Compensatory Function of the Subtalar Joint for Lower Extremity Malalignment

Yoshimoto, Kensei; Noguchi, Masahiko; Yamada, Akifumi; Nasu, Yuki

doi:10.1155/2019/7656878

Cited by 16 publications

(14 citation statements)

References 32 publications

(85 reference statements)

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“…Enough range of motion in this region might not be given in patients with an ankle arthrodesis by a nail. In patients with indication for osteotomy around the knee and primary or secondary arthritis of the ankle joints, we would recommend performing the osteotomy around the knee first and then treat the ankle afterwards-especially when indicating ankle arthrodesis [22][23][24][25][26][27]. With this sequence of surgeries, the surgeon can sustainably accomplish a correct foot position when performing the ankle arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Konrads

Eis

Ahmad

et al. 2021

Eur J Orthop Surg Traumatol

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Introduction Despite the fact that osteotomies around the knee represent well-established treatment options for the redistribution of loads and forces within and around the knee joint, unforeseen effects of these osteotomies on the ankle are still to be better understood. It was therefore the aim of this study to determine the influence of osteotomies around the knee on the coronal alignment of the ankle. We hypothesize that osteotomies around the knee for correction of genu varum or valgum lead to a change of the ankle orientation in the frontal plane by valgisation or varisation. Materials and methods Long-leg standing radiographs of 154 consecutive patients undergoing valgisation or varisation osteotomy around the knee in 2017 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy site. The hip knee ankle angle (HKA), the mechanical lateral distal femur angle (mLDFA), the mechanical medial proximal tibia angle (mMPTA) and five angles around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann–Whitney test. Results One hundred fifty-four patients (96 males, 58 females) underwent osteotomies around the knee for coronal realignment. The mean age was 51 ± 11 years. Correction osteotomies consisted of 73 HTO, 54 DFOs, and 27 double level osteotomies. Of all osteotomies, 118 were for valgisation and 36 for varisation. For valgisation osteotomies, the mean HKA changed from 5.8° ± 2.9° preoperatively to − 0.9° ± 2.5° postoperatively, whereas the mMPTA changed from 85.9° ± 2.7° to 90.7° ± 3.1° and the malleolar-horizontal-orientation-angle (MHA) changed from 16.4° ± 4.2° to 10.9° ± 4.2°. For varisation osteotomies, the mean HKA changed from − 4.3° ± 3.7° to 1.1° ± 2.2° postoperatively, whereas the mLDFA changed from 85.7° ± 2.2° to 89.3° ± 2.3° and the MHA changed from 8.8° ± 5.1° to 11.2° ± 3.2°. Conclusion Osteotomies around the knee for correction of coronal limb alignment not only lead to lateralization or medialization of the weight-bearing line at the knee but also lead to a coronal reorientation of the ankle. This can be measured at the ankle using the MHA. When planning an osteotomy around the knee for correction of genu varum or valgum, the ankle should also be appreciated—especially in patients with preexisting deformities, ligament instabilities, or joint degeneration around the ankle.

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Section: Discussionmentioning

confidence: 99%

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Konrads

Eis

Ahmad

et al. 2021

Eur J Orthop Surg Traumatol

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“…The compensatory function of the hindfoot has been extensively studied. When severe deformities in lower limb joints (e.g., the ankle or knee) are surgically corrected, compensation by the subtalar joint sometimes occurs [13][14][15][16][17]28,29]. The fact that this phenomenon does not always occur suggests the presence of limiting factors in subtalar compensation [15,17,18,30].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding hindfoot compensation in the coronal plane, the ability of the subtalar joint is superior to that of the ankle joint. Several studies have reported changes in the angle of the subtalar joint after TKA [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Poor Correction Capacity of Preexisting Ankle Valgus Deformity after Total Knee Arthroplasty

Shih

Liao

et al. 2021

JCM

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This study investigated the differences in ankle alignment changes after TKA in patients with varying preexisting ankle deformities. We retrospectively examined 90 knees with osteoarthritis and varus deformity in 78 patients who underwent TKA. Preoperative and postoperative radiographic parameters were analyzed. According to their preexisting ankle deformity, patients were assigned to the valgus or varus group. Overall, 14 (15.6%) cases were of preoperative valgus ankle deformity; the remainder were of preoperative varus ankle deformity. Hip–knee–ankle angle (HKA), tibial plafond–ground angle (PGA), and talus–ground angle (TGA) all exhibited significant correction in both groups; however, tibial plafond–talus angle (PTA) and superior space of ankle joint (SS) only changed in the varus group. The median PTA and SS significantly decreased from 1.2° to 0.3° (p < 0.001) and increased from 2.5 to 2.6 mm (p = 0.013), respectively. Notably, ∆PTA positively correlated with ∆HKA in the varus group (r = 0.247, p = 0.032) but not in the valgus group. Between-group differences in postoperative PTA (p < 0.001) and ∆PTA (p < 0.001) were significant. The degree of ankle alignment correction after TKA differed between patients with preexisting varus and valgus ankle deformities. TKA could not effectively correct the preexisting ankle valgus malalignment.

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“…8,15 However, in the cavovarus deformity, the subtalar joint (STJ) is generally stiff, because subtalar, talonavicular, and calcaneocuboid joints (triple joint complex) are typically locked in the push-off position. 13 In contrast, in a neutral or valgus hindfoot alignment, the STJ is more mobile 24 and may thereby compensate the power of particularly the COT, reducing its effect on correction of the tibiotalar pressure distribution. This assumption may lead to the preferred clinical use of SMOT as opposed to COT in mobile STJ but has not been proven biomechanically.…”

Section: Introductionmentioning

confidence: 99%

The Effect of the Mobile Subtalar Joint on Calcaneal and Supramalleolar Osteotomies

Krause

Gueorguiev

Vellasamy³

et al. 2021

Foot Ankle Int.

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Background: The mobile subtalar joint (STJ) may compensate for supra- and inframalleolar deformities and counteract the effect of realigning calcaneal or distal tibial osteotomies. The purpose of this study was to evaluate the compensatory effect of the mobile STJ after supramalleolar osteotomy (SMOT) and calcaneus osteotomy (COT) and whether the extent of the compensation correlates with STJ shape and orientation. Methods: In 10 human lower leg cadavers without evidence of deformity or prior trauma 700 Newton load were applied as a simulated standing pose. The center of force (COF) migration, maximum pressure (Pmax), and the area loaded were measured with high-resolution sensors in the ankle before and after 10-mm varus/valgus sliding COT and 10-degree varus / valgus SMOT. A computed tomographic evaluation of subtalar anatomy was conducted to correlate posterior facet curvature, its varus/valgus orientation in the coronal plane, and the effect on COF, Pmax, and area loaded. Results: The COF migration was significant for both varus and valgus SMOTs (varus SMOT: 1.78 mm, P = .0029; valgus SMOT: 1.85 mm, P = .0018) but not for COT (varus COT: 0.45 mm, P = .85; valgus COT: 1.15 mm, P = .11). Pmax and area loaded changed but not significantly. The radius of the posterior STJ surface showed a moderate correlation (varus SMOT: r = 0.61, P = .063; valgus SMOT: r = 0.28, P = .43, varus COT: r = −0.61, P = .063; valgus COT: r = 0.13, P = .38) and the axis a weak inverse correlation (varus SMOT: r = −0.51, P = .013; valgus SMOT: r = 0.58, P = .079; varus COT: r = −0.51, P = .14; valgus COT: r = 0.38, P = .28) with the COF migration after the osteotomies. Conclusion: The compensatory capacity of a mobile STJ is relatively small but appears to limit the effect of COT more than SMOT. The COT is less effective in influencing ankle joint pressure for realignment purposes than SMOT in mobile STJ and clinically more consistent in stiff STJ. Correlations are moderate to weak, whereas the curvature more than orientation of posterior facet inversely correlates with osteotomy’s effects. Level of Evidence: IV (biomechanical cadaver study).

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Compensatory Function of the Subtalar Joint for Lower Extremity Malalignment

Cited by 16 publications

References 32 publications

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Poor Correction Capacity of Preexisting Ankle Valgus Deformity after Total Knee Arthroplasty

The Effect of the Mobile Subtalar Joint on Calcaneal and Supramalleolar Osteotomies

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