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Radiographic correction of stage III posterior tibial tendon dysfunction with a modified triple arthrodesis.
Foot Ankle Int. 2013 Oct; 34(10):1355-63.FA

Abstract

BACKGROUND

The literature supports fusion as the surgical treatment of choice for stage III posterior tibial tendon dysfunction (PTTD). The present study reports the radiographic correction following a modified triple arthrodesis (fusions of the subtalar, talonavicular, and first tarsometatarsal joints) in patients with stage III PTTD.

METHODS

An institutional review board-approved retrospective study was performed to assess the radiographic outcome of a modified triple arthrodesis in 21 patients (22 feet). Pre- and postoperative weight-bearing radiographs were reviewed in a blinded fashion by clinicians of varying levels of training. The talo-first metatarsal, talocalcaneal, and talonavicular coverage angles were measured on anteroposterior views. On lateral views, the talo-first metatarsal (Meary's), talocalcaneal, calcaneal pitch, and talar declination angles and the medial cuneiform to floor distance were measured. Statistical analysis was performed to compare pre- and postoperative measurements, assess the degree of correction, and determine interobserver reliability of the radiographic measurements.

RESULTS

All measurements improved significantly after treatment with a modified triple arthrodesis (P ≤ .001). The medial cuneiform to floor distance (0.910), talonavicular coverage angle (0.896), and lateral talo-first metatarsal angle (0.873) were the most reproducible between observers. Postoperatively, 100% of feet were corrected to normal medial cuneiform to floor distance and talonavicular coverage angle, and 90.9% were corrected to a normal lateral talo-first metatarsal angle.

CONCLUSION

The modified triple arthrodesis resulted in a reliable and reproducible correction of the deformity seen in rigid stage III PTTD.

LEVEL OF EVIDENCE

Level IV, case series.

Authors+Show Affiliations

Department of Orthopaedic Surgery & Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23832712

Citation

Mehta, Siddhant K., et al. "Radiographic Correction of Stage III Posterior Tibial Tendon Dysfunction With a Modified Triple Arthrodesis." Foot & Ankle International, vol. 34, no. 10, 2013, pp. 1355-63.
Mehta SK, Kellum RB, Robertson GH, et al. Radiographic correction of stage III posterior tibial tendon dysfunction with a modified triple arthrodesis. Foot Ankle Int. 2013;34(10):1355-63.
Mehta, S. K., Kellum, R. B., Robertson, G. H., Moore, A. R., Wingerter, S. A., & Tarquinio, T. A. (2013). Radiographic correction of stage III posterior tibial tendon dysfunction with a modified triple arthrodesis. Foot & Ankle International, 34(10), 1355-63. https://doi.org/10.1177/1071100713489285
Mehta SK, et al. Radiographic Correction of Stage III Posterior Tibial Tendon Dysfunction With a Modified Triple Arthrodesis. Foot Ankle Int. 2013;34(10):1355-63. PubMed PMID: 23832712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiographic correction of stage III posterior tibial tendon dysfunction with a modified triple arthrodesis. AU - Mehta,Siddhant K, AU - Kellum,R Bradley, AU - Robertson,George H, AU - Moore,Allen Ryves, AU - Wingerter,Scott A, AU - Tarquinio,Thom A, Y1 - 2013/07/05/ PY - 2013/7/9/entrez PY - 2013/7/9/pubmed PY - 2013/12/16/medline KW - modified triple arthrodesis KW - posterior tibial tendon dysfunction KW - radiographic correction KW - stage III PTTD KW - tendon disorders SP - 1355 EP - 63 JF - Foot & ankle international JO - Foot Ankle Int VL - 34 IS - 10 N2 - BACKGROUND: The literature supports fusion as the surgical treatment of choice for stage III posterior tibial tendon dysfunction (PTTD). The present study reports the radiographic correction following a modified triple arthrodesis (fusions of the subtalar, talonavicular, and first tarsometatarsal joints) in patients with stage III PTTD. METHODS: An institutional review board-approved retrospective study was performed to assess the radiographic outcome of a modified triple arthrodesis in 21 patients (22 feet). Pre- and postoperative weight-bearing radiographs were reviewed in a blinded fashion by clinicians of varying levels of training. The talo-first metatarsal, talocalcaneal, and talonavicular coverage angles were measured on anteroposterior views. On lateral views, the talo-first metatarsal (Meary's), talocalcaneal, calcaneal pitch, and talar declination angles and the medial cuneiform to floor distance were measured. Statistical analysis was performed to compare pre- and postoperative measurements, assess the degree of correction, and determine interobserver reliability of the radiographic measurements. RESULTS: All measurements improved significantly after treatment with a modified triple arthrodesis (P ≤ .001). The medial cuneiform to floor distance (0.910), talonavicular coverage angle (0.896), and lateral talo-first metatarsal angle (0.873) were the most reproducible between observers. Postoperatively, 100% of feet were corrected to normal medial cuneiform to floor distance and talonavicular coverage angle, and 90.9% were corrected to a normal lateral talo-first metatarsal angle. CONCLUSION: The modified triple arthrodesis resulted in a reliable and reproducible correction of the deformity seen in rigid stage III PTTD. LEVEL OF EVIDENCE: Level IV, case series. SN - 1071-1007 UR - https://www.unboundmedicine.com/medline/citation/23832712/Radiographic_correction_of_stage_III_posterior_tibial_tendon_dysfunction_with_a_modified_triple_arthrodesis_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100713489285?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -