Tibiocalcaneal fusion after talectomy in arthrogrypotic patients.

The authors evaluated the results of five arthrogrypotic patients who had tibiocalcaneal fusion after previous talectomy. The average follow-up was 5 years (range 2-12 years) after fusion, and seven feet were available for evaluation in terms of function, pain, and radiologic changes. Using the American Orthopaedic Foot and Ankle Society clinical rating score, the five patients scored an average rating of fair after the arthrodesis compared with a rating of poor prior to the fusion. Four patients noted a subjective improvement with regard to their function and ankle pain after the fusion. Two patients still reported pain over the ankle but not enough to affect their activities. All the patients had residual leg length discrepancies ranging from 1 to 2 cm, but none of them required shoe lifts to correct the deformity. All the feet examined showed a plantigrade foot with an average tibia-floor angle of 91 degrees in the sagittal plane and an average hindfoot valgus of 2.75 degrees in the coronal plane. Radiographic examination showed that two patients already showed signs of mild degenerative arthritis over the knee and midtarsal joints that were not present before the tibiocalcaneal fusion. Tibiocalcaneal fusion may improve the function and the pain symptoms of arthrogrypotic patients, but it can lead to early degenerative arthritis of the adjacent joints.