Tibiotalocalcaneal arthrodesis

Abstract

The purpose of this study was to evaluate retrospectively the outcomes of the Ludloff osteotomy for severe hallux valgus. Thirty cases in 23 patients, with an average clinical follow-up of 29.5 months, are reported. The hallux valgus angle improved on average 22°, from a preoperative average of 33.8° to 11.8° at follow-up. The intermetatarsal (IM)1–2 angle improved on average 12.8°, from 19.6° preoperatively to 7.7° at follow-up. The lateral plantar first metatarsal angle did not change; union occurred at an average of 6 weeks. Tibial sesamoid position improved from a preoperative average position of 2.8 to an average position of 0.6. The AOFAS Rating Score improved from a preoperative average of 48.8/100 to an average of 90.1/100 at follow-up. There were four patients with complications, including three cases with delayed unions and one with superficial wound infection. We found a significantly favourable correlation in the amount of IM 1–2 angle, hallux valgus and tibial sesamoid position correction when compared with an increased postoperative foot score. This is an important finding because there is a direct correlation here between improved measurable radiographical findings and an improved subjective evaluation. Furthermore, we found a trend for a longer follow-up period to be correlated with a better postoperative foot score. Based on our results and on the review of the literature, we conclude that Ludloff osteotomy provides reliable successful long-term results for the treatment of severe symptomatic hallux valgus and metatarsus primus adductus deformity.