Single-incision medial approach for double arthrodesis of hindfoot in posterior tibialis tendon dysfunction.

BACKGROUND: Triple arthrodesis through a 2-incision approach has been the primary salvage procedure for rigid hindfoot malalignment resulting from posterior tibialis dysfunction. However, complications like calcaneocuboid joint nonunion, lateral wound dehiscence, and adjacent joint arthritis have been reported after triple arthrodesis. Hence we adopted single-incision medial approach arthrodesis of subtalar and talonavicular joints, sparing the uninvolved calcaneocuboid joint and lateral skin.

METHOD: We report the results of a series of 18 feet with posterior tibialis dysfunction that had correction of malalignment by this approach. Mean age at surgery was 65 years. The mean follow-up was 24 months.

RESULTS: There was statistically significant improvement in all the radiological parameters measured. There were no wound-related complications. The union rate was 89%. There were 2 malunions, and 2 feet developed valgus ankle deformity. The overall satisfaction rate among patients was 78%.

CONCLUSION: We present a case series of treatment of posterior tibialis tendon dysfunction by arthrodesis of the subtalar and talonavicular joints through an isolated medial approach. The results were not encouraging enough to recommend adopting this approach as an alternative to triple arthrodesis.

LEVEL OF EVIDENCE: Level IV, retrospective case series.