Change of Alignment by Calcaneocuboid Distraction Arthrodesis for Acquired Flatfoot

Transcription

1 Change of Alignment by Calcaneocuboid Distraction Arthrodesis for Acquired Flatfoot Akira Taniguchi, Yasuhito Tanaka, Kunihiko Kadono, Kiyonori Tomiwa, So Kameda, Hiroaki Kurokawa, Takenori Matsuda, Tsukasa Kumai, Yoshinori Takakura Department of Orthopaedic Surgery, Nara Medical University

2 < Presentation Title > Change of Alignment by Calcaneocuboid Distraction Arthrodesis for Acquired Flatfoot < Presenter s Name > Akira Taniguchi My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Introduction Dysfunction of the tibialis posterior tendon leading to acquired flatfoot deformity in adults is a progressive, disabling condition. Mann et al. 1 reported that loss of function of the PTT led to lack of support on the medial aspect of the longitudinal arch. Myerson 2 reported that PTTD resulted in relative internal rotations of the tibia and talus, and flattening of the medial longitudinal arch. The reported angles difficult to assess the arch of the foot composed of several tarsal bones, only with 2 tarsal bones. Komeda et al. 3 developed the Yokokura s two-dimensional analyzing system, 4 and estimated a method of radiographic mapping for evaluation of the longitudinal arch. This study aimed to investigate the change in position of the tarsal bones composing the longitudinal arch using this mapping system according to the hypothesis of recovery of the arch by CCDA. Nara Medical Univ.

4 Materials 19 cases 21 feet treated by CCDA for stage 2 PTTD Gender: Male; 5 cases (5 ankles) Female; 14 cases (16 ankles) Mean FU 50mos(6~119) Ave. age: 57yrs (47~72) Nara Medical Univ.

5 Calcaneocuboid Distraction Arthrodesis (CCDA) Anderson R.B. and Davis W.H Nara Medical Univ.

6 Implant for Fixation Staples 6 feet FU 90mos(24~117) Locking plates 15 feet FU 34mos(6~119) Nara Medical Univ.

7 Methods Pre/post lateral radiograph in standing position X axis; The line joining the lowest point (O) of the calcaneus and the lowest point of the first metatarsal head Y axis: the line perpendicular to the x-axis passing through the point of O.

8 Measuring points TP R TA NS NA P B S TI AS f b C NP NI N UP m O M5I 100 SE US UI L M1P UA M1S M5A M1A Y

9 Measured angles Calcaneal pitch (CP) Talometatarsal angle(tma) Calcaneal metatarsal angle(cma) Metatarsal angle (MA) TP TI f L M1A O

10 Results Values of x and y coordinates at each point of the mapping system Preoperation Postoperation Length of O-Y 150.3±6.7mm 146.7±9.9mm X(%) Y(%) X(%) Y(%) L 69.6± ± ±1.8 ns 16.9±2.0 * N 53.7± ± ±1.4 ns 21.6±3.6 * C 43.9± ± ±1.7 * 24.4±3.2 * R 26.6± ± ±2.4 ns 43.4±2.6 * f 34.7± ± ±3.5 ns 7.3±2.2 * b 43.1± ± ±3.4 ns 3.0±2.5 ns m 50.6± ± ±3.9 ns -2.1±1.3 ** M1A 105.4± ± ±0.9 ns 3.9±0.7 ns M1S 73.0± ± ±2.2 ns 25.0±2.6 * M1P 67.7± ± ±1.8 ns 8.1±2.0 * UA 71.6± ± ±1.9 * 26.3±2.9 * UI 66.0± ± ±2.0 ns 9.0±2.1 ** US 53.6± ± ±1.3 ** 30.9±3.6 * UP 50.0± ± ±1.3 ns 14.7±3.9 * NA 52.4± ± ±1.3 * 31.6±4.0 * NI 47.1± ± ±1.0 ns 14.9±4.9 * NS 44.7± ± ±1.1 * 33.3±3.1 ** NP 38.9± ± ±3.3 ns 17.3±3.3 ns TA 43.9± ± ±1.3 ns 33.4±4.5 * TP 12.3± ± ±1.6 ns 34.4±1.5 * TI 36.3± ± ±3.1 * 18.1±3.7 * AS 36.7± ± ±2.7 ns 26.0±1.9 * S 14.4± ± ±1.6 * 33.7±1.1 * B -5.9± ± ±2.1 * 27.7±1.6 ns P -12.1± ± ±1.3 ns 13.7±2.7 ns M5I 86.6± ± ±6.4 ns -5.4±3.3 ns M5A 91.9± ± ±5.5 ns -2.1±3.1 * SE 96.6± ± ±2.0 ns -5.4±2.2 * *p<0.05; **p<0.01 Values are given as means and SD ns, Not significant (P>0.05)

11 60 Results P 40 B 20 0 S TP R AS f TI TA NS C NP NI b NA US SE m 120 M5A UP N UI UA L M1S Pre op Post op -20 Nara Medical Univ.

12 TMA CP CMA MA CP; TMA; CMA; MA; Nara Medical Univ.

13 63 M Stage 2 calcaneocuboid distraction arthrodesis (CCDA) with plate Nara Medical Univ.

14 Discussion Correction of forefoot rotation Calcaneocuboid lengthening Rotation of forefoot is thought to be corrected coupled with calcaneocuboid lengthening.

15 m SE M5A Correction of forefoot rotation was confirmed by drop-off of 5th metatarsal. And correction of 1st metatarsal pronation was confirmed by drop-off of sesamoid. Nara Medical Univ.

16 Kitaoka et al. evaluated the restoration of the arch by CCDA 3 dimensionally using magnetic tracking system by cadaver. Calcaneocuboid distraction arthrodesis for posterior tibial tendon dysfunction and flatfoot. Clin Orthop Relat Res. 381: ,

17 Concerning the arch height, Yokokura investigated the orientation of the medial and lateral arch heights using the conventional radiography, in Yokokura S: A radiographic oriterion of the medial and lateral longuitudinal arch of the normal foot and classification of the flat foot. J Jpn Orthop Assoc 1928;3:331-60, (in Japanese)

18 Over the seventy years after the Yokokura's work, our colleague Komeda produced modification of Yokokura's method adding the points of tarsal bones to evaluate the arch of the foot with hallux valgus. Komeda T, Tanaka Y, Takakura Y, Fujii T, Samoto N, Tamai S: Evaluation of the longitudinal arch of the foot with hallux valgus using a newly developed two-dimensional coordinate system. J Orthop Sci 2001;6:110-8.

19 References 1. Mann RA, Thompson FM: Rupture of the posterior tibial tendon causing flat foot. J Bone Joint Surg [Am] 1985;67-A: Myerson MS: Adult acquired flatfoot deformity. J Bone Joint Surg [Am] 1996;78- A: ,. 3. Komeda T, Tanaka Y, Takakura Y, Fujii T, Samoto N, Tamai S: Evaluation of the longitudinal arch of the foot with hallux valgus using a newly developed twodimensional coordinate system. J Orthop Sci 2001;6: Yokokura S: A radiographic criterion of the medial and lateral longuitudinal arch of the normal foot and classification of the flat foot. J Jpn Orthop Assoc 1928;3:331-60, (in Japanese). 5. Anderson RB, Davis WH: Calcaneocuboid distraction arthrodesis for the treatment of the adult-axquired flatfoot. Foot Ankle Clin 1996;1: Kitaoka HB, Kura H, Luo ZP, An KN: Calcaneocuboid distraction arthrodesis for posterior tibial tendon dysfunction and flatfoot. Clin Orthop 2000;381:241-7.

20 Conclusion Restoration of the medial longitudinal arch and correction of rotation of the forefoot by CCDA were demonstrated in clinical cases using modified X-ray Yokokura method. Thank you for your attention.