Subtalar Joint Arthrodesis

The following investigation consists of a retrospective review of more than 50 patients having undergone an isolated subtalar joint fusion for the correction of the multi-planar flatfoot deformity. These results support the notion that the isolated subtalar joint fusion can provide enhanced stability in selected patients with painful flatfoot deformities. Radiographic evaluation & chart review were conducted for 48 isolated subtalar joint fusions in 44 patients with a minimum of 3 months follow-up. Traditionally, triple arthrodesis is the procedure of choice for the correction of a severely pronated foot secondary to a variety of etiologies (i.e. tarsal coalition, osseous trauma, and tibialis posterior tendon pathology). Triple arthrodesis affords multiplanar correction of deformity and will provide improved or optimal function if osseous union is achieved in an acceptable position. Postoperative function, or more specifically, unlimited, pain-free ambulation is the main goal when treating patients with this condition. Astute preoperative evaluation, proper procedure selection and execution, and attentive postoperative management are mandatory in order to insure long-term success. The main objectives when treating a severely pronated foot are to decrease deformity, to increase stability, and to decrease pain. Elimination of pain is achieved predominately by the arthrodesis. Stability and deformity are addressed by the selected position of fusion. Optimal results can be consistently achieved by osseous union with the subtalar joint in a neutral position. Thus, if nonunion or malunion (successful fusion in an inappropriate position) occur, then recurrence of instability, deformity, and/or pain is probable. Throughout the literature, triple arthrodesis is utilized to address the pain, instability, and deformity associated with a severely pronated rearfoot complex. However, triple arthrodesis is a technically demanding procedure, and in some instances, presents a formidable challenge to even the experienced surgeon. Triple arthrodesis is a very definitive procedure which can be quite unforgiving if performed incorrectly. Even if the procedure is executed to perfection, postoperative sequelae are common due to the extensive dissection, number of fusion sites, amount and placement of fixation materials, operative time, and postoperative convalescence. In the absence of significant midfoot arthritis or a rigid midfoot deformity, isolated subtalar joint arthrodesis can be an effective alternative procedure with less potential shortand long-term complications. The balance of this paper represents a preliminary report on the effectiveness of an isolated subtalar arthrodesis in the restoration of neutral position of the rearfoot