Valgus deformity is a relatively common occurrence in rheumatic or degenerative disease of the tarsus. Frequently the angular deformity can exceed 25° ; in these situations dislocations of talo-calcaneal and/or talo-navicular joints can be observed. These conditions are usually progressive and affect the walking ability of the patient The goal of the study is to present a series of patients surgically treated in order to evaluate the best solutions and the problems of the surgical technique.

In the period 1996–2002, 22 patients were treated for significant valgus deformity of the rearfoot; 16 were affected by rheumatoid arthritis and six by a degenerative pathology. In all cases combined talo-navicular and talo-calcaneal arthrodesis was performed. In seven patients a bone graft was used to fill bone defects. The follow-up was 5.3 years. The results were evaluated using the AOFAS score for rearfoot; fusion was achieved in all but one case (talo-navicular joint). All patients were satisfied regarding subjective results (pain and function).

Combined arthrodesis of talo-calcaneal and talo-navicular joints is an effective method of treating significant valgus deformity of the hindfoot; fixation by screws for talo-calcaneal joint and by staples or screw for talo-navicular joint is the recommended method for synthesis.

Aims: Failure after arthroplasties of þrst metatarso-phalangeal joint (MPJ) is relatively common because the instability and the insufþciency of the great toe; the Patients usually complaint for transfer metatarsalgia and secondary deformities of the lesser toes. The goal of the study is to evaluate a series of arthrodesis of þrst MPJ performed for failed Keller or Hueter procedures; in all cases bone grafts were used in order to restore the normal lenght of the þrst ray. Methods: Between 1996 and 2002 16 Patients were treated with this technique; there were 14 cases of failed Keller arthroplasty and 2 cases of failed Hueter procedure. In all cases tibial or iliac cortico-cancellous grafts were used. Stabilization was performed by 1.5 mm. K-wirws. In 10 cases additional procedures about lesser rays were used. Results: Evaluation of the results was made using AOFAS forefoot score with a minimum follow-up of 7 months (average 3.3 yrs). Fusion was achieved in all cases but one. Average time of fusion was 9 weeks. All Patients were satisfyed with the results in term of pain relief, function and cosmesis. Conclusions: Interposition graft arthrodesis is an effective procedure for failed arthroplasties of þrst MPJ.