Surgical Correction of Lower Extremity Deformities by Triple Arthrodesis
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1 Surgical Correction of Lower Extremity Deformities by Triple Arthrodesis 足踝畸形矯治 振興醫療財團法人振興醫院 骨科部 熊永萬醫師
2 Introduction: The primary goals of a triple arthrodesis are to relieve pain from arthritic, deformed, or unstable joints. Other important goals are the correction of deformity and creation of a stable, balanced plantigrade foot. A triple arthrodesis consists of surgical fusion of the talocalcaneal (TC), talonavicular (TN), and calcaneocuboid (CC) joints in the foot. The most common indications of triple arthrodesis are to correct lower extremity deformities in victims resulting from poliomyelitis, cerebral palsy, rigid pes planus, clubfoot, and trauma.
3 Materials and Methods: We present the deformities with the foot included poliomyelitis, cerebral palsy, rigid pes planus, clubfoot, and trauma, etc. The preoperative deformities included equinocavovarus, planovalgus, equinovalgus, flail foot, calcaneovalgus, hindfoot varus, cavovarus i, and hindfoot valgus. Some cases had procedures performed before triple arthrodesis. These procedures included soft tissue release with Achilles-tendon lengthening, All of these patients had an arthrodesis of the talonavicular, calcaneocuboid, and talocalcaneal joints with rigid internal fixation with staples.
4 Cases Illustration: Case I: : A 1-Year-Old Boy with Club Foot
5 Maintaining the Alignment of Right Ankle & Foot with the Splint after Soft Tissue Release with Triple Arthrodesis over Right Foot
6 3-Year Follow-Up after Operation 6-Year Follow-Up after Operation
7 10-Year Follow-Up after Reconstruction of Bilateral Ankles & Feet
8 16-Year Follow-Up after Operation
9 Case II: A 48-Year-Old Male with Deformity of Right Ankle & Foot due to Sequela of Menigitis
10 Talipes Equino-cava-varus, Right
11 X Film before Operation S/P Triple Arthrodesis of Right Foot following Soft Tissue Release
12 Stage I: Lengthening of Achilles Tendon with Plantar Fascia Release Stage II: Triple Arthrodesis of Right Foot
13 3-Month after Reconstruction of Right Ankle & Foot
14 Ambulation Training after Reconstruction of Right Ankle & Foot
15 Case III: : A 17-Year-Old Girl with Rigid Joints Deformity over Bilateral Ankles & Feet due to Sequela of Cerebral Palsy
16 Stage I : Soft Tissue Release Including Achilles Tendon, Anterior Tibialis, and Plantar Fascia Stage II : Bony Wedge Reconstruction with Triple Arthrodesis
17 S/P Reconstruction of Right Foot
18 S/P Reconstruction of Both Ankles & Feet with Leg Casts Bilateral Splints to Maintain the Alignment of Both Ankles & Feet
19 Case IV: A 56-Year-Old Male with Rigid Joints Deformity over Right Ankles & Feet due to Sequela of Trauma
20 Stage I: Release of Anterior Tibialis & Lengthening of Achiilles Tendon Stage II: Triple Arthrodesis of Left Foot
21 Removal of Cast after 3-Month Immobilization
22 Physical Therapy & Ambulation Training after Operation
23 CaseV: A 44-Year-Old Male with Talipes Equino-Cavo-Varus with Inversion of Right Foot, Subluxation of the 1st. M-P Joint due to Poliomylitis
24 Stage I : Lengthening of Achilles Tendon with Plantar Fascia Release Stage II: Wedge Osteotomy with Triple Arthrodesis & Fusion of the 1st. M-P Joint
25 Talipes Equino-Cavo-Varus with Marked Inversion of Right Foot
26 Stage I : Lengthening of Achilles Tendon with Plantar Fascia Release Stage II: Wedge Osteotomy with Triple Arthrodesis & Fusion of the 1st. M-P joint
27 Planti-Grade Weight Bearing Foot after Reconstruction of Right Foot
28 Case VI : A 48-Year-Old Male with Talipes Equino-Cavo-Varus of Left Lower Leg due to Poliomylitis
29 Talipes Equino-Cavo-Varus Wedge Osteotomy with Triple Arthrodesis of Left Foot
30 Stage I : Lengthening of Achilles Tendon with Plantar Fasciectomy Stage II: Wedge Osteotomy with Triple Arthrodesis of Left Foot
31 Planti-Grade Weight Bearing of Left Foot after Operation
32 Case VII : A 23-Year-Old Male with Rigid Pes Planus
33 Rigid Pes Planus Create Arch in Foot with Triple Arthrodesis
34 Results: The posterior splint was removed ten days after operation. The patient was non-weight-bearing while wearing a below-the-knee cast for four weeks, and then a weightbearing cast was used for six additional weeks until osseous union was evident radiographically. These patients had satisfactory of pain relief under more anatomic plantigrade foot than pre-operation. They had remarkable improvement in their gait and ability for daily activity.
35 Discussion: Triple arthrodesis is a technically difficult procedure that results in fusion of the hind foot. It is indicated for pain, deformity, and instability of the tritarsal complex. Although osseous consolidation is important to outcome, success depends primarily on appropriate realignment. A poorly positioned triple arthrodesis may result in continued pain, disability, and gait disturbances
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