Abstract
Category:
Midfoot/Forefoot; Diabetes
Introduction/Purpose:
The complex challenge of reconstructing severe planovalgus deformity of the foot and ankle, often accompanied by subtalar dislocation, is characterized by a heightened risk of lateral wound complications and significant anatomical distortions. These cases, typically arising from chronic conditions such as diabetes (Charcot neuroarthropathy), rheumatoid arthritis, or congenital deformities, necessitate careful consideration of their underlying anatomical pathology. In this study, we introduce a novel all-medial approach for correcting these deformities and provide insights gleaned from our clinical experience.
Methods:
Retrospective review of prospectively collected data of all patients with severe foot and ankle plano-valgus deformity between May 2014-Jan 2024 treated surgically utilising an all-medial approach. We identified 18-feet in 11 patients with an associated subtalar dislocation and describe the patho-anatomy and a single medial approach encompassing 3 surgical windows to the ankle joint, hind-foot, and mid-foot to reconstruct the deformity and stabilise the foot. Functional, radiological, and surgical outcomes are reported of the newly developed surgical approach.
Results:
The average age of patients undergoing surgery was 58 years (ranging from 47 to 78). The mean follow-up duration was 32.7 months (2.7 years), ranging from 8 to 82 months. In nine feet, the posteromedial neurovascular bundle was displaced inferior-laterally, leading to attrition of the flexor hallucis longus (FHL) tendon in three feet due to entrapment between the calcaneum and talus.
Surgical intervention involved pan-talar fusion in 12 feet and medial column extension in nine feet. Only one patient experienced delayed wound healing necessitating the removal of metalwork, yet all patients were ambulatory at the two-year mark, with no instances of limb loss during the study period.
Conclusion:
The novel approach outlined in this study represents a safe and effective technique for reconstructing severe planovalgus foot and ankle deformities accompanied by dislocated subtalar joints. This approach offers predictable radiological and functional outcomes while circumventing the unique complications associated with traditional lateral approaches, thus enhancing patient safety and treatment efficacy.