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Reconstruction of the medial talonavicular joint in simulated flatfoot deformity.
Foot Ankle Int. 2015 Apr; 36(4):424-9.FA

Abstract

BACKGROUND

Reconstructing the ligamentous constraints of the medial arch associated with adult acquired flatfoot deformity remains a challenge. The purpose of this study was to test the efficacy of several reconstruction techniques of the medial arch. We hypothesized that an anatomic reconstruction of the spring ligament complex would correct the deformity better than other techniques tested.

METHODS

Three reconstructions of the medial support structures were performed on each specimen to recreate the different lines of action and insertions of the medial ligamentous complex in 12 specimens with a simulated flatfoot deformity. Talonavicular and tibiocalcaneal (hindfoot) orientations were measured in the axial, sagittal, and coronal planes in the intact, flatfoot, and reconstructed conditions.

RESULTS

While each reconstruction technique corrected the deformity (P < .05), proximal fixation of the graft corrected the greatest amount of talonavicular deformity while also correcting hindfoot valgus (P < .05).

CONCLUSION

The fixation points and lines of action of a medial arch reconstruction have important implications on deformity correction in a flatfoot model. Despite its fidelity to the native structure, the anatomic spring ligament reconstruction provided the least amount of correction. These findings suggest that other ligamentous structures of the medial arch are critical in supporting the midfoot.

CLINICAL RELEVANCE

Reconstruction of the ligamentous supports of the medial arch might be able to correct substantial amounts of deformity without osseous procedures like calcaneal osteotomies or midfoot fusions.

Authors+Show Affiliations

Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA baxterj@hss.edu.Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA Orthopedic Department, Hospital Israelita Albert Einstein, São Paulo-SP, Brazil.Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA.Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25367252

Citation

Baxter, Josh R., et al. "Reconstruction of the Medial Talonavicular Joint in Simulated Flatfoot Deformity." Foot & Ankle International, vol. 36, no. 4, 2015, pp. 424-9.
Baxter JR, LaMothe JM, Walls RJ, et al. Reconstruction of the medial talonavicular joint in simulated flatfoot deformity. Foot Ankle Int. 2015;36(4):424-9.
Baxter, J. R., LaMothe, J. M., Walls, R. J., Prado, M. P., Gilbert, S. L., & Deland, J. T. (2015). Reconstruction of the medial talonavicular joint in simulated flatfoot deformity. Foot & Ankle International, 36(4), 424-9. https://doi.org/10.1177/1071100714558512
Baxter JR, et al. Reconstruction of the Medial Talonavicular Joint in Simulated Flatfoot Deformity. Foot Ankle Int. 2015;36(4):424-9. PubMed PMID: 25367252.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reconstruction of the medial talonavicular joint in simulated flatfoot deformity. AU - Baxter,Josh R, AU - LaMothe,Jeremy M, AU - Walls,Raymond J, AU - Prado,Marcelo Pires, AU - Gilbert,Susannah L, AU - Deland,Jonathan T, Y1 - 2014/11/03/ PY - 2014/11/5/entrez PY - 2014/11/5/pubmed PY - 2015/12/30/medline KW - biomechanics KW - deformity KW - flatfoot KW - spring ligament KW - talonavicular SP - 424 EP - 9 JF - Foot & ankle international JO - Foot Ankle Int VL - 36 IS - 4 N2 - BACKGROUND: Reconstructing the ligamentous constraints of the medial arch associated with adult acquired flatfoot deformity remains a challenge. The purpose of this study was to test the efficacy of several reconstruction techniques of the medial arch. We hypothesized that an anatomic reconstruction of the spring ligament complex would correct the deformity better than other techniques tested. METHODS: Three reconstructions of the medial support structures were performed on each specimen to recreate the different lines of action and insertions of the medial ligamentous complex in 12 specimens with a simulated flatfoot deformity. Talonavicular and tibiocalcaneal (hindfoot) orientations were measured in the axial, sagittal, and coronal planes in the intact, flatfoot, and reconstructed conditions. RESULTS: While each reconstruction technique corrected the deformity (P < .05), proximal fixation of the graft corrected the greatest amount of talonavicular deformity while also correcting hindfoot valgus (P < .05). CONCLUSION: The fixation points and lines of action of a medial arch reconstruction have important implications on deformity correction in a flatfoot model. Despite its fidelity to the native structure, the anatomic spring ligament reconstruction provided the least amount of correction. These findings suggest that other ligamentous structures of the medial arch are critical in supporting the midfoot. CLINICAL RELEVANCE: Reconstruction of the ligamentous supports of the medial arch might be able to correct substantial amounts of deformity without osseous procedures like calcaneal osteotomies or midfoot fusions. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/25367252/Reconstruction_of_the_medial_talonavicular_joint_in_simulated_flatfoot_deformity_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100714558512?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -