SLR - December 2011 - Steve Czymbor
Reference: Frost, N.L., Grassbaugh, J.A., Baird, G., & Caskey, P. (2011). Triple arthrodesis with lateral column lengthening for the treatment of planovalgus deformity. Journal of Pediatric Orthopaedics, 31, 773-782.
Scientific Literature Review
Reviewed by: Steve Czymbor, DPM
Residency Program: Columbia St Mary’s Hospital, Milwaukee, WI
Podiatric Relevance:
Rigid flatfoot in an adolescent can be a difficult deformity to correct. Previous studies focusing solely on triple arthrodesis for correction relate a high recurrence of deformity as a cause of failure. This study is relevant in assessing triple arthrodesis combined with lateral column lengthening for correction of a rigid flatfoot deformity.
Methods:
A retrospective study was performed on patients with rigid flatfoot due to cerebral palsy, tarsal coalition, or resection of a coalition with continued symptoms. Twenty-two patients, 29 feet, were evaluated with mean operative age of 15.7 years. The talonavicular, subtalar, and calcaneocuboid joint surfaces were prepared for fusion with insertion of a iliac crest auto- or allograft into the calcaneocuboid joint. Clinical assessment of functionality and pain, as well as radiographic success were measured using previously defined criteria with a mean follow-up of 32 months.
Results:
Clinical results based on the Angus criteria revealed the following in the 29 feet: 1 poor result, 3 fair results, and 25 good results. Three radiographic failures were identified with Mosca criteria although this could not be correlated with clinically poor outcomes. Eleven feet experienced surgery-related complications.
Conclusions:
A previous study showed clinical success combining triple arthrodesis with lateral column lengthening, but did not correlate radiographic findings of correction. This study shows that Mosca criteria are not correlated with clinical outcome, although the highest trending measurement in relation to outcome is the calcaneal pitch angle. Overall 84% good clinical success was achieved with a high complication rate of almost 38%. Longer term studies will need to be performed to determine if better realignment with a lateral column lengthening will decrease post-operative arthritic changes in an adolescent triple arthrodesis.