Abstract
Long-standing loss of medial column support in the end-stage flatfoot leads to valgus deformity and arthritic degeneration in the ankle. When surgery is considered, the traditional approach has been pantalar arthrodesis. As experience is gained with newer designs of ankle replacements, the restoration of painless ankle motion to these feet has become a possibility. Ankle arthroplasty in the advanced valgus foot requires restoration of osseous alignment and muscle balance. In most cases, realignment and fusion of the subtalar, talonavicular, and possibly other medial column joints is necessary, along with posterior tibial tendon reconstruction and Achilles tendon lengthening. Ankle arthroplasty is then performed as a second stage procedure. The talus is realigned relative to the tibia, and appropriate tension is regained in the deltoid through distraction. Realigning the bony deformity and restoring soft tissue balance optimizes the chances for long-term survival of the ankle implant.
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