Hindfoot Arthrodesis for the Elective and Posttraumatic Foot Deformity

Normal and malaligned talonavicular fusion alters cadaveric foot pressure and kinematics

Talonavicular (TN) fusion is a common treatment for TN arthritis or deformity correction. There is incongruous evidence regarding remaining motion at the talocalcaneal and calcaneocuboid joints after TN fusion. Additionally, the effects of a malaligned TN fusion are not well understood and alignment of the fusion may be important for overall foot integrity. This project assessed the kinematic and kinetic effects of neutral and malaligned TN fusions. Ten cadaveric feet were tested on a gait simulator in four conditions: unfused, fused in neutral, fused in varus, and fused in valgus. The fusions were simulated with external fixation hardware. An eight-camera motion analysis system and a 10-segment foot model generated kinematic data, and a pressure mat captured pressure data. Simulated TN fusion was achieved in eight feet. From unfused to fused-neutral, range of motion (ROM) was not eliminated in the adjacent joints, but the positions of the joints changed significantly throughout stance phase. Furthermore, the ROM increased at the tibiotalar joint. Plantar pressure and center of pressure shifted laterally with neutral fusion. The malalignments marginally affected the ROM but changed joint positions throughout stance phase. Pressure patterns were shifted laterally in varus malalignment and medially in valgus malalignment. The residual motion and the altered kinematics at the joints in the triple joint complex after TN fusion may subsequently increase the incidence of arthritis. Clinical significance: This study quantifies the effects of talonavicular fusion and malalignment on the other joints of the triple joint complex.

Sprunggelenk- und Vorfußtherapie in der Rheumatologie – wie lange können wir den aufrechten Gang erhalten?

Die Therapie des rheumatischen Fußes ist komplex und erstreckt sich über ein breites Spektrum von konservativen und operativen Behandlungsmethoden. Das Ziel ist, bei guter Stabilität, möglichst viel Beweglichkeit zu erhalten. Nebenerkrankungen wie die Polyneuropathie mit und ohne Diabetes mellitus beeinflussen die Behandlungsoptionen entscheidend. Aufgrund dessen, dass beim Rheumatiker multiple Gelenke befallen sind, unterliegen die orthopädische Schuhversorgung und die operative Therapie des rheumatischen Fußes speziellen Anforderungen im Hinblick auf das Gewicht, die Stabilität des Schuhs und Bettung des Fußes bzw. die Zugangswege und die Primärstabilität der Osteosynthesen. Der aufrechte Gang kann durch einen stadiengerechten zielgerichteten Einsatz aller Therapieoption sehr lange erhalten bleiben. Hierfür müssen die therapeutischen Fenster erkannt und genutzt sowie eine Übertherapie vermieden werden.

Common Pitfalls in Subtalar Joint Preparation for Arthrodesis via Sinus Tarsi Approach

This cadaveric study assessed factors that could lead to nonunions in subtalar joint arthrodesis. The purpose of this study was to assist surgeons in achieving sufficient joint preparation in hopes to achieve more frequent arthrodesis of the subtalar joint. We evaluated the influence of experience in regard to cartilage preparation of the joint. We also assessed which quadrants of the subtalar joint were more likely to have unprepared cartilage. The subtalar joints in 17 cadaveric limbs were prepared by 17 participants with differing levels of experience. After the cartilage was denuded, the percentage of unprepared cartilage in each subtalar joint was calculated. The medial quadrants were more likely to have unprepared surfaces. There was also a learning curve present with subtalar joint preparation, as seen by the significantly larger percentage of unprepared cartilage in cadavers prepared by first year residents.