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Combined Subtalar and Naviculocuneiform Fusion for Treating Adult Acquired Flatfoot Deformity With Medial Arch Collapse at the Level of the Naviculocuneiform Joint.
Foot Ankle Int. 2019 Jan; 40(1):42-47.FA

Abstract

BACKGROUND:

A challenge in treating acquired flatfoot deformities is the collapse of the medial arch at the level of the naviculocuneiform (NC) joint. Triple fusions, being a treatment option, may lead to problems such as increased foot stiffness. We thus established a method that combines subtalar (ST) fusion with NC fusion while preserving the Chopart joint. We analyzed the radiographic correction, fusion rate, and patient satisfaction with this procedure.

METHODS:

34 feet in 31 patients (female, 23; male, 8; age 67 [45-81] years) were treated with a ST and NC joint fusion. In 15 cases, a medial sliding-osteotomy was additionally necessary to fully correct hindfoot valgus. The following radiographic parameters were measured on weightbearing radiographs preoperatively and at 2 years: talo-first metatarsal angle, talocalcaneal angle, calcaneal pitch, talonavicular coverage angle and calcaneal offset. Fusion was radiologically confirmed.

RESULTS:

All parameters, except the calcaneal pitch, showed a significant improvement. Fusion was observed after 1 year in all but 2 cases (94.1%). One nonunion each occurred at the ST and NC joint without needing any subsequent treatment. One patient developed avascular necrosis of the lateral talus with need for total ankle replacement after 1 year. All patients were satisfied with the obtained results.

CONCLUSION:

Our data suggest that a combined fusion of the ST and NC joint was effective and safe when treating adult acquired flatfoot with collapse of the medial arch at the level of the NC joint. Although the talonavicular joint was not fused, its subluxation was significantly reduced.

LEVEL OF EVIDENCE:

Level IV, case series.

Authors+Show Affiliations

1 Kantonsspital Baselland, Liestal, Switzerland.1 Kantonsspital Baselland, Liestal, Switzerland. 2 Inselspital, Universitätsspital Bern, Switzerland.1 Kantonsspital Baselland, Liestal, Switzerland.1 Kantonsspital Baselland, Liestal, Switzerland.1 Kantonsspital Baselland, Liestal, Switzerland.1 Kantonsspital Baselland, Liestal, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30317867

Citation

Steiner, Caspar Samuel, et al. "Combined Subtalar and Naviculocuneiform Fusion for Treating Adult Acquired Flatfoot Deformity With Medial Arch Collapse at the Level of the Naviculocuneiform Joint." Foot & Ankle International, vol. 40, no. 1, 2019, pp. 42-47.
Steiner CS, Gilgen A, Zwicky L, et al. Combined Subtalar and Naviculocuneiform Fusion for Treating Adult Acquired Flatfoot Deformity With Medial Arch Collapse at the Level of the Naviculocuneiform Joint. Foot Ankle Int. 2019;40(1):42-47.
Steiner, C. S., Gilgen, A., Zwicky, L., Schweizer, C., Ruiz, R., & Hintermann, B. (2019). Combined Subtalar and Naviculocuneiform Fusion for Treating Adult Acquired Flatfoot Deformity With Medial Arch Collapse at the Level of the Naviculocuneiform Joint. Foot & Ankle International, 40(1), 42-47. https://doi.org/10.1177/1071100718800295
Steiner CS, et al. Combined Subtalar and Naviculocuneiform Fusion for Treating Adult Acquired Flatfoot Deformity With Medial Arch Collapse at the Level of the Naviculocuneiform Joint. Foot Ankle Int. 2019;40(1):42-47. PubMed PMID: 30317867.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined Subtalar and Naviculocuneiform Fusion for Treating Adult Acquired Flatfoot Deformity With Medial Arch Collapse at the Level of the Naviculocuneiform Joint. AU - Steiner,Caspar Samuel, AU - Gilgen,Andrea, AU - Zwicky,Lukas, AU - Schweizer,Christine, AU - Ruiz,Roxa, AU - Hintermann,Beat, Y1 - 2018/10/13/ PY - 2018/10/16/pubmed PY - 2020/1/15/medline PY - 2018/10/16/entrez KW - adult acquired flatfoot deformity KW - hindfoot valgus KW - instability KW - naviculocuneiform fusion KW - posterior tibial tendon dysfunction KW - subtalar fusion SP - 42 EP - 47 JF - Foot & ankle international JO - Foot Ankle Int VL - 40 IS - 1 N2 - BACKGROUND:: A challenge in treating acquired flatfoot deformities is the collapse of the medial arch at the level of the naviculocuneiform (NC) joint. Triple fusions, being a treatment option, may lead to problems such as increased foot stiffness. We thus established a method that combines subtalar (ST) fusion with NC fusion while preserving the Chopart joint. We analyzed the radiographic correction, fusion rate, and patient satisfaction with this procedure. METHODS:: 34 feet in 31 patients (female, 23; male, 8; age 67 [45-81] years) were treated with a ST and NC joint fusion. In 15 cases, a medial sliding-osteotomy was additionally necessary to fully correct hindfoot valgus. The following radiographic parameters were measured on weightbearing radiographs preoperatively and at 2 years: talo-first metatarsal angle, talocalcaneal angle, calcaneal pitch, talonavicular coverage angle and calcaneal offset. Fusion was radiologically confirmed. RESULTS:: All parameters, except the calcaneal pitch, showed a significant improvement. Fusion was observed after 1 year in all but 2 cases (94.1%). One nonunion each occurred at the ST and NC joint without needing any subsequent treatment. One patient developed avascular necrosis of the lateral talus with need for total ankle replacement after 1 year. All patients were satisfied with the obtained results. CONCLUSION:: Our data suggest that a combined fusion of the ST and NC joint was effective and safe when treating adult acquired flatfoot with collapse of the medial arch at the level of the NC joint. Although the talonavicular joint was not fused, its subluxation was significantly reduced. LEVEL OF EVIDENCE:: Level IV, case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/30317867/Combined_Subtalar_and_Naviculocuneiform_Fusion_for_Treating_Adult_Acquired_Flatfoot_Deformity_With_Medial_Arch_Collapse_at_the_Level_of_the_Naviculocuneiform_Joint_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100718800295?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -