No abstract

It is generally accepted that resection is the treatment of choice for an intractably painful small talocalcaneal tarsal coalition that is associated with a wide, healthy posterior facet and minimal valgus deformity of the hindfoot. Although triple arthrodesis has been recommended for those who do not meet all three criteria, the present study suggests that an algorithmic treatment approach is justified. Treatment of the valgus deformity appears to be as important as that of the coalition. Calcaneal lengthening osteotomy with gastrocnemius or Achilles tendon lengthening is effective for correcting deformity and relieving pain in rigid flatfeet, just as it is in flexible flatfeet.

The lateral talar-first metatarsal angle measured on weightbearing radiographs is a simple means of monitoring patients' risk of development of midfoot ulceration. Only patients with a lateral talar-first metatarsal angle of greater than -27 degrees had an ulcer. This may be a clinically useful threshold for increased risk of the development of ulceration in midfoot diabetic neuroarthropathy.

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Ankle fractures in patients with osteoporosis present significant operative challenges. Patients have more medical comorbidities and can be poorly compliant. Decreased bone density and fracture comminution make stable fixation difficult. This article presents a variety of techniques that have been reliably used at our institution to address many of these issues. The recent advances in anatomical and low-profile locking plates have enhanced the available options. Surgical treatment of the osteoporotic ankle will remain technically challenging, with the maintenance of any reduction often the most difficult step.