For surgeons familiar with posterior ankle or subtalar arthroscopy, PASTA offers superior exposure of the posterior talocalcaneal facet, high patient satisfaction, an excellent fusion rate, and less postoperative morbidity for patients with subtalar arthritis.

Background-In ankles with end-stage osteoarthritis or with total ankle replacement (TAR), radiographic landmarks based on joint surface morphology are usually obscured and thus inadequate for radiographic measurement. Furthermore, because of difficulty in reproducibly positioning the ankle for a standing radiograph, any radiographic measure to accurately describe ankle alignment needs to tolerate perturbations of ankle positioning in clinical radiographs. To identify a radiographic measure of antero-posterior (AP) tibial-talar alignment that meets those requirements, three candidate measures were compared by means of sensitivity to perturbations of ankle positioning.

683 e treated 35 brachymetatarsal rays of 18 feet in 12 patients by one-stage lengthening with interpositional bone grafts or by gradual lengthening with callotasis combined with shortening of the adjacent metatarsals and phalanges. Definition of the two parabolas which connect the metatarsal heads and the tips of the toes, and recognition of three patterns of metatarsal length, were helpful guides in treatment. In total, 36 excisions of the phalanges and/or the metatarsals were undertaken. The mean shortening was 8 mm.The radiological results were satisfactory. The mean values were as follows: one-stage lengthening, length gain, 1.3 cm; healing index, 1.3 months/cm; percentage increase, 30%; gradual lengthening, length gain, 2.0 cm; healing index, 2.0 months/cm; percentage increase, 50%.Associated shortening of an adjacent bone can avoid the disadvantages of one-stage lengthening which may not achieve target length and can result in neurovascular complications. Reduction of the target length enables the surgeon to carry out one-stage instead of gradual lengthening. It also shortens the length of treatment in the group undergoing callotasis and improves cosmesis. J Bone Joint Surg [Br] 2003;85-B:683-90.