Objective: To investigate the effectiveness of double arthrodesis to correct flatfoot deformity with pes valgus.
Methods: Between May 2009 and May 2012, 12 patients with flatfoot deformity and pes valgus were treated using subtalar and talonavicular joints arthrodesis through a single medial incision approach. There were 5 males and 7 females with an average age of 53.3 years (range, 21-78 years), including 5 left feet and 7 right feet. Of them, 11 cases had posterior tibial tendon dysfunctions; 6 cases were at Johnson-Strom stage III, 5 cases at stage II(c); and 1 case had tarsal coalition. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 48.75 ± 3.46 and 6.08 ± 1.14, respectively.
Results: The mean operation time was 85.6 minutes (range, 65-125 minutes). Eleven patients were followed up for 19.4 months on average (range, 13-30 months). All of the cases obtained primary healing of incision, with no complication of infection and nerve or blood vessel injury. X-ray film showed that the mean time of bone union was 9.8 weeks (range, 7-18 weeks): no bone nonunion occurred. No loosening or breakage of internal fixation was observed. Pain occurred at the calcaneal-cuboid joint (1 case) and at fixation site (1 case), and was relieved after symptomatic treatment. The mean AOFAS score and VAS score were significantly increased to 81.36 ± 2.98 and 0.72 ± 0.11 respectively, showing significant differences when compared with preoperative scores (t = 19.946, P = 0.000; t = 16.288, P = 0.000).
Conclusion: Subtalar and talonavicular joints arthrodesis by a single medial incision approach is a useful alternative to triple arthrodesis for the correction of flatfoot deformity with pes valgus.