MALLEOLAR RESECTION AND WEDGE ARTHRODESIS OF THE ANKLE FOR VALGUS DEFORMITY WITH ULCERATION IN RHEUMATOID DISEASE

Abstract

Introduction: We describe an operation, which have performed in patients with rheumatoid arthritis, valgus deformities of the ankle and hind foot with overlying ulcer.

Materials and Methods: The operation has been performed in seven female patients with an average age of 69 years. All patients had severe functional problems.

Technique: The ulcer is excised through an elliptical incision and the medial malleolous is excised level with the ankle joint. Then the tibia surface is osteotomized just above the ankle joint with a planar cut perpendicular to the long axis of the tibia in both saggital and coronal planes. The talus is also transected, with the cut parallel to the sole of the foot and the arthrodesis is closed. The patient starts to mobilize weight bearing in a POP cast with an over boot with rigid sole and rocher in 2–3 days. After 8 weeks the patient is transferred to a shoe with fixed double iron attached. This is retained until radiological union occurs.

Results: Primary healing of the skin was obtained in all cases. Each patient was able to walk within the bounds of their disease early after surgery. In every case union has been delayed. No patient has had recurrent deformity or ulceration.

Conclusion: Such deformity severely impairs the functional status of the patient and may threaten the viability of the foot. Primary surgery with excision of the medial malleolous and correction of the deformity of the ankle has proved successful in treating pain, deformity and ulceration in this small series.