Review Question - QID 4540

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Ankle Arthrodesis Complications Hindfoot arthritis QID: 4540 (OBQ12.180)

QID 4540 (Type "4540" in App Search)

A 40-year-old male presents with long-standing right heel pain. He reports pain and swelling and points to the region of the sinus tarsi as the maximal area of pain, particularly when walking on uneven surfaces. He also reports a history of recurrent ankle sprains when he was younger. A clinical image of his foot posture is shown in Figure A. Inversion and eversion of the hindfoot reproduce pain. He has no discomfort with passive ankle dorsiflexion and plantarflexion. Coleman block testing reveals a rigid hindfoot. Sensation is fully intact throughout the extremity and he has full strength with ankle dorsiflexion, ankle plantarflexion and he can perform a single-leg heel rise without difficulty. A radiograph is shown in Figure B. What is the most appropriate step in management if conservative measures fail?

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Brostrom anatomic reconstruction with Gould modification

430/4627

Hindfoot arthroscopy with synovial debridement and Os trigonum resection

336/4627

Subtalar arthrodesis

63%

2905/4627

Chrisman-Snook nonanatomic reconstruction using tendon transfer

174/4627

Triple arthrodesis

16%

726/4627

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The patient presents with long-standing pes cavus with subsequent development of symptomatic subtalar joint arthritis.

Osteoarthritis of the hindfoot can develop from trauma (calcaneus or talus fractures), rheumatoid arthritis, osteoarthritis, end-stage posterior tibial tendon disorders, tarsal coalitions, or Charcot-Marie-Tooth. Hindfoot arthrodesis aims to create 5° of hindfoot valgus.

Easley et al. peformed a Level 4 case review with 148 patients undergoing a subtalar joint arthrodesis. At an average of 4 year follow-up there was an 84% union rate. Complications included prominent hardware requiring screw removal (20%), lateral impingement (10%), symptomatic valgus malalignment (3%), symptomatic varus malalignment (3%), and infection (3%).

Figure A is a clinic image demonstrating a pes cavus foot posture. Figure B is a lateral radiograph demonstrating subtalar arthritis and no discernible tibiotalar or talonavicular arthritis. Illustration A demonstrates a subtalar arthrodesis with screw fixation.

Incorrect Answers:
Answer 1: Brostrom anatomic reconstruction with Gould modification is indicated for ankle instability symptoms recalcitrant to conservative management.
Answer 2: Hindfoot arthroscopy with synovial debridement and Os trigonum resection is indicated in recalcitrant posterior impingement symptoms.
Answer 4: Chrisman-Snook nonanatomic reconstruction using tendon transfer is indicated in advanced ankle instability.
Answer 5: Triple arthrodesis is indicated in combined talonavicular, calcaneocuboid, and subtalar joint arthritis.

ILLUSTRATIONS:

Isolated subtalar arthrodesis.

Foot & Ankle
- Ankle Arthrodesis

M E Easley, JBJS 2000

85 responses

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