Abstract
Single, double, and triple hindfoot arthrodeses are used to correct hindfoot deformities and relieve chronic pain. However, joint fusion may lead to dysfunction in adjacent articular surfaces. We compared range of motion in adjacent joints before and after arthrodesis to determine the effects of each procedure on joint motion. The theory of moment of couple, bending moment and balanced loading was applied to each of 16 fresh cadaver feet to induce dorsiflexion, plantarflexion, internal rotation, external rotation, inversion, and eversion. Range of motion was measured with a 3-axis coordinate measuring machine in a control foot and in feet after subtalar, talonavicular, calcaneocuboid, double, or triple arthrodesis. All arthrodeses restricted mainly internal-external rotation and inversion-eversion. The restriction in a double arthrodesis was more than that in a single arthrodesis, but that in a calcaneocuboid arthrodesis was relatively low. After triple arthrodeses, the restriction on dorsiflexion and plantarflexion movements was substantial, and internal-external rotation and inversion-eversion were almost lost. Considering that different arthrodesis procedures cause complex, three-dimensional hindfoot motion reductions, we recommend talonavicular or calcaneocuboid arthrodesis for patients with well-preserved functions of plantarflexion/dorsiflexion before operation, subtalar or calcaneocuboid arthrodesis for patients with well-preserved abduction/adduction, and talonavicular arthrodesis for patients with well-preserved eversion/inversion.
Highlights
Single, double, and triple hindfoot arthrodeses are used to correct hindfoot deformities and relieve chronic pain
After an isolated subtalar fusion, the range of motion (ROM) of the subtalar joint was reduced by 20%, that of the calcaneocuboid joint was reduced 44%, and that of the talonavicular joint, by 74%1
Astion et al found that simulated arthrodesis of the calcaneocuboid joint had little effect on the ROM of the subtalar joint, but it reduced the ROM of the talonavicular joint to 67%10
Summary
Double, and triple hindfoot arthrodeses are used to correct hindfoot deformities and relieve chronic pain. Range of motion was measured with a 3-axis coordinate measuring machine in a control foot and in feet after subtalar, talonavicular, calcaneocuboid, double, or triple arthrodesis. The restriction on dorsiflexion and plantarflexion movements was substantial, and internal-external rotation and inversioneversion were almost lost. Considering that different arthrodesis procedures cause complex, threedimensional hindfoot motion reductions, we recommend talonavicular or calcaneocuboid arthrodesis for patients with well-preserved functions of plantarflexion/dorsiflexion before operation, subtalar or calcaneocuboid arthrodesis for patients with well-preserved abduction/adduction, and talonavicular arthrodesis for patients with well-preserved eversion/inversion. Fortin[4] reported that subtalar joint motion was reduced by 80% to 90% after an isolated fusion of the talonavicular joint and that motion of the calcaneocuboid joint was lost completely, leading to accelerated arthrosis of adjacent joints. The past few years, several foot models have been published[14], including cadaveric arthrodesis models[1,7]
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