Adult-Acquired Flatfoot Deformity: Combined Talonavicular Arthrodesis and Calcaneal Displacement Osteotomy versus Double Arthrodesis.

Sebastian Fischer,Jan Altmeppen,Sebastian Manegold,Reinhard Hoffmann,Julia Oepping,Oliver Neun,Yves Gramlich

doi:10.3390/jcm11030840

Abstract

Background: Adult-acquired flatfoot deformity due to posterior tibial tendon dysfunction (PTTD) is one of the most common foot deformities among adults. Hypothesis: Our study aimed to confirm that the combined procedures of calcaneal displacement osteotomy and talonavicular arthrodesis are equivalent to double arthrodesis. Methods: Between 2016 and 2020, 41 patients (13 male and 28 females, mean age of 63 years) were retrospectively enrolled in the comparative study. All deformities were classified into Stages II and III of PTTD, according to Johnson and Strom. All patients underwent isolated bony realignment of the deformity: group A (n = 19) underwent calcaneal displacement osteotomy and talonavicular arthrodesis, and group B (n = 23) underwent double arthrodesis. Measurements from the Foot Function Index-D (FFI-D) and the SF-12 questionnaire were collected, with a comparison of pre- and post-operative radiographs conducted. The mean follow-up period for patients was 3.4 years. Results: The mean FFI-D was 33.9 (group A: 34.5; group B: 33.5), the mean SF-12 physical component summary was 43.13 (group A: 40.9; group B: 44.9), and the mean SF-12 mental component summary was 43.13 (group A: 40.9; group B: 44.9). The clinical data and corrected angles showed no significant intergroup differences. Conclusion: Based on the available data, our study confirmed that the combined procedures of talonavicular arthrodesis and calcaneal shift, with preservation of the subtalar joint, can be considered equivalent to the established double arthrodesis, with no significant differences in terms of clinical and radiological outcomes.

Highlights

Adult-acquired flatfoot deformity (AAFD) due to posterior tibial tendon dysfunction (PTTD) is one of the most common foot deformities among adults
The staging of PTTD, according to Johnson and Strom (Stages I–III), along with its modification according to Raikin and extension according to Myerson (Stage IV) has become established [5,6,7]
A proportional decrease in the number of triple arthrodesis performed in favour of double arthrodesis can be observed [10,13]

Summary

Introduction

Adult-acquired flatfoot deformity (AAFD) due to posterior tibial tendon dysfunction (PTTD) is one of the most common foot deformities among adults. Stage III, according to Johnson and Strom, describes a longitudinal or transverse rupture of the posterior tibial tendon on magnetic resonance imaging (MRI) with fixed deformity in addition to the above symptoms [10,11]. In these cases, restoration of the physiological axes by tarsal arthrodesis has become an established treatment [12]. Conclusion: Based on the available data, our study confirmed that the combined procedures of talonavicular arthrodesis and calcaneal shift, with preservation of the subtalar joint, can be considered equivalent to the established double arthrodesis, with no significant differences in terms of clinical and radiological outcomes

Methods

Findings

Discussion

Conclusion