Extended hindfoot fusions and pantalar fusions. History, biomechanics, and clinical results.

Contemporary techniques of hindfoot and ankle arthrodesis can result in a high rate of osseous union, pain relief, and patient satisfaction. Methods range from open approaches to fully arthroscopic surgical techniques. Arthrodesis should be limited to the joints involved with the arthritic, deforming, or neuromuscular process because the rate and severity of progressive adjacent joint degeneration appear related to the number of joints fused initially. Appropriate joint position, maintained with stable internal fixation applied in compression and augmented with bone-graft material when necessary, should be considered the gold standard for most hindfoot and ankle arthrodeses. External fixation may be used in the revision or salvage setting if needed or when soft tissues or bone stock do not permit stable internal fixation. Meticulous attention must be given to the handling of soft and hard tissues as well as to correction of the underlying deformity and to appropriate positioning of the joints in question. Newer techniques, such as intramedullary fixation, arthroscopic or arthroscopically assisted ankle arthrodesis, and total ankle arthroplasty, have shown some promise and warrant more extensive study.