Skip to main content

Advertisement

SpringerLink
Log in

Minimally invasive technique for stage III adult-acquired flatfoot deformity: a mid- to long-term retrospective study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to present the functional, radiological, and quality of life outcomes of a series of stage III adult-acquired flatfoot deformity corrections using an original operative approach based on minimal incision surgery (MIS).

Methods

Sixty-two patients (67 feet) with a symptomatic stage III flatfoot deformity were treated using a modified double arthrodesis by MIS. The mean age was 63 years (range, 50 to 81) and the mean follow-up was 6.6 years (range, 3.2 to 11.5). Clinical, radiological, American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score), quality of life (SF-36), and satisfaction scores were collected retrospectively.

Results

The mean AOFAS score improved by 54.27 (95% [CI], 57.27–51.3; P < 0.0001), and the SF-36 improved by a mean of 17.5 points (95% CI, 1.4–20.9) in the physical component summary (PCS). Deformity correction was confirmed by a significant improvement in the x-ray measurements (six angles). Bony union was observed in 89.5% of cases (60/67). In all, nine patients (13.4%) needed a secondary surgery: three for talonavicular nonunion, four for progression of the flatfoot deformity, and two for screw protrusion. No cases of superficial infection, wound dehiscence, or avascular necrosis of the talus were observed.

Conclusion

The present series represents the largest study of stage III flatfoot correction using MIS with a mid- to long-term follow-up. Because the data showed clinical and functional improvement after surgery with fewer complications, this technique may be ideal for patients at risk of complications.

Graphical abstract

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

References

  1. Johnson KA, Strom DE (1989) Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 239:196–206

    Google Scholar 

  2. Hyer CF, Galli MM, Scott RT, Bussewitz B, Berlet GC (2014) Ankle valgus after hind-foot arthrodesis: a radiographic and chart comparison of the medial double and triple arthrodesis. J Foot Ankle Surg 53(1):55–58. https://doi.org/10.1053/j.jfas.2013.02.018

    Article  PubMed  Google Scholar 

  3. Pell RF IV, Myerson MS, Schon LC (2000) Clinical outcomes after primary triple arthrodesis. J Bone Joint Surg Am 82(1):47–57. https://doi.org/10.2106/00004623-200001000-00006

    Article  PubMed  Google Scholar 

  4. Brilhault J (2009) Single medial approach to modified double arthrodesis in rigid flatfoot with lateral deficient skin. Foot Ankle Int 30(1):21–26. https://doi.org/10.3113/FAI.2009.0021

    Article  PubMed  Google Scholar 

  5. Tisdel CL, Marcus RE, Heiple KG (1995) Triple arthrodesis for diabetic peritalar neuroarthropathy. Foot Ankle Int 16:332–338. https://doi.org/10.1177/107110079501600604

    Article  CAS  PubMed  Google Scholar 

  6. Wukich DK, Crim BE, Frykberg RG, Rosario BL (2014) Neuropathy and poorly controlled diabetes increase the rate of surgical site infection after foot and ankle surgery. J Bone Joint Surg Am 96(10):832–839. https://doi.org/10.2106/JBJS.L.01302

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bibbo C, Anderson RB, Hodges DW (2001) Complications of midfoot and hindfoot arthrodesis. Clin Orthop Relat Res 391:45–58. https://doi.org/10.1097/00003086-200110000-00007

    Article  Google Scholar 

  8. Carranza-Bencano A, Tejero García S, Fernández Torres JJ, Del Castillo-Blanco G, Alegrete-Parra A (2013) Isolated subtalar arthrodesis through minimal incision surgery. Foot Ankle Int 34(8):1117–1127. https://doi.org/10.1177/1071100713483114

    Article  CAS  PubMed  Google Scholar 

  9. Lee DL, Mulder GD (2009) Foot and ankle surgery: considerations for the geriatric patient. J Am Board Fam Med 22(3):316–324. https://doi.org/10.3122/jabfm.2009.03.080122

    Article  PubMed  Google Scholar 

  10. Carranza-Bencano A, Tejero S, Fernández Torres JJ, Del Castillo-Blanco G, Alegrete-Parra A (2015) Isolated talonavicular joint arthrodesis through minimal incision surgery. Foot Ankle Surg 21(3):171–177. https://doi.org/10.1016/j.fas.2014.11.003

    Article  CAS  PubMed  Google Scholar 

  11. Galli MM, Scott RT, Bussewitz B, Hatic S II, Hyer CF (2014) Structures at risk with medial double hindfoot fusion: a cadaveric study. J Foot Ankle Surg 53(5):598–600. https://doi.org/10.1053/j.jfas.2014.03.001

    Article  PubMed  Google Scholar 

  12. Phisitkul P, Haugsdal J, Vaseenon T, Pizzimenti MA (2013) Vascular disruption of the talus: comparison of two approaches for triple arthrodesis. Foot Ankle Int 34(4):568–574. https://doi.org/10.1177/1071100713479318

    Article  PubMed  Google Scholar 

  13. Mulfinger GL, Trueta J (1970) The blood supply of the talus. J Bone Joint Surg (Br) 52(1):160–167

    CAS  Google Scholar 

  14. Gelberman RH, Mortensen WW (1983) The arterial anatomy of the talus. Foot Ankle 4(2):64–72

    CAS  PubMed  Google Scholar 

  15. Rohm J, Zwicky L, Horn Lang T, Salentiny Y, Hintermann B, Knupp M (2015) Mid- to long-term corrective hindfoot fusions in 84 patients with rigid flatfoot deformity. Bone Joint J 97-B(5):668–674. https://doi.org/10.1302/0301-620X.97B5.35063

    Article  CAS  PubMed  Google Scholar 

  16. Smith RW, Shen W, Dewitt S, Reischl SF (2004) Triple arthrodesis in adults with non- paralytic disease. A minimum ten-year follow-up study. J Bone Joint Surg Am 86(12):2707–2713. https://doi.org/10.2106/00004623-200412000-00018

    Article  PubMed  Google Scholar 

  17. Cody EA, Younger A, Cerrato RA, Johnson AH (2019) The flatfoot through a pinhole: do it percutaneously! Tech Foot Ankle Surg 18(4):156–159. https://doi.org/10.1097/BTF.0000000000000247

    Article  Google Scholar 

  18. Hughes AM, Gosling O, McKenzie J, Amirfeyz R, Winson IG (2014) Arthroscopic triple fusion joint preparation using two lateral portals: a cadaveric study to evaluate efficacy and safety. Foot Ankle Surg 20(2):135–139. https://doi.org/10.1016/j.fas.2014.02.001

    Article  PubMed  Google Scholar 

  19. Jagodzinski NA, Parsons AM, Parsons SW (2015) Arthroscopic triple and modified double hindfoot arthrodesis. Foot Ankle Surg 21(2):97–102. https://doi.org/10.1016/j.fas.2014.10.001

    Article  CAS  PubMed  Google Scholar 

  20. Lui TH (2017) Arthroscopic triple arthrodesis in management of chronic flatfoot deformity. Arthrosc Tech 6(3):e871–e877. https://doi.org/10.1016/j.eats.2017.02.020

    Article  PubMed  PubMed Central  Google Scholar 

  21. Coughlin MJ, Grimes JS, Traughber PD, Jones CP (2006) Comparison of radiographs and CT scan in the prospective evaluation of the fusion of the hindfoot arthrodesis. Foot Ankle Int 27:780–787. https://doi.org/10.1177/107110070602701004

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Head of Foot Ankle Unit, University Hospital Virgen del Rocío, University of Sevilla, Avda Manuel Siurot s/n, CP 41011, Sevilla, Spain

    Sergio Tejero

  2. University Hospital Virgen del Rocío, Avda Manuel Siurot s/n, CP 41011, Sevilla, Spain

    Andres Carranza-Pérez-Tinao, Maria Dolores Zambrano-Jiménez, Estefanía Prada-Chamorro, Jose Juan Fernández-Torres & Andrés Carranza-Bencano

Authors
  1. Sergio Tejero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andres Carranza-Pérez-Tinao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Dolores Zambrano-Jiménez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Estefanía Prada-Chamorro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jose Juan Fernández-Torres
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrés Carranza-Bencano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sergio Tejero.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval for this study was obtained from our institution’s ethical review committee (CEI:2013PI/303).

Additional information

Publisher’s note

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

Level of evidence: Level IV, case series

Electronic supplementary material

Supplementary 1

Graphic 1 Preoperative AOFAS score; postoperative AOFAS scores (n = 67). (JPG 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tejero, S., Carranza-Pérez-Tinao, A., Zambrano-Jiménez, M.D. et al. Minimally invasive technique for stage III adult-acquired flatfoot deformity: a mid- to long-term retrospective study. International Orthopaedics (SICOT) 45, 217–223 (2021). https://doi.org/10.1007/s00264-020-04724-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04724-5

Keywords

Search

Navigation