ARTHRODESIS OF THE HINDFOOT

Arthrodesis of the hindfoot is indicated in congenital foot deformity of young adults, in posttraumatic arthrosis of the subtalar joint foll owing calcaneus fractures, in idiopathic, isolated arthroses of hindfo ot joints, in rheumatoid arthritis and in deformities of the longitudi nal arch of the foot. Common and useful combinations are the triple-ar throdesis and the arthrodesis of the subtalar and the calcaneocuboid j oint, in particular if both joints are affected by calcaneus fractures . Arthrodesis of the subtalar and the talonavicular joint are often pe rformed as isolated procedures. The three-dimensional structure of the hindfoot articulations may impede perfect contact of the bone surface s in combined arthrodeses. Various fixation methods are in use. Follow -up examination of 52 arthrodeses after 11.1 years revealed good, symp tomatic improvement in most patients. However, complete bony union was achieved in only 47 percent, and this was due to insufficient stabili zation of the arthrodesis in many cases. In view of comparable rates o f pseudarthroses in the literature, we advocate stable internal fixati on with screws or bone staples.