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Increases in midfoot load seen after arthrodesis for planovalgus deformity
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HOLLYWOOD, Fla., USA — Patients who underwent double arthrodesis to correct planovalgus deformity showed significant changes in plantar pressure distribution postoperatively with increased loads detected in the midfoot region, according to results of a study.
“The group saw high correction of the deformity with this therapy and increased load in the midfoot area,” Peter Bock, MD, of the Orthopaedic Hospital Speising, in Vienna, Austria, said during a presentation at the American Orthopaedic Foot & Ankle Society (AOFAS) Meeting.
In order to better understand kinematic changes and the impact of radiographic alignment on the foot, Bock and colleagues evaluated plantar pressure distribution in patients who underwent double arthrodesis for their study.
According to Bock, he and his colleagues discovered a statistically significant increase in maximum force on the midfoot in these patients compared to a control group.
Increased midfoot load
“We had a decreased load force of the hindfoot and the hallux region, as well as the third metatarsal head compared with the healthy controls,” Bock said. “Those findings were similar to a study done before [that] saw a tendency toward shift of load force to the lateral forefoot and increased load in the midfoot region, which could present as stress on the adjacent joints [and] could cause degenerative joint disease.”
There were 10 patients in the group who underwent double arthrodesis for pes planovalgus deformity and 10 healthy patients in the control group. Both groups were matched for gender, age, height, weight and body mass index. Patients had an average age of 65.8 years. They either had Johnson stage III acquired flatfoot or neuropathic pes planovalgus deformity, as well as primary osteoarthritis of the subtalar and talonavicular joints. The mean follow up was 46 months.
Good results reported
The researchers measured plantar pressure in both groups with an Emed portable platform measuring system (Novel GmbH; Munich, Germany).
The AOFAS scores improved from 38 points preoperatively to 70 points postoperatively, which was a good result in 50% of patients, fair in 36% of patients and poor in 14% of patients.
“Triple arthrodesis is a good and confirmed therapy for pes planovalgus deformities, but we know about possible complications like wound problems with the lateral approach, limited motion and increased pressure to the adjacent joints, which could cause degenerative joint disease,” Bock said. “There are several studies proving that one gets good clinical results and good correction power with a medial approach [and double arthrodesis]. Future studies have to be done to compare triple vs. double arthrodesis.”
In this study, the investigators observed radiographic improvement in talocalcaneal angle from 41.3° to 35.8° and in the lateral talus-first metatarsal-angle from -16.3° to -8.2°. These improvements were statistically significant, according to Bock. – by Renee Blisard Buddle
- Reference:
- Bock P. Paper #11. Presented at: American Orthopaedic Foot & Ankle Society Meeting; July 17-20, 2013; Hollywood, Fla., USA
- Schuh R. J Orthop Res. 2013;doi:10.1002/jor.22269.
- For more information:
- Peter Bock, MD, can be reached at Speisingerstrasse 109, 1130 Vienna, Austria; email: peter.bock@oss.at.
Disclosure: Bock has no relevant financial disclosures.
Perspective
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Fabian Krause, MD
The dynamic pedobarographic study demonstrates that patients having hindfoot double arthrodesis (subtalar and talonavicular) mostly for pes planovalgus stage III have alterations of plantar pressure distribution similar to triple arthrodesis (subtalar, talonavicular and calcaneocuboid). The study set-up was sufficient, postoperative functional results were significantly increasing and improvement of radiographic alignment was appropriate. This supports the general agreement among foot and ankle surgeons that triple instead of double hindfoot arthrodesis are not necessary in the majority of cases, unless the calcaneocuboid joint is arthritic. Particularly, the calcaneocuboid joint has a high nonunion rate and patients often complain of postoperative lateral column stiffness. However, the results are not surprising and the authors themselves state that further studies including direct prospective comparative analyses between patients undergoing double and triple arthrodesis are necessary to investigate if sparing of the calcaneocuboid joint can lead to fewer alterations of physiologic plantar pressure distribution and a lower rate of arthritis of the adjacent joints in the long-term.
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