CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2019; 54(03): 275-281
DOI: 10.1055/s-0039-1692445
Artigo Original | Original Article
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda Rio de Janeiro, Brazil

What is the Prognosis of Triple Arthrodesis in the Treatment of Adult Acquired Flatfoot Deformity (AAFD)?[]

Artikel in mehreren Sprachen: português | English
1   Departamento de Ortopedia e Traumatologia, Santa Casa de São Paulo, São Paulo, SP, Brasil
,
Nilson Roberto Severino
1   Departamento de Ortopedia e Traumatologia, Santa Casa de São Paulo, São Paulo, SP, Brasil
,
Ricardo Cardenuto Ferreira
1   Departamento de Ortopedia e Traumatologia, Santa Casa de São Paulo, São Paulo, SP, Brasil
› Institutsangaben
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Publikationsverlauf

01. Januar 2019

29. März 2019

Publikationsdatum:
27. Juni 2019 (online)

Abstract

Objective The present study aims to evaluate the ability of triple arthrodesis in eliminating the main complaints presented by patients with adult acquired flatfoot deformity (AAFD): 1) disabling hindfoot pain; 2) major deformities, such as medial arch collapse, valgus, abduction, and supination.

Methods A total of 17 patients (20 feet) with advanced AAFD who underwent surgical correction by triple arthrodesis were evaluated after a mean follow-up period of 43 months (range: 18–84 months). The average age of the patients at surgery was 62 years old (range: 38–79 years old). The visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were used to assess the final results.

Results According to the VAS, the average residual pain was 3 points; the AOFAS hindfoot score points increased 23% after the surgery; and the correction of deformities was considered satisfactory in 10 out of 20 feet; partially satisfactory in 4 out of 20 feet; partially unsatisfactory in 5 out of 20 feet; and unsatisfactory in 1 out of 20 feet.

Conclusion Despite the high index of bone fusion after triple arthrodesis, which is the gold standard treatment in advanced AAFD, the incomplete correction of major deformities and the persistence of residual pain contributed to a high disappointment rate of the patients with the surgical results.

The present work was developed at the Foot and Ankle Surgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, São Paulo, SP, Brazil.


 
  • Referências

  • 1 Kulowski J. Tendovaginitis (tenosynovitis), general discussion and report of one case involving the posterior tibial tendon. J Miss State Med Assoc 1936; 33: 135-137
  • 2 Lipscomb P. Non-suppurative tenosynovitis and paratendinitis. Instr Course Lect 1950; 7: 254
  • 3 Taylor R, Sammarco VJ. Minimizing the role of fusion in the rigid flatfoot. Foot Ankle Clin 2012; 17 (02) 337-349
  • 4 Grunander TR, Thordarson DB. Results of calcaneocuboid distraction arthrodesis. Foot Ankle Surg 2012; 18 (01) 15-18
  • 5 Lin JS, Myerson MS. The management of complications following the treatment of flatfoot deformity. Instr Course Lect 2011; 60: 321-334
  • 6 Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 1989; (239) 196-206
  • 7 Myerson MS. Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. J Bone Joint Surg Am 1996; 78 (05) 780-792
  • 8 Hatic II SO, Philbin TM. Management of the recurrent deformity in a flexible foot following failure of tendon transfer: is arthrodesis necessary?. Foot Ankle Clin 2012; 17 (02) 299-307
  • 9 Gentchos CE, Anderson JG, Bohay DR. Management of the rigid arthritic flatfoot in the adults: alternatives to triple arthrodesis. Foot Ankle Clin 2012; 17 (02) 323-335
  • 10 Mosier SM, Pomeroy G, Manoli II A. Pathoanatomy and etiology of posterior tibial tendon dysfunction. Clin Orthop Relat Res 1999; (365) 12-22
  • 11 Schuh R, Salzberger F, Wanivenhaus AH, Funovics PT, Windhager R, Trnka HJ. Kinematic changes in patients with double arthrodesis of the hindfoot for realignment of planovalgus deformity. J Orthop Res 2013; 31 (04) 517-524
  • 12 Ellington JK, Myerson MS. The use of arthrodesis to correct rigid flatfoot deformity. Instr Course Lect 2011; 60: 311-320
  • 13 Bluman EM, Title CI, Myerson MS. Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin 2007; 12 (02) 233-249 , v
  • 14 Raikin SM, Winters BS, Daniel JN. The RAM classification: a novel, systematic approach to the adult-acquired flatfoot. Foot Ankle Clin 2012; 17 (02) 169-181
  • 15 Neville CG, Candidate MS, Houck JR. Science behind the use of orthotic devices to manage posterior tibial tendon dysfunction. Tech Foot Ankle Surg 2008; 7 (02) 125-133
  • 16 Ryerson E. Arthrodesing operations on the feet. J Bone Joint Surg Am 1923; 5: 453-471
  • 17 Pinsker E, Daniels TR. AOFAS position statement regarding the future of the AOFAS Clinical Rating Systems. Foot Ankle Int 2011; 32 (09) 841-842
  • 18 Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15 (07) 349-353
  • 19 Gift AG. Visual analogue scales: measurement of subjective phenomena. Nurs Res 1989; 38 (05) 286-288
  • 20 Saltzman CL, el-Khoury GY. The hindfoot alignment view. Foot Ankle Int 1995; 16 (09) 572-576
  • 21 de Cesar Netto C, Schon LC, Thawait GK, da Fonseca LF, Chinanuvathana A, Zbijewski WB. , et al. Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography. J Bone Joint Surg Am 2017; 99 (18) e98
  • 22 Flemister Jr AS, 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 (01) 22-29
  • 23 Griend RV. Lateral column lengthening using a “Z” osteotomy of the calcaneus. Tech Foot Ankle Surg 2008; 7 (04) 257-263
  • 24 Pomeroy GC, Manoli II A. A new operative approach for flatfoot secondary to posterior tibial tendon insufficiency: a preliminary report. Foot Ankle Int 1997; 18 (04) 206-212
  • 25 Myerson MS, Corrigan J. Treatment of posterior tibial tendon dysfunction with flexor digitorum longus tendon transfer and calcaneal osteotomy. Orthopedics 1996; 19 (05) 383-388
  • 26 Hirose CB, Johnson JE. Plantarflexion opening wedge medial cuneiform osteotomy for correction of fixed forefoot varus associated with flatfoot deformity. Foot Ankle Int 2004; 25 (08) 568-574
  • 27 Holmes Jr GB, Mann RA. Possible epidemiological factors associated with rupture of the posterior tibial tendon. Foot Ankle 1992; 13 (02) 70-79
  • 28 Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D. The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 2012; 94 (20) 1839-1844
  • 29 Linberg CJ, Sperling JW, Schleck CD, Cofield RH. Shoulder arthroplasty in morbidly obese patients. J Shoulder Elbow Surg 2009; 18 (06) 903-906
  • 30 Dowsey MM, Liew D, Stoney JD, Choong PF. The impact of obesity on weight change and outcomes at 12 months in patients undergoing total hip arthroplasty. Med J Aust 2010; 193 (01) 17-21
  • 31 Chan CL, Villar RN. Obesity and quality of life after primary hip arthroplasty. J Bone Joint Surg Br 1996; 78 (01) 78-81
  • 32 Soukup DS, MacMahon A, Burket JC, Yu JM, Ellis SJ, Deland JT. Effect of Obesity on Clinical and Radiographic Outcomes Following Reconstruction of Stage II Adult Acquired Flatfoot Deformity. Foot Ankle Int 2016; 37 (03) 245-254
  • 33 Barrôco R, Nery C, Netto AA. Pé plano adquirido por disfunção do tibial posterior: resultados cirúrgicos. Rev Bras Ortop 2002; 37 (06) 211-218
  • 34 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 (02) 243-247