TALONAVICULAR ARTHRODESIS FOR HINDFOOT ST ABILIZATION - RESULTS OF 50CASES

Hindfoot stabilization can be obtained by an isolated talonavicular ar throdesis as well as a triple arthrodesis. Material There were 27 case s of unstable neurological foot, 13 cases of Rhumatoid foot, 7 cases o f flat feet and 3 cases of post-trauma arthritis of the talonavicular joint. The procedure was, in all cases, a talonavicular arthrodesis, a ssociated in some cases to a lengthening of the Achilles tendon, tendo n transfer and forefoot correction. Method 50 cases were reviewed with a mean follow-up of 40 months. Results There were 18 per cent cases o f non-union. This could be explained by 2 technical errors : bad carti lagenous resection of the surfaces and unstable bone fixation. No subt alar mobility was noted in all cases. Only one case had a midtarsal mo bility associated to a non-union. 39 feet had a normal heel axation. I n most cases functional improvement was significant with a painless ga it. Discussion Hindfoot stabilization can be obtained by an isolated t alonavicular arthrodesis. Non-union coulb be avoided by a better surgi cal technique and a cast immobilization of 2 and a half months. The pr e-operative deformities should be reduced manually, because isolated f ixed valgus and varus can not be corrected by an isolated talonavicula r arthrodesis. In conclusion, the indications are : - An early valgus deformity of the hindfoot in rhumatoid arthritis. The aim is to avoid a fixed valgus deformity. - Neurological induced equino varus deformit ies specially after stroke and other reducible neurological deformitie s. - Flat foot due to posterior tibialis insufficiency. - Isolated art hritis of the talonavicular joint.