Triple Arthrodesis for Adult-Acquired Flatfoot Deformity

Erard, Maj Uma E.; Sheean, Maj Andrew J.; Sangeorzan, Bruce J.

doi:10.1177/2473011419849609

Cited by 11 publications

(8 citation statements)

References 82 publications

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“…Staple constructs have shown very similar fusion rates to screws for hindfoot fusions. 35 The key to any combination of fusions is correcting the deformity and creating a plantigrade foot. Although AAFD is hindfoot driven, the talonavicular fusion can be used to both correct the forefoot abduction deformity and any residual forefoot varus, with screws, plates, or staples.…”

Section: Stage IIImentioning

confidence: 99%

“…There is evidence in the literature that both are acceptable options. 34,35 The subtalar fusion is used to correct the hindfoot valgus and should be corrected to 5 degrees of valgus. Correction of the hindfoot alignment is vital to prevent persistent deltoid failure due to undercorrection or overcorrection into varus.…”

Section: Stage IIImentioning

confidence: 99%

“…First, TMT fusions may be needed to bring the first ray down if the deformity cannot be corrected through the talonavicular joint. 4,31,35…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…First, TMT fusions may be needed to bring the first ray down if the deformity cannot be corrected through the talonavicular joint. 4,31,35 There is no clear answer whether a calcaneocuboid fusion should be done in the correction of AAFD treated with arthrodesis. Some authors propose that it can correct some of the residual forefoot varus by elevating the lateral column.…”

Section: Stage IIImentioning

confidence: 99%

“…11,34 However, there is no clear evidence that doing a double over a triple arthrodesis will limit ankle arthritis rates over time. 35…”

Section: Stage IIImentioning

confidence: 99%

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Adult Acquired Flatfoot Deformity

Jackson

Pacana

Gonzalez

2022

J Am Acad Orthop Surg

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Adult acquired flatfoot deformity (AAFD) is a condition commonly seen by orthopaedic surgeons. Posterior tibial tendon dysfunction is thought to be the initial pathoanatomic etiology that leads to this deformity. Successful resolution of the pain associated with AAFD can be achievable with nonsurgical methods. Patients who continue to have pain or functional limitations despite nonsurgical treatment can find improvement with appropriately selected surgical interventions. This article addresses new advances in treatment based on the stage of AAFD and will identify areas of continued development with a focus on surgical management. The literature continues to evolve as demonstrated by a recent update regarding the nomenclature and treatment of this condition to progressive collapsing flatfoot deformity. Future goals of research include understanding the natural history of the disease, from asymptomatic to symptomatic, and studying a wide array of newer treatments and implants that have not been prospectively evaluated.

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Section: Stage IIImentioning

confidence: 99%

Section: Stage IIImentioning

confidence: 99%

“…First, TMT fusions may be needed to bring the first ray down if the deformity cannot be corrected through the talonavicular joint. 4,31,35…”

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Stage IIImentioning

confidence: 99%

“…11,34 However, there is no clear evidence that doing a double over a triple arthrodesis will limit ankle arthritis rates over time. 35…”

Section: Stage IIImentioning

confidence: 99%

See 3 more Smart Citations

Adult Acquired Flatfoot Deformity

Jackson

Pacana

Gonzalez

2022

J Am Acad Orthop Surg

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Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts

Fadle

El-Adly

Attia

et al. 2021

International Orthopaedics (SICOT)

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Purpose The study aims to prospectively compare double and triple arthrodesis in terms of functional outcomes and deformity correction. To the best of our knowledge, this is the first prospective comparative study in the literature to date. Methods This is a prospective comparative cohort study carried out between May 2017 and May 2019. The study was approved by the IRB at Assiut University and done according to the Helsinki declaration. Patients with AAFD stage III aged between 15 and 40 years old were assigned to double arthrodesis or triple arthrodesis. The groups were prospectively followed for one year. Primary outcomes were union rates, AOFAS scores, and radiological parameters of deformity correction on AP and lateral plain radiographs. Secondary outcomes were operative time, time to union, and complications. The double arthrodesis was done through the medial approach, while the triple arthrodesis was done through dual medial and lateral approaches. The post-operative protocol was standardized for both groups. Results A total of twenty-three patients matched the inclusion criteria and provided their consent to participate in the study. Thirteen (all males) patients underwent double arthrodesis, while ten (nine males and one female) patients underwent triple arthrodesis. The mean age for double and triple arthrodesis was 20.15 ± 5.63 and 25.10 ± 8.36 years, respectively, and the mean follow-up lengths were 12.46 and 12.9 months, respectively. There were no statistically significant differences between both groups in age, gender, laterality, or duration of follow-up. There were no statistically significant differences between both groups in AOFAS hindfoot scores or radiographic parameters. All patients were available for the final follow-up evaluation. All patients in both groups achieved union by four months post-operatively. The mean time to union in the double and triple arthrodesis groups was 3.39 ± 0.65 vs. 3.31 ± 0.6 months, respectively, with no statistically significant differences (p = 0.77). The mean operative time was significantly shorter in the double arthrodesis group than the triple arthrodesis group, 55.77 ± 15.18 vs. 91.6 ± 24.14 min (p < 0.001), respectively. Both double and triple arthrodesis groups had a statistically significant improvement of the mean AOFAS hindfoot score post-operatively (71.46 ± 7.77 vs. 88.38 ± 3.66, p < 0.001) and (66.9 ± 7.69 vs. 85 ± 5.83, p < 0.001), respectively. In the double arthrodesis group, the mean calcaneal pitch angle increased from 11.46° pre-operatively to 19.34° (MD = 8.45°, p < 0.001). The mean Meary’s angle improved from − 4.19 to 2.9° (MD = 7.32°, p < 0.001). Hibbs angle had a mean reduction of 6.45° post-operatively (p = 0.069). In the triple arthrodesis group, the mean calcaneal pitch angle improved from 10.06° pre-operatively to 17.49° post-operatively (MD = 7.12°, p < 0.001). The mean Meary’s angle improved from − 4.72 to 2.29° (MD = 7.09°, p < 0.001). The mean Hibbs angle decreased from 153.07 to 142.32° (MD = 10.54°, p < 0.001). The double vs. triple arthrodesis groups had no statistically significant differences in AOFAS hindfoot score improvement (16.92 vs. 19.1, p = 0.44), respectively. The two groups had no statistically significant differences in the magnitude of correction of all the radiographic parameters. Conclusion Double arthrodesis is an equally reliable surgical option for AAFD stage III for achieving union, improving the functional outcomes, and deformity correction as triple arthrodesis with a significantly shorter operative time in the former. The authors recommend double arthrodesis if the calcaneocuboid joint is unaffected.

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Flatfoot over the centuries: the background of current conservative and operative treatments

Biz,

Cerchiaro,

Mori

et al. 2023

International Orthopaedics (SICOT)

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Purpose Although flatfoot is a widespread human condition, historical medical texts and ancient illustrations on this deformity are extremely rare. Nowadays, doubts regarding its management remain unsolved. This historical review aims to identify the presence of pes planus since the prehistoric era and examine the treatments proposed over the centuries up to the present. Method For this propose, we performed an extensive electronic search of the relevant literature, complemented by a manual search of additional sources from archaeological to artistic, literary, historical, and scientific accounts, describing flatfoot and its treatment in different eras. Results Flatfoot accompanied the evolutionary timeline of human species: from Lucy Australopithecus to Homo Sapiens. It was described among various diseases suffered by Tutankhamun (1343–1324 B.C.), while the first anatomical description dates to Emperor Trajan (53–117 A.D.) and the medical studies of Galen (129–201 A.D.). It was also represented in the anatomical drawings of Leonardo da Vinci (1452–1519) and Girolamo Fabrici d'Acquapendente (1533–1619). Historically, the conservative treatment by insoles was the only one proposed until the nineteenth century. Since then, the most popular surgical procedures performed for correction have been osteotomies, arthrodesis, arthrorisis, and tendon lengthening and transfer. Conclusion During the centuries, conservative therapeutic strategies have not radically changed in their substance, while operative ones have become the protagonists during the twentieth century up to the present. Nevertheless, after more than 2000 years of history, there is no consensus regarding the best indication for the flatfoot and if it really needs to be treated.

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Triple Arthrodesis for Adult-Acquired Flatfoot Deformity

Cited by 11 publications

References 82 publications

Adult Acquired Flatfoot Deformity

Adult Acquired Flatfoot Deformity

Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts

Flatfoot over the centuries: the background of current conservative and operative treatments

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