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Correction of Foot Deformities by Triple Arthrodesis

January 01, 2013

Contributors: Antonello Montanaro, MD; Luca Labianca, MD; Vincenzo Di Sanzo, MD, PhD; Cosma Calderaro, MD; Andrea Ferretti, MD; Francesco Turturro, MD; Francesco Turturro, MD

Keywords: Bony Procedure

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

The triple arthrodesis, first described by Edwin W. Ryerson in 1923, consists of surgically fusing the talocalcaneal (TC), talonavicular (TN), and calcaneocuboid (CC) joints by removing bone wedges to correct a foot deformity. The goal is to create a well-aligned, plantigrade, and stable foot. The most common indications are to correct foot deformities resulting from relapsed or resistant clubfoot, Charcot-Marie-Tooth disease, and other neuromuscular disorders. The resection of bone wedges from the TC, TN and CC joints separates the foot into three movable segments, which allows the correction of all the foot deformities. Although changing the orientation of the bone wedges (laterally, medially, or dorsally) is possible to correct the varus, valgus, and cavus deformities respectively, the main indication for this procedure is the fixed varus deformity. To correct the varus deformity, two wedges of bone at right angles to each other are removed. The actual amount of bone wedges to be removed is determined by evaluating the foot deformity during surgery. To correct the hind foot, a laterally based bone wedge is removed by the TC joint. During this maneuver, the line of the osteotomy of the calcaneus must be parallel to its inferior surface. After the wedges are removed, the foot is placed in the corrected position facing the osteotomy cuts and staples are applied. A short-leg cast without weight bearing is the first step toward rehabilitation. At 6 weeks, the cast is removed, radiographs are checked, and a short-leg walking cast is applied for 6 more weeks. Outcomes are good. A recent report showed that, when performed appropriately, good to excellent results may be obtained with triple arthrodesis in about 80% of patients. However, return to high-impact activity is not a given. Lower-impact activities_walking, cycling, swimming_are reasonable postoperative goals.

Results for "Bony Procedure"

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