Talo-navicular arthrodesis for residual midfoot deformities of a previously corrected clubfoot

Triangular navicular, dorsal-lateral subluxation of the talo-navicular (TN) joint with a secondary forefoot cavovarus deformity, and degenerative chan ges of the TN joint are frequent causes of residual clubfoot deformity and pain in the midfoot after surgical correction, This study investigates the usefulness of TN arthrodesis to correct these deformities and to resolve sy mptoms resulting from these deformities. During the period from 1991-1996, the senior author performed 19 TN fusions (16 patients) for the above resid ual clubfoot deformities involving a painful TN joint. Eight of the procedu res (seven patients) also required a lateral column shortening with a calca neal wedge osteotomy to allow for a complete correction of the TN joint. Th e procedure was only performed in cases involving a hindfoot that was adequ ately aligned during a previous clubfoot correction. The average age of the patients at the time of surgery was 11 years (range: 4-20), One patient (b ilateral procedures) was lost to follow-up. Fifteen patients (17 procedures ) were followed-up for an average of four years (range: 2-6), All patients reported symptomatic improvement after the TN arthrodesis. Fourteen of the patients (15 procedures) were completely satisfied. The remaining patient ( bilateral procedures) was only partially satisfied due to the subsequent de velopment of navicular-cuneiform osteoarthritis in both feet, Two cases (2 patients) developed complications requiring a second procedure for satisfac tory results. In addition, the procedure resulted in an improvement of the talus-first metatarsal angle on both antero-posterior and lateral radiograp hs. TN arthrodesis produced a correction of the residual clubfoot deformiti es of the midfoot and resulted in satisfactory clinical improvement in all the patients.