The Effect of Subtalar Arthrodesis Alignment on Ankle Biomechanics

Abstract

Background: The position, axis, and control of each lower extremity joint intimately affects adjacent joint function as well as whole limb performance. There is little describing the biomechanics of subtalar arthrodesis and none describing the effect that subtalar arthrodesis position has on ankle biomechanics. The purpose of the current study is to establish this effect on sagittal plane ankle biomechanics. Methods: A study was performed utilizing a three-dimensional, validated, computational model of the lower extremity. A subtalar arthrodesis was simulated from 20 degrees of varus to 20 degrees of valgus. For each of these subtalar arthrodesis positions, the ankle dorsiflexor and plantarflexor muscles’ fiber force, moment arm, and moments were calculated throughout a physiologic range of motion. Results: Throughout ankle range of motion, plantarflexion and dorsiflexion strength varies with subtalar arthrodesis position. When the ankle joint is in neutral position, plantarflexion strength is maximized in 10 degrees of subtalar valgus and strength varies by a maximum of 2.6% from the peak 221 Nm. In a similar manner, with the ankle joint in neutral position, dorsiflexion strength is maximized with a subtalar joint arthrodesis in 5 degrees of valgus and strength varies by a maximum of 7.5% from the peak 46.8 Nm. The change in strength is due to affected muscle fiber force generating capacities and muscle moment arms. Conclusion: The clinical significance of this study is that subtalar arthrodesis in a position of 5–10 degrees subtalar valgus has biomechanical advantage. This supports previous clinical outcome studies and offers biomechanical rationale for their generally favorable outcomes.