Skip to main content
SpringerLink
Log in

Incidence and predictors of valgus tibiotalar tilt after progressive collapsing foot deformity reconstruction using subtalar fusion with concomitant procedures

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Development of valgus tibiotalar tilt is a significant complication after subtalar fusion for progressive collapsing foot deformity (PCFD) correction. However, its incidence and etiologic factors have not been extensively studied. The purpose of this study was to define the incidence of valgus tibiotalar tilt after subtalar fusion for PCFD reconstruction, and to determine predictors of this complication.

Methods

This study included 59 patients who underwent PCFD reconstruction with subtalar fusion. Patients with tibiotalar tilt prior to surgery were excluded. On standard weightbearing radiographs, the talonavicular coverage angle, talo-1st metatarsal angle, calcaneal pitch, hindfoot moment arm (HMA), and medial distal tibial angle were measured. Weightbearing computed tomography (WBCT) was used to determine the presence of lateral bony impingement. A radiologist evaluated the superficial and deep deltoid ligaments using magnetic resonance imaging (MRI). Univariate regression analysis was used to identify the factors associated with development of postoperative valgus tibiotalar tilt, defined as tilt > 2 degrees.

Results

Seventeen patients (28.8%) developed postoperative valgus tibiotalar tilt at a mean of 7.7 (range 2–31) months. Eight (47.1%) of these patients developed valgus tibiotalar tilt within 3 months. Univariate logistic regression demonstrated association between preoperative HMA and postoperative valgus tibiotalar tilt (odds ratio 1.06, P = 0.026), with a 6% increase in risk per millimeter of increased HMA. Deltoid ligament status and concomitant procedures on other joints did not correlate with postoperative valgus tilt.

Conclusion

Our findings indicate that surgeons should be cognizant of patients with a greater degree of preoperative hindfoot valgus and their propensity to develop a valgus ankle deformity. Additionally, our relatively high incidence of valgus tibiotalar tilt suggests that weightbearing ankle radiographs should be included in the initial and subsequent follow-up of PCFD patients with hindfoot valgus treated with subtalar fusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Hintermann B, Deland JT, de Cesar NC, Ellis SJ, Johnson JE, Myerson MS, Sangeorzan BJ, Thordarson DB, Schon LC (2020) Consensus on indications for isolated subtalar joint fusion and naviculocuneiform fusions for progressive collapsing foot deformity. Foot Ankle Int 41:1295–1298

    Article  PubMed  Google Scholar 

  2. JacksonPacana JBMJ, Gonzalez TA (2022) Adult acquired flatfoot deformity. JAAOS-J Am Acad Orthopaed Surg 30:e6–e16

    Article  Google Scholar 

  3. Henry JK, Shakked R, Ellis SJ (2019) Adult-acquired flatfoot deformity. Foot Ankle Orthopaed 4:2473011418820847

    Article  Google Scholar 

  4. Kim J, Deland JT (2022) Progressive collapsing foot deformity-flatfoot. Foot and ankle disorders. Springer, Berlin, pp 537–554

    Chapter  Google Scholar 

  5. Davies JP, Ma X, Garfinkel J, Roberts M, Drakos M, Deland J, Ellis S (2020) Subtalar fusion for correction of forefoot abduction in stage II adult-acquired flatfoot deformity. Foot Ankle Spec 15(3):221–235

    Article  PubMed  Google Scholar 

  6. Pinney SJ, Lin SS (2006) Current concept review: acquired adult flatfoot deformity. Foot Ankle Int 27:66–75

    Article  PubMed  Google Scholar 

  7. Miniaci-Coxhead SL, Weisenthal B, Ketz JP, Flemister AS (2017) Incidence and radiographic predictors of valgus tibiotalar tilt after hindfoot fusion. Foot Ankle Int 38:519–525

    Article  PubMed  Google Scholar 

  8. Hyer CF, Galli MM, Scott RT, Bussewitz B, Berlet GC (2014) Ankle valgus after hindfoot arthrodesis: a radiographic and chart comparison of the medial double and triple arthrodeses. J Foot Ankle Surg 53:55–58

    Article  PubMed  Google Scholar 

  9. Song SJ, Lee S, O’Malley MJ, Otis JC, Sung H, Deland JT (2000) Deltoid ligament strain after correction of acquired flatfoot deformity by triple arthrodesis. Foot Ankle Int 21:573–577

    Article  CAS  PubMed  Google Scholar 

  10. Fitzgibbons TC (1996) Valgus tilting of the ankle joint after subtalar (hindfoot) fusion: complication or natural progression of valgus hindfoot deformity? In. SLACK incorporated thorofare, NJ. pp. 415–423

  11. Neufeld SK, Myerson MS (2001) Complications of surgical treatments for adult flatfoot deformities. Foot Ankle Clin 6:179–191

    Article  CAS  PubMed  Google Scholar 

  12. Saltzman CL, El-Khoury GY (1995) The hindfoot alignment view. Foot Ankle Int 16:572–576

    Article  CAS  PubMed  Google Scholar 

  13. Stufkens SA, Barg A, Bolliger L, Stucinskas J, Knupp M, Hintermann B (2011) Measurement of the medial distal tibial angle. Foot Ankle Int 32:288–293

    Article  PubMed  Google Scholar 

  14. Bock P, Pittermann M, Chraim M, Rois S (2018) The inter-and intraobserver reliability for the radiological parameters of flatfoot, before and after surgery. Bone Joint J 100:596–602

    Article  PubMed  Google Scholar 

  15. Sensiba PR, Coffey MJ, Williams NE, Mariscalco M, Laughlin RT (2010) Inter-and intraobserver reliability in the radiographic evaluation of adult flatfoot deformity. Foot Ankle Int 31:141–145

    Article  PubMed  Google Scholar 

  16. Röhm J, Zwicky L, Horn Lang T, Salentiny Y, Hintermann B, Knupp M (2015) Mid-to long-term outcome of 96 corrective hindfoot fusions in 84 patients with rigid flatfoot deformity. Bone Jt J 97:668–674

    Article  Google Scholar 

  17. Kim J, Kim J-B, Lee W-C (2021) Outcomes of joint preservation surgery in valgus ankle arthritis without deltoid ligament insufficiency. Foot Ankle Int 42:1419–1430

    Article  PubMed  Google Scholar 

  18. Kim J, Rajan L, Fuller R, Sofka C, Cororaton A, Demetracopoulos C, Ellis S, Deland J (2022) Radiographic cutoff values for predicting lateral bony impingement in progressive collapsing foot deformity. Foot Ankle Int 43(9):1219–1226

    Article  PubMed  Google Scholar 

  19. Deland JT, de Asla RJ, Sung I-H, Ernberg LA, Potter HG (2005) Posterior tibial tendon insufficiency: which ligaments are involved? Foot Ankle Int 26:427–435

    Article  PubMed  Google Scholar 

  20. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163

    Article  PubMed  PubMed Central  Google Scholar 

  21. Resnick RB, Jahss MH, Choueka J, Kummer F, Hersch JC, Okereke E (1995) Deltoid ligament forces after tibialis posterior tendon rupture: effects of triple arthrodesis and calcaneal displacement osteotomies. Foot Ankle Int 16:14–20

    Article  CAS  PubMed  Google Scholar 

  22. Cody EA, Williamson ER, Burket JC, Deland JT, Ellis SJ (2016) Correlation of talar anatomy and subtalar joint alignment on weightbearing computed tomography with radiographic flatfoot parameters. Foot Ankle Int 37:874–881

    Article  PubMed  Google Scholar 

  23. Probasco W, Haleem AM, Yu J, Sangeorzan BJ, Deland JT, Ellis SJ (2015) Assessment of coronal plane subtalar joint alignment in peritalar subluxation via weight-bearing multiplanar imaging. Foot Ankle Int 36:302–309

    Article  PubMed  Google Scholar 

  24. Wagner E, Wagner P (2021) Current concepts in treatment of ligament incompetence in the acquired flatfoot. Foot Ankle Clin 26:373–389

    Article  PubMed  Google Scholar 

  25. Kim J, Rajan L, Henry J, Mizher R, Kumar P, Srikumar S, Demetracopoulos C, Ellis S, Deland J (2023) Axial plane rotation of the talus in progressive collapsing foot deformity: a weightbearing computed tomography analysis. Foot Ankle Int 44(4):281–290

    Article  PubMed  Google Scholar 

  26. Kim Y, Kim J, Lee KM, Koo S (2019) The increase of joint contact forces in foot joints with simulated subtalar fusion in healthy subjects. Gait Post 74:27–32

    Article  Google Scholar 

  27. de Cesar Netto C, Saito GH, Roney A, Day J, Greditzer H, Sofka C, Ellis SJ, Society WBC, Richter M, Barg A (2021) Combined weightbearing CT and MRI assessment of flexible progressive collapsing foot deformity. Foot Ankle Surg 27:884–891

    Article  Google Scholar 

  28. Kim J, Rajan L, Kumar P, Kim J-B, Lee W-C (2023) Lower limb alignment in patients with primary valgus ankle arthritis: a comparative analysis with patients with varus ankle arthritis and healthy controls. Foot Ankle Surg 29:72–78

    Article  PubMed  Google Scholar 

  29. Haraguchi N, Ota K, Tsunoda N, Seike K, Kanetake Y, Tsutaya A (2015) Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. JBJS 97:333–339

    Article  Google Scholar 

  30. Kim J, Henry JK, Kim J-B, Lee W-C (2021) Dome supramalleolar osteotomies for the treatment of ankle pain with opposing coronal plane deformities between ankle and the lower limb. Foot Ankle Int 43(4):474–485

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Agnes Cororaton, MS (Hospital for Special Surgery) and Prashanth Kumar, AB (Columbia Vagelos College of Physicians and Surgeons) for their help with statistical analysis.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA

    Jaeyoung Kim, Lavan Rajan, Jensen Henry, Rami Mizher, Anne Holly Johnson, Constantine Demetracopoulos, Scott Ellis & Jonathan Deland

Authors
  1. Jaeyoung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lavan Rajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jensen Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rami Mizher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne Holly Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Constantine Demetracopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Scott Ellis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jonathan Deland
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JK, LR, JH, and RM. The first draft of the manuscript was written by JK and all attending surgeons (AHJ, CD, SE, and JD) commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jaeyoung Kim.

Ethics declarations

Conflict of interest

The authors received no financial or material support for the research, authorship, and/or publication of this article.

Ethics approval

Ethical approval for this study was obtained from the Foot and Ankle Registry Steering Committee of the authors’ institution (IRB #2013–038).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 KB)

Supplementary file2 (DOCX 14 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J., Rajan, L., Henry, J. et al. Incidence and predictors of valgus tibiotalar tilt after progressive collapsing foot deformity reconstruction using subtalar fusion with concomitant procedures. Arch Orthop Trauma Surg 143, 6087–6096 (2023). https://doi.org/10.1007/s00402-023-04906-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-04906-x

Keywords

Search

Navigation