Summary. Triple arthrodesis (TA) is a final surgical decision in treatment of the acquired flat foot (FF).
Objective: to study late outcomes of TA in the acquired FF; to establish factors influencing functional outcome of treatment.
Materials and Methods. The study included 51 patients (56 feet) with acquired FF at the age 32 – 77 years (54.7±1.2 years). Vertical and horizontal talometatarsal angles (TMA), as well as calcaneal inclination angle were determined by standing radiographs of the foot. The severity of osteoarthritis of the ankle joint (AJ) was assessed according to the Kellgren-Lawrence classification; range of motion in the AJ was determined according to the 0-pass method. Foot function was assessed by the dynamics of indicators: AOFAS scale (hindfoot and ankle joint), FFI (Italian version), quality of life (Roles and Maudsley scale), and VAS (pain). Establishment of factors influencing the outcome of treatment was performed using regression-correlation and factor analysis.
Results. Long-term results were studied in 32 cases. Cases of non-unions were registered at the following levels: talonavicular (2) and calcaneocuboidea (2). The dynamics of skiological indicators was significantly positive (p˂0.05; unpaired t-test). According to the AOFAS scale, 2 excellent, 19 good and 11 satisfactory results of treatment were obtained. Significant influence of pain level (inverse dependence) and range of foot extension (direct dependence) on the result (regression analysis) were determined, as well as significant effect of ankle osteoarthritis on the function of the foot (Fisher’s exact test; 0.002).
Conclusions. TA in the treatment of acquired FF is an effective surgery that provides favorable results in cases of severe deformity, degenerative changes in the joints, and contraindications to extra-articular corrective osteotomies.
Kohls-Gatzoulis J, Woods B, Angel JC, Singh D. The prevalence of symptomatic posterior tibial tendon dysfunction in women over the age of 40 in England. Foot Ankle Surg. 2009;15(2):75-81. DOI: 10.1016/j.fas.2008.08.003.
Pita-Fernandez S, Gonzalez-MartinC, Alonso-Tajes F, Seoae-Pillado T, Pertega-Diaz S, Perez-Garcia S et al. Flat foot in a random population and its impact on quality of life and functionality. J Clin Diagn Res. 2017;11(4):LC22-LC27. DOI: 10.7860/JCDR/2017/24362.9697.
Haddad SL, Myerson MS, Younger A, Anderson RB, Davis WH, Manoli A 2nd. Symposium: adult acquired flatfoot deformity. Foot Ankle Int. 2011;32(1):95-111. DOI: 10.3113/FAI.2011.0095.
Holmes GB Jr, Mann RA. Possible epidemiological factors associated with rupture of the posterior tibial tendon. Foot Ankle. 1992;13(2):70-79. DOI: 10.1177/107110079201300204.
Flemister AS Jr, Baumhauer JF, Digiovanni BF. Flexor digitorum longus to posterior tibialis transfer with lateral column lengthening for stage ii posterior tibial tendon dysfunction. Tech Foot Ankle Surg. 2007;6(1):22-29.
Reyerson EW. The Classic. Arthrodesing operations on the feet. Clin Orthop Relat Res. 2008;466(1):5-14. DOI: 10.1007/s11999-007-0035-0.
Gobbo DKP, Severino NR, Ferreira RC. What is the prognosis of triple arthrodesis in the treatment of adult acquired flatfoot deformity (AAFD)? Rev Bras Ortop. 2019;54(3):275-281. doi:10.1055/s-0039-1692445.
Ellington JK, Myerson MS. The use of arthrodesis to correct rigid flatfoot deformity. Instr Course Lect. 2011;60:311-320. PMID: 21553783.
Hatic SO II, Philbin TM. Management of the recurrent deformity in a flexible foot following failure of tendon transfer: is arthrodesis necessary? Foot Ankle Clin. 2012;17(2):299-307. DOI: 10.1016/j.fcl.2012.03.007.
Saltzman CL, Fehrle MJ, Cooper RR, Spencer EC, Ponseti IV. Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients. J Bone Joint Surg Am. 1999;81(10):1391-402. PMID: 10535589.
Graves SC, Mann RA, Graves KO. Triple arthrodesis in older adults. Results after long-term follow-up. J Bone Joint Surg Am. 1993;75(3):355-62. DOI: 10.2106/00004623-199303000-00006.
Rosenfeld PF, Budgen SA, Saxby TS. Triple arthrodesis: is bone grafting necessary? The results in 100 consecutive cases. J Bone Joint Surg Br. 2005; 87(2):175-8. DOI: 10.1302/0301-620x.87b2.15455.
Pell RF 4th, Myerson MS, Schon LC. Clinical outcome after primary triple arthrodesis. J Bone Joint Surg Am. 2000;82(1):47-57. DOI: 10.2106/00004623-200001000-00006.
Persaud S, Hentges MJ, Catanzariti AR. Occurrence of lateral ankle ligament disease with stage 2 to 3 adult-acquired flatfoot deformity confirmed via magnetic resonance imaging: a retrospective study. J Foot Ankle Surg. 2019;58(2):243-247. DOI: 10.1053/j.jfas.2018.08.030.
Bennett GL, Graham CE, Mauldin DM. Triple arthrodesis in adults. Foot Ankle. 1991;12(3):138-43. DOI: 10.1177/107110079101200302.
Angus PD, Cowell HR. Triple arthrodesis. A critical long-term review. J Bone Joint Surg Br. 1986;68(2):260-5. DOI: 10.1302/0301-620X.68B2.3958012.
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