Professional Documents
Culture Documents
By
Kelvin A. Barry, Sr., DPM, BS
Introduction
Triple Arthrodesis is the fusion of the subtalar,
talonavicular, and calcaneocuboid joints.
It is done to:
stabilize the foot and ankle
relieve pain
correct deformity
This ultimately improves function during gait.
Indications
• Valgus foot deformities
• pes planovalgus
• ruptured tibialias posterior tendon
• tarsal coalition and arthritic deformities
• Other
• lateral ankle instability
• neuromuscular diseases (i.e. paralytic deformities and charco joint deformities)
Procedures
Ryerson: This is the classic triple arthrodesis. It consists of simple joint resection.
Hoke: Involves the use of the head and neck of the talus as a bone graft.
Lambrinudi: This is the most effective in dealing with a drop foot provided
adequate musculature is available for concurrent transfer. When the foot attempts to
plantarflex, the posterior process of the talus serves as a stop against the posterior
tibial malleolus.
Closure
Distally retracted extensor digitorum brevis is repositioned proximally across area of sinus tarsi
and is sutured with 2-0 chromic cat gut.
Subcutaneous tissue and skin are then closed. On dorsal side, retinaculum is closed using 2-0
chromic gut. Skin is closed.
Maicaine (0.25%) is instilled into incision site to achieve initial postoperative analgesia
A compressive dressing is applied
Disadvantages
1. Pseudoarhrosis and nonunion
2. Recurrence of the deformity
3. Development of DJD in joints proximal or distal to the arthrodesis site
4. Avascular necrosis
5. Ankle instability
6. Alteration on overall growth when performed in children
7. Callous formation
8. Scarring
9. Chronic edema
10. Post incisional entrapment neuropathy
11. Muscle atrophy