Triple Arthrodesis of Foot for Correction of Lower Extremity Deformities 振興醫療財團法人振興醫院骨科部 * 熊永萬
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.
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, plantar fasciecotmy for cavus. soft tissue releae around ankle & foot.
Cases Illustration: Case I : A 38-Year-Old Male with Deformity of Right Ankle & Foot due to Sequela of Menigitis
Talipes Equino-cava-varus, Right
X Film before Operation S/P Triple Arthrodesis of Right Foot following Soft Tissue Release
Stage I: Lengthening of Achilles Tendon with Plantar Fascia Release Stage II: Triple Arthrodesis of Right Foot
3-Month after Reconstruction of Right Ankle & Foot
Ambulation Training after Reconstruction of Right Ankle & Foot
Case II: : A 15-Year-Old Girl with Rigid Joints Deformity over Bilateral Ankles & Feet due to Sequela of Cerebral Palsy
Stage I : Soft Tissue Release Including Achilles Tendon, Anterior Tibialis, and Plantar Fascia Stage II : Bony Wedge Reconstruction with Triple Arthrodesis
S/P Reconstruction of Right Foot
S/P Reconstruction of Both Ankles & Feet with Leg Casts Bilateral Splints to Maintain the Alignment of Both Ankles & Feet
Case III: A 56-Year-Old Male with Rigid Joints Deformity over Right Ankles & Feet due to Sequela of Trauma
Stage I: Release of Anterior Tibialis & Lengthening of Achiilles Tendon Stage II: Triple Arthrodesis of Left Foot
Removal of Cast after 3-Month Immobilization
Physical Therapy & Ambulation Training after Operation
Case IV: 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
Stage I : Lengthening of Achilles Tendon with Plantar Fascia Release Stage II: Wedge Osteotomy with Triple Arthrodesis & Fusion of the 1st. M-P Joint
Talipes Equino-Cavo-Varus with Marked Inversion of Right Foot
Stage I : Lengthening of Achilles Tendon with Plantar Fascia Release Stage II: Wedge Osteotomy with Triple Arthrodesis & Fusion of the 1st. M-P joint
Planti-Grade Weight Bearing Foot after Reconstruction of Right Foot
Case V : A 48-Year-Old Male with Talipes Equino-Cavo-Varus of Left Lower Leg due to Poliomylitis
Talipes Equino-Cavo-Varus Wedge Osteotomy with Triple Arthrodesis of Left Foot
Stage I : Lengthening of Achilles Tendon with Plantar Fasciectomy Stage II: Wedge Osteotomy with Triple Arthrodesis of Left Foot
Planti-Grade Weight Bearing of Left Foot after Operation
Case VI : A 23-Year-Old Male with Rigid Pes Planus
Rigid Pes Planus Create Arch in Foot with Triple Arthrodesis
Case VII: A 1-Year-Old Boy with Club Foot
Maintaining the Alignment of Right Ankle & Foot with the Splint after Soft Tissue Release
1-Year Follow-Up after Operation 3-Year Follow-Up after Operation
10-Year Follow-Up after Reconstruction of Bilateral Ankles & Feet
The leg splint was removed ten days after op. The patient was partial-weight-bearing while wearing a short leg cast for six weeks, and then weight-bearing 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.
Conclusion: 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
Dr. 熊永萬 Dr. Bear