Effect of Subtalar Fusion and Calcaneal Osteotomy on Function, Pain, and Gait Mechanics for Calcaneal Malunion

Farouk, Amr; Ibrahim, Amr; Abd-Ella, Mohamed Mokhtar; Ghazali, Sherif El

doi:10.1177/1071100719853291

Cited by 15 publications

(11 citation statements)

References 17 publications

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“…Adjustment of the hindfoot alignment in a slight valgus position could lessen the pressure on the lateral column. 26,31 Farouk et al 16 presented that in cases with malunion, valgus calcaneus osteotomy combined with subtalar fusion could lead to improvement in the gait of patients. In our study, a moderate shift of the loading from the medial to the lateral column was seen, showing statistically significant increase of pressure distribution only on the lateral forefoot (lateral forefoot P = .018).…”

Section: Discussionmentioning

confidence: 99%

Midterm Outcome of Subtalar Joint Revision Arthrodesis

Chraim

Recheis²,

Alrabai

et al. 2021

Foot Ankle Int.

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Background: The outcomes of revision subtalar arthrodesis have received relatively little focus in research compared with primary subtalar arthrodesis outcomes. This study aimed to assess the midterm clinical and radiologic results of subtalar joint revision arthrodesis and to analyze the risk factors that might influence the outcome of this procedure. Methods: We performed a retrospective review of 20 patients after subtalar joint revision arthrodesis for malunion, using interposition of iliac crest bone graft. The mean age was 55.75 years and the average follow-up lasted for 48.93 months. Eighty-five percent of the patients had at least 1 risk factor identified prior to revision. Patients’ satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot & Ankle Society Scale (AOFAS), the Foot and Ankle Outcome Score (FAOS), the Foot Function Index (FFI), and dynamic pedobarography. Results: A fusion rate of 80% was recorded whereas 20% of the cases ended with a painful pseudarthrosis requiring additional surgery. Pedobarographic measurements demonstrated that loading has a propensity toward the lateral column, but no substantial effect on the gait of patients. In this group, the following patient-reported outcomes were observed: 70% of the patients were satisfied, 20% of the patients found the result fair, and 10% were not satisfied with the results. Compared with the preoperative evaluation, postoperative functional scores showed significant improvement on the FOAS, AOFAS, and FFI outcome scales. Conclusions: Revision arthrodesis of the subtalar joint remains a challenging issue with a relatively high rate of nonunion, especially in a population of patients with multiple risk factors. Level of Evidence: Level IV, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Midterm Outcome of Subtalar Joint Revision Arthrodesis

Chraim

Recheis²,

Alrabai

et al. 2021

Foot Ankle Int.

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“…Lateral stability requires active adjustment. And longitudinal stability passive adjustment through the conversion of energy absorbed by the stride and loading response to gradually eliminate external disturbances reduces the impact [ 4 ]. In contrast to previous research, this study carried out a correlation analysis of the dynamic indicators in the stance phase as well as an analysis of the differences between the groups according to gait events.…”

Section: Discussionmentioning

confidence: 99%

“…The frequently occurring traffic accidents, cardiovascular and cerebrovascular events, and the increasing aging of the population in our society have led to the presence of large numbers of potentially or apparently unstable gait holders. Moreover, in the available studies, cases of decreased gait stability or abnormal gait due to disease [1][2][3] and surgery [4,5] have been reported. Falls and their secondary injuries caused by instability of gait often have serious consequences.…”

Section: Introductionmentioning

confidence: 99%

Effect of Different Ankle-Foot Immobility on Lateral Gait Stability in the Stance Phase

Fan

Hatanaka

2022

Applied Bionics and Biomechanics

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Background. This study aimed to investigate the effect of limited foot and ankle mobility on the lateral stability of gait through the observation of the mediolateral margin of stability and related kinematic parameters. Methods. Thirty young, healthy participants walked at a fixed gait velocity on a level surface. Participants achieved different degrees of restricted mobility by wearing soft-soled shoes (S), an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion activity only (A), and an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion and adjustable horizontal rotation of the foot (OU/OR). Furthermore, the spatiotemporal parameters, mediolateral margin of stability, center of pressure, angle of the fore and hind foot relative to the tibia, and correlation coefficients of the factors were analyzed. Regression analysis was also performed. Results. At right heel strike, group A had a significantly lower mediolateral margin of stability than group S and group OU. Meanwhile, forefoot adduction (0.2 < | r | <0.4) and plantarflexion (0.2 < | r | <0.4), as well as hindfoot internal rotation (0.2 < | r | <0.6) and inversion (0.2 < | r | <0.4), correlated negatively with lateral stability. Regression analysis revealed forefoot dorsiflexion and supination were the main independent variables for group A. At right heel off, groups OU and OR had a significantly lower mediolateral margin of stability than those in groups A and S. Forefoot adduction (0.2 < | r | <0.4) and dorsiflexion (0.4 < | r | <0.6) were correlated with lateral stability, as were hindfoot dorsiflexion (0.2 < | r | <0.4) and inversion (0.2 < | r | <0.4). Regression analysis revealed forefoot abduction and plantarflexion were the main independent variables for groups OU and OR. Conclusions. The present study verified from gait data that forefoot dorsiflexion and supination at the initial contact of the stance phase were relevant factors for the differences in lateral gait stability, whereas abduction and plantar flexion of the forefoot at the terminal stance phase were the main influencing factors of lateral gait stability.

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“…The restoration of anatomy can help improve gait and prevent complications such as calcaneofibular impingement, subfibular impingement, decreased tibiotalar motion, and calcaneal widening, resulting in poor shoe wear. 2,20,22,36,41,43,47 Radnay et al 41 reviewed patients who underwent delayed STA, stratifying them by initial treatment as either nonoperative or ORIF. Their results showed that patients initially treated nonoperatively who then underwent a subtalar arthrodesis for painful malunion had worse functional outcomes and higher complications than patients managed with initial ORIF.…”

Section: Discussionmentioning

confidence: 99%

Screws-Only Primary Subtalar Arthrodesis for Calcaneus Fractures

et al. 2022

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Background: The management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem with disappointing results from open reduction internal fixation (ORIF). Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using only screws through a sinus tarsi approach. Methods: A retrospective study of patients who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was used in all cases consisting of only screws; no plates were used. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data were collected including worker’s compensation claims. Plain radiographs were used to characterize injuries and review outcomes. Results: Seventy-nine DIACFs underwent PSTA with a median follow-up of 200 days (n = 69 patients). Median time to weightbearing was 57.5 days postoperatively. Ten fractures were documented as Sanders II, 36 as Sanders III, and 32 as Sanders IV. Sixty-eight fractures (86.1%) achieved fusion on radiographs at a median of 126.5 (range, 54-518) days. Thirty-nine fractures (57.3%) demonstrated radiographic fusion in all 3 predefined locations. Nine of the 14 worker’s compensation patients returned to work within the period of observation. There were 8 complications: 3 requiring a secondary operation. Eleven of 79 fractures treated did not go on to achieve radiographic union. Conclusion: In this retrospective case series, we found that screws-only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach was associated with relatively high rates of return to work and radiographic fusion. Level of Evidence: Level IV, retrospective case series.

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Effect of Subtalar Fusion and Calcaneal Osteotomy on Function, Pain, and Gait Mechanics for Calcaneal Malunion

Cited by 15 publications

References 17 publications

Midterm Outcome of Subtalar Joint Revision Arthrodesis

Midterm Outcome of Subtalar Joint Revision Arthrodesis

Effect of Different Ankle-Foot Immobility on Lateral Gait Stability in the Stance Phase

Screws-Only Primary Subtalar Arthrodesis for Calcaneus Fractures

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