Change in Talar Axial Rotation and Pain Intensity Following Correction of Progressive Collapsing Foot Deformity

Area of Science:

• Orthopedics
• Foot and Ankle Surgery
• Radiology

Background:

• Progressive collapsing foot deformity (PCFD) is characterized by internal rotation of the talus within the ankle mortise.
• Previous research has not quantified the change in talar axial rotation (AR) after PCFD reconstruction.
• Understanding postoperative talar AR is crucial for optimizing surgical outcomes.

Purpose of the Study:

• To investigate the change in talar axial rotation (AR) following surgical reconstruction in patients with PCFD.
• To assess the association between talar AR changes and other radiographic parameters or surgical procedures.
• To determine if postoperative talar AR correlates with patient-reported outcome scores at two years.

Main Methods:

• A cohort of 27 adult patients undergoing flexible PCFD reconstruction was studied.
• Preoperative and postoperative weight-bearing computed tomography (WBCT) scans and radiographs were analyzed.
• Talar AR was measured on WBCT scans; radiographic parameters and PROMIS scores were also assessed.

Main Results:

• PCFD reconstruction led to a significant increase in external talar AR (median 8.3 degrees, P < .001).
• Changes in talar AR were not associated with radiographic parameter changes or specific procedures like lateral column lengthening or subtalar fusion.
• Greater postoperative external talar AR was linked to increased PROMIS pain intensity (r = 0.38).

Conclusions:

• Surgical reconstruction for PCFD effectively achieves external rotation of the talus within the ankle mortise.
• While achieving a neutral talar position, excessive external rotation may lead to poorer pain outcomes.
• This suggests a potential for overcorrection of the native internal talar rotation deformity.