Hindfoot fusions: when and how?

Cao Ba Huong, MD
University of Medicine and Pharmacy, HCM City, Vietnam

Đà Nẵng, Dec 18-19,2021

Learning outcomes

• Identify the biomechanism of hindfoot

• List some hindfoot arthrodesis indications

• List the different options of hindfoot

arthrodesis techniques.
 Anatomy
• 3 articular : subtalar, talonavicular,
calcaneocuboid joints .

• The subtalar : one posterior, one

middle, and one anterior facet

• The transverse tarsal joint, or the

Chopart joint.
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Biomechanics

• Subtalar joint : mitred hinge

• As a shock absorber and mobile adaptor
• As a rigid lever
Biomechanics
 Imaging

• Standard radiographs
• Weight-bearing
radiographs
• Broden and Harris
radiographic views
• CT scanning
Hindfoot Arthrodesis

• Subtalar arthrodesis

• Triple arthrodesis

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Subtalar arthrodesis : indications

• Pain due to arthritis or instability of the joint

• Posttraumatic arthritis (talar or calcaneal fracture)
• Selected comminuted fractures
• OA, rheumatoid …
• Instability due to posterior tibial tendon dysfunction
• Flat foot
• Talocalcaneal coalition
• Hindfoot malalignment
Subtalar arthrodesis

• Two basic types:

• Fusion performed in situ

• Distraction bone block arthrodesis

 Subtalar arthrodesis :
Fusion performed in situ
 Subtalar arthrodesis :
Fusion performed in situ
 Subtalar arthrodesis :
Fusion performed in situ
 Subtalar arthrodesis :
Fusion performed in situ

Internal rotation of the calcaneus in a position of 5° to 10° of valgus

 Subtalar arthrodesis :
Fusion performed in situ
 Subtalar arthrodesis :
Distraction Bone Block Arthrodesis
 Distraction Bone Block Arthrodesis :
Indication
• Shortening of the heel height (loss of height greater
than 15 mm) with painful anterior ankle
impingement and weakened push-off strength.

• In planning, consider Achilles tendon lengthening

Distraction Bone Block Arthrodesis
• The graft size :
• Measured fluoroscopically
• Depend on the space
opened by the laminar
spreader
• The optimal shape : trapezoid,
slightly higher medially than
laterally and higher posteriorly
than anteriorly.
• The heel must be in slight
valgus, avoid varus angulation.
Distraction Bone Block Arthrodesis
Triple arthrodesis

• Subtalar

• Talonavicular

• Calcaneocuboid
Triple arthrodesis : indications

• Hindfoot arthritis

• Hindfoot instability

• Hindfoot malalignment

• Posttraumatic arthritis : talar neck fracture with

malunion, particularly a varus malunion
associated with arthritis
Triple arthrodesis
Triple arthrodesis
Triple arthrodesis
Triple arthrodesis
• The union rate : 88% to 96%.
• 93% satisfactory results
• Transverse tarsal motion was decreased by 40%,
dorsiflexion was reduced by 30%
• 36% and 41% rates of progressive arthrosis in the
ankle and midfoot joints, respectively.
• Most common site of nonunion in triple
arthrodesis: talonavicular joint : 5-10%

• 2 crucial components :

• 1st : preparation of the joint surfaces for the

arthrodesis

• 2nd : proper alignment of the joint

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Take home messages

• Indications for hindfoot arthritis

• 2 types of subtalar arthrodesis, indicated for
isolated subtalar arthritis
• Triple arthrodesis : processing hindfoot arthritis
• 2 common complications : nonunion and malunion
• Preparation of the joint surfaces for the arthrodesis
and proper alignment of the joint

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Thank you for your attention !