Talonavicular Arthrodesis for the Painful Adult Acquired Flatfoot

Abstract

Twenty-seven consecutive patients with posterior tibial tendon insufficiency were treated with talonavicular arthrodesis as the primary stabilizing procedure. Twenty-six patients were followed a minimum of 12 and an average of 27 months. Twenty-four patients had either no pain or pain only after heavy usage. Eleven patients were completely satisfied with postoperative foot function, 13 were satisfied, with minor reservations, and 2 were satisfied, with major reservations. Results were rated as excellent in 10 patients, good in 14 patients, and fair in 2 patients. Successful arthrodesis was achieved in all patients, although one patient required two additional bone grafts. Progressive arthrosis in adjacent joints was noted in five patients, four of whom had arthrosis preoperatively. No deterioration of foot position was seen in any patient with follow-up as long as 5 years. An isolated talonavicular arthrodesis seems to offer patients with this disorder both reliable pain improvement and lasting stability.

Isolated talonavicular joint arthrodesis through minimal incision surgery

“…Elboar et al [26] reported that 37% of the patients who had TNA developed degenerative changes in the calcaneocuboid, subtalar and navicular-cuneiform joints after TNA. Harper et al reported progressive arthrosis in adjacent joints in 5 of 27 (18.5%) patients [16,17]. Chen et al reported adjacent joint arthritic changes occurred in 5 of 16 feet (31%) [11].…”

“…According to the reviewed literature, single joint talonavicular fusion has been shown to yield a higher incidence of non-unions, pseudoarthrosis occurring in 3-10%, when compared with double arthrodesis of the subtalar and talonavicular joints or talocalcaneal arthrodesis [16,18,[22][23][24]. Therefore, if we consider that talonavicular degeneration has been caused by a destabilization of the talo-calcaneal-navicular complex, we indicate another type of Fig.…”

“…It is currently being used to treat traumatic, rheumatoid, and degenerative isolated talonavicular arthritis, posterior tibial tendon deficiencies, and pes valgus deformities, as well as congenital deformities and neuromuscular diseases [1][2][3]5,[11][12][13][14][15][16][17][18]. We used isolated TNA by MIS, fundamentally for patients with precarious soft tissue, but without malalignment of the hindfoot or peritalar destabilization [19].…”

Arthrodesis of the talonavicular joint using angle-stable mini-plates: a prospective study

“…At the time of the last clinicoradiological evaluation, no case of adjacent osteoarthritis was detected. Here, the relatively short follow-up period might be critical [20].…”

Talonavicular Arthrodesis for the Treatment of Neurological Flat Foot Deformity in Pediatric Patients

“…10 However, this procedure has not been universally successful due to undercorrection or overcorrection of the foot deformity. 2 Talonavicular arthrodesis has been reported to be a safe option to correct foot deformity in adult patients with primary arthrosis, arthrosis secondary to trauma, 11 rheumatoid arthritis, 12 acquired painful flat foot, 13 and dorsal rotatory subluxation of the navicular in clubfoot. 14,15 However, to our knowledge, no study has determined the outcome of this technique in pediatric patients with neurological disorders.…”