Triple Arthrodesis With Lateral Column Lengthening for the Treatment of Planovalgus Deformity

Abstract

The rigid planovalgus foot has historically been difficult to correct and maintain in a corrected position with triple arthrodesis (TA). The lateral column lengthening (LCL) is a procedure that corrects the position of the planovalgus foot. Combining the TA with LCL at the calcaneocuboid joint may improve ultimate position after fusion for patients with rigid planovalgus foot deformities. A retrospective review of all patients who underwent TA with LCL through the calcaneocuboid joint for rigid planovalgus foot deformity was performed. Preoperative and postoperative radiographs were compared for foot alignment by measuring the talo-first metatarsal angle in the anterior-posterior and lateral planes, calcaneal pitch, talo-horizontal angle, metatarsal stacking angle, and medial/lateral column ratio. Clinical outcomes were evaluated for correlation with preoperative and postoperative deformity and surgical indications. were evaluated using radiographic and clinic outcome measures developed for TA and LCL. : Twenty-nine surgeries were identified with solid fusions occurring in 27 patients by 12 weeks postoperatively. Two patients with cerebral palsy had persistent hindfoot valgus. At an average follow-up of 32 months after surgical intervention, correction of the talo-first metatarsal angle in the AP and lateral planes, calcaneal pitch, and talo-horizontal angles were statistically significant. There were 25 good clinical results with minimal or no pain with activity (86.2%) and 4 poor or fair results with moderate or severe pain (13.8%). There were 26 radiographic successes (89.7%) and 3 radiographic failures (10.3%). Cerebral palsy was associated with a higher rate of radiographic failures (P=0.01). There were 15 total complications in 11 feet (37.9%). These included 4 related to hardware, 3 involving neurological symptoms, 2 related to soft tissues, development of a symptomatic bony prominence in 2 patients, 1 forefoot deformity, 2 nonunions, and 1 case of Achilles tendonitis. Good correction can be obtained and maintained with LCL and TA for rigid planovalgus foot deformity. The procedure is associated with good short-term clinical and radiographic outcomes and improves the position of the foot with diminished risk of recurrent or continued deformity as compared with historical controls. Level IV (case series).