Journal article
Consensus on Indications for Isolated Subtalar Joint Fusion and Naviculocuneiform Fusions for Progressive Collapsing Foot Deformity
Foot & ankle international, Vol.41(10), pp.1295-1298
10/01/2020
DOI: 10.1177/1071100720950738
PMID: 32851856
Abstract
Recommendation: Peritalar subluxation represents an important hindfoot component of progressive collapsing foot deformity, which can be associated with a breakdown of the medial longitudinal arch. It results in a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and pronation. Loss of peritalar stability allows the talus to rotate and translate on the calcaneal and navicular bone surfaces, typically moving medially and anteriorly, which may result in sinus tarsi and subfibular impingement. The onset of degenerative disease can manifest with stiffening of the subtalar (ST) joint and subsequent fixed and possibly arthritic deformity. While ST joint fusion may permit repositioning and stabilization of the talus on top of the calcaneus, it may not fully correct forefoot abduction and it does not correct forefoot varus. Such varus may be addressed by a talonavicular (TN) fusion or a plantar flexion osteotomy of the first ray, but, if too pronounced, it may be more effectively corrected with a naviculocuneiform (NC) fusion. The NC joint has a curvature in the sagittal plane. Thus, preserving the shape of the joint is the key to permitting plantarflexion correction by rotating the midfoot along the debrided surfaces and to fix it. Intraoperatively, care must be also taken to not overcorrect the talocalcaneal angle in the horizontal plane during the ST fusion (eg, to exceed the external rotation of the talus and inadvertently put the midfoot in a supinated position). Such overcorrection can lead to lateral column overload with persistent lateral midfoot pain and discomfort. A contraindication for an isolated ST fusion may be a rupture of posterior tibial tendon because of the resultant loss of the internal rotation force at the TN joint. In these cases, a flexor digitorum longus tendon transfer is added to the procedure.
Details
- Title: Subtitle
- Consensus on Indications for Isolated Subtalar Joint Fusion and Naviculocuneiform Fusions for Progressive Collapsing Foot Deformity
- Creators
- Beat Hintermann - Kantonsspital BasellandJonathan T. Deland - Hospital for Special SurgeryCesar de Cesar Netto - University of IowaScott J. Ellis - Hospital for Special SurgeryJeffrey E. Johnson - Washington University in St. LouisMark S. Myerson - University of Colorado DenverBruce J. Sangeorzan - University of WashingtonDavid Thordarson - Cedars-Sinai Medical CenterLew C. Schon - Mercy Medical Center
- Resource Type
- Journal article
- Publication Details
- Foot & ankle international, Vol.41(10), pp.1295-1298
- Publisher
- Sage
- DOI
- 10.1177/1071100720950738
- PMID
- 32851856
- ISSN
- 1071-1007
- eISSN
- 1944-7876
- Number of pages
- 4
- Language
- English
- Date published
- 10/01/2020
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984303977602771
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