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Talonavicular fusion for dorsal subluxation of the navicular in resistant clubfoot.

Swaroop VT, Wenger DR, Mubarak SJ - Clin. Orthop. Relat. Res. (2009)

Bottom Line: Previous attempts at soft tissue release and reduction have been largely unsuccessful.Level IV, therapeutic study.See Guidelines for Authors for a complete description of levels of evidence.

View Article: PubMed Central - PubMed

Affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.

ABSTRACT

Unlabelled: Dorsal rotatory subluxation of the navicular, a common sequela of resistant surgically treated clubfeet, presents a challenging treatment problem. This subluxation typically progresses after posteromedial release. Patients develop a cavovarus foot deformity and complain of pain, gait problems, and difficulty with shoe wear. Previous attempts at soft tissue release and reduction have been largely unsuccessful. We reviewed 13 patients with dorsal rotatory subluxation of the navicular treated with talonavicular arthrodesis. The minimum followup after surgery was 6 months (average, 36 months; range, 6 to 93 months). At last followup 12 of 13 patients were symptom-free. The mean preoperative subluxation of 42% was reduced to a mean of 6% at last followup. We noted improvement in the talo-first metatarsal angle from an average of 18 masculine preoperatively to 8 masculine postoperatively. One patient treated by another surgeon with attempted talonavicular arthrodesis developed a nonunion; we observed no other complications. We believe talonavicular arthrodesis a reasonable option to correct the deformity and symptoms associated with dorsal rotatory subluxation of the navicular in a single surgical setting with a low complication rate.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Related in: MedlinePlus

(A) Preoperative standing lateral demonstrating dorsal rotatory subluxation of the navicular on the head of the talus. Note also the loss of normal calcaneal pitch as compared to the contralateral side. (B) Postoperative standing lateral radiograph demonstrating talonavicular arthrodesis with restoration of calcaneal pitch.
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Fig1: (A) Preoperative standing lateral demonstrating dorsal rotatory subluxation of the navicular on the head of the talus. Note also the loss of normal calcaneal pitch as compared to the contralateral side. (B) Postoperative standing lateral radiograph demonstrating talonavicular arthrodesis with restoration of calcaneal pitch.

Mentions: The average preoperative percent subluxation of the navicular was 42% (range, 5%–76%). Postoperatively the average percent subluxation decreased to 6% (range, 0–33%). The lateral talo-first metatarsal angle improved from an average of 18° (range, 5°–40°) preoperatively to 8° (range, 0–16°). The AP talo-first metatarsal angle changed only minimally, from a preoperative average of 16° (range, 3°–46°) to postoperative average of 14° (range, 0–39°) (Fig. 1A–B).Fig. 1A–B


Talonavicular fusion for dorsal subluxation of the navicular in resistant clubfoot.

Swaroop VT, Wenger DR, Mubarak SJ - Clin. Orthop. Relat. Res. (2009)

(A) Preoperative standing lateral demonstrating dorsal rotatory subluxation of the navicular on the head of the talus. Note also the loss of normal calcaneal pitch as compared to the contralateral side. (B) Postoperative standing lateral radiograph demonstrating talonavicular arthrodesis with restoration of calcaneal pitch.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2664444&req=5

Fig1: (A) Preoperative standing lateral demonstrating dorsal rotatory subluxation of the navicular on the head of the talus. Note also the loss of normal calcaneal pitch as compared to the contralateral side. (B) Postoperative standing lateral radiograph demonstrating talonavicular arthrodesis with restoration of calcaneal pitch.
Mentions: The average preoperative percent subluxation of the navicular was 42% (range, 5%–76%). Postoperatively the average percent subluxation decreased to 6% (range, 0–33%). The lateral talo-first metatarsal angle improved from an average of 18° (range, 5°–40°) preoperatively to 8° (range, 0–16°). The AP talo-first metatarsal angle changed only minimally, from a preoperative average of 16° (range, 3°–46°) to postoperative average of 14° (range, 0–39°) (Fig. 1A–B).Fig. 1A–B

Bottom Line: Previous attempts at soft tissue release and reduction have been largely unsuccessful.Level IV, therapeutic study.See Guidelines for Authors for a complete description of levels of evidence.

View Article: PubMed Central - PubMed

Affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.

ABSTRACT

Unlabelled: Dorsal rotatory subluxation of the navicular, a common sequela of resistant surgically treated clubfeet, presents a challenging treatment problem. This subluxation typically progresses after posteromedial release. Patients develop a cavovarus foot deformity and complain of pain, gait problems, and difficulty with shoe wear. Previous attempts at soft tissue release and reduction have been largely unsuccessful. We reviewed 13 patients with dorsal rotatory subluxation of the navicular treated with talonavicular arthrodesis. The minimum followup after surgery was 6 months (average, 36 months; range, 6 to 93 months). At last followup 12 of 13 patients were symptom-free. The mean preoperative subluxation of 42% was reduced to a mean of 6% at last followup. We noted improvement in the talo-first metatarsal angle from an average of 18 masculine preoperatively to 8 masculine postoperatively. One patient treated by another surgeon with attempted talonavicular arthrodesis developed a nonunion; we observed no other complications. We believe talonavicular arthrodesis a reasonable option to correct the deformity and symptoms associated with dorsal rotatory subluxation of the navicular in a single surgical setting with a low complication rate.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Show MeSH
Related in: MedlinePlus