LONG-TERM OUTCOME AFTER TREATMENT OF REDUCIBLE TALIPES PLANOVALGUS BY MEDIOTARSAL ARTHRODESIS: 22 CASES IN ADULTS

Abstract

Purpose: Mediotarsal arthrodesis can correct the deformation and relieve pain in adults with reducible talipes planovalgus. We assess clinical and radiological outcome.

Material and methods: This retrospective analysis involved 22 cases of reducible talipes planovalgus (Johson stage 2) in 19 patients (eleven men and eight women), mean age 43 years (15–75). Clinical assessment was based on pain, function and motion (AOFAS and Mann). AP and lateral weight-bearing radiographs with Meary cerclage were used to determine the Djian angle, talometatarsal alignment, talar tilt, calcaneal valgus, and stage of osteoarthritis in adjacent joints.

Results: Mean follow-up was 88 months (6–243). Two non-unions evolved favourably after cancellous graft. The Kitaoka score was 73.5 points/94 (53–94). Pain and function improved respectively from 2.8 to 1.1/4 points and 3.5 to 1.6/4 points on the de Mann scale. Flexion-extension remained unchanged. The foot was well aligned in 68% of the cases (7.5 points). Mean talar tilt and talocalcaneal divergence were normalised but defective Djian angle persisted with a broken de Meary line in 98% and 41% of cases respectively. Calcaneal valgus was reduced 6.6° (16.6 to 10°) and podoscopy showed that flat foot persisted in 86% of the cases. In 50%, neighbouring joints presented progressive osteoarthritic degeneration with clinical impact in only one patient (4.5%). Subjectively, 73% of the patients were satisfied or very satisfied and none of the patients were disappointed. The objective outcome was excellent or good in 68% of cases.

Discussion: Pain, function, motion, complications and rate of satisfaction were comparable with data in the literature (Mann, Baxter, Steinhäuser). Mediotarsal arthrodesis is effective against pain and allows satisfactory recovery of function without morbidity greater than talonavicular arthrodesis (Harper). However, while the foot is well aligned in the majority of the cases, the plantar vault is poorly restored clinically and radiologically. Compensatory over-motion of the adjacent joints probably leads to bone remodelling and moderate asymptomatic osteoarthritis seven years after the procedure.