[Principles of reorientation in triple arthrodesis]

Triple arthrodesis can be used for a three-dimensional correction of all types of hindfoot deformities. Prerequisites are a functional integrity of the ankle joint and an adequate bone stock. The procedure blocks the cardanic mechanism of the hindfoot and therefore reduces the shock-absorbing and mobile-adaptive functions of the foot. This results in increased stresses with the risk of long-term degenerative changes. In addition to triple arthrodesis, procedures to the forefoot are often necessary. Especially in neurogenic deformities, muscle lengthening and balancing procedures may be needed. In the evaluation of the results, different etiologies (e.g. posttraumatic, degenerative, neurogenic, congenital) and different deformities (varus, valgus, cavovarus, equinus) should not be mixed up. The results in congenital and neurogenic deformities in the literature are inferior to those of degenerative and posttraumatic origin. A standardization of indications, techniques, and evaluation criteria is still needed in order to exactly estimate the value of this procedure for different pathologies.