restore their proper alignment according the collapse degree of foot arch. The optimal positioning of the hindfoot can be achieved and fixed by Kirschner wires. The guide wires from a cannulated screw system was inserted under the help of C-arm machine, including intraoperative AP, lateral, and calcaneal axial views. Two cannulated screws of 7.3 mm were delivered through the plantar aspect of the heel to fixate the STJ. And then, two cannulated screws of 4.5mm individually fixated the TNJ and CCJ, directed distal to proximal. Clinical evaluation was based on the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale in addition to subjective assessments of pain, function, cosmesis, and overall satisfaction. Radiographic evaluation included measurements of the anterior-posterior talo-second metatarsal angle, lateral talocalcaneal angle, and lateral talo-first metatarsal angle, as well as an assessment of time to union of all arthrodeses. Results All patients were followed-up with mean time of 13.2 months (6~21months). The average AOFAS Ankle-Hindfoot Scale improved from 39.4±4.4 preoperatively to 83.7±2.6 postoperatively (p < 0.01). Subjectively, patients experienced improvements in pain, function, cosmesis. Overall, all patients were satisfied. Radiographically, the rate of bone healing was 100%. All parameters statistically improved. There was no any complication, including infection, un-union, and so on. Conclusion Triple arthrodesis with osteotomy is an effective procedure for the treatment of stage IIB and III adult-acquired flatfoot deformity, to relieve pain and correct structural deformities, to get good clinical outcomes.
Key words: Triple Arthrodesis; Osteotomy; Treatment; Adult;Flatfoot