Hindfoot arthrodesis for neuropathic deformity

Area of Science:

• Orthopaedic Surgery
• Neurosurgery
• Podiatry

Background:

• Acquired neurologic foot disorders cause significant arthrosis, deformities, and functional loss.
• Hindfoot arthrodesis is a primary treatment for severe neuropathic foot deformities.
• Ankle arthrodesis has shown high complication and nonunion rates in these patients.

Purpose of the Study:

• To evaluate the efficacy of tibiotalocalcaneal (TTC) arthrodesis versus ankle arthrodesis for acquired neuropathic foot deformities.
• To compare fusion rates, complication profiles, and functional outcomes between the two surgical techniques.
• To establish indications for TTC arthrodesis and revision ankle arthrodesis in this patient population.

Main Methods:

• Retrospective review of 17 patients with acquired neuropathic foot deformities treated between 1990 and 2001.
• Four patients underwent tibiotalocalcaneal (TTC) arthrodesis; 13 underwent ankle arthrodesis.
• Surgical outcomes, including fusion rates, union times, and American Orthopaedic Foot and Ankle Society (AOFAS) scores, were assessed.

Main Results:

• TTC arthrodesis achieved a 100% fusion rate with no nonunions.
• Seven initially ununited ankle arthrodeses were salvaged, with one subsequent nonunion after revision.
• Overall fusion rate was 88% (15/17) with an average union time of 6.9 months.
• Functional outcomes included 5.8% excellent, 41% good, 53.3% fair, and 5.8% poor.

Conclusions:

• TTC arthrodesis is indicated for neuropathic feet with combined ankle and subtalar involvement or severe deformities.
• Ankle arthrodesis is a viable option for cases with an intact subtalar joint.
• Revision ankle arthrodesis is recommended for failed ankle fusions with adequate talar bone stock; TTC arthrodesis is reserved for cases with poor talar bone stock.