Our Summary

This research paper discusses the evolution of surgical treatments for progressive collapsing foot deformity, which is a condition where the foot’s arch collapses, making it flat and often causing discomfort or pain. Previously, surgeons would fuse a joint in the foot known as the talonavicular joint. However, this method limits foot movement and may speed up the wear and tear of surrounding joints.

More recent research suggests alternative methods that avoid fusing the talonavicular joint. These methods, such as naviculocuneiform or isolated subtalar fusions, allow for more foot movement while still correcting the foot’s deformity.

Additional reconstructive procedures can also be used alongside subtalar fusion for severe deformities. Isolated subtalar fusions could be a good option for patients with specific deformities like sinus tarsi or subfibular impingement.

In simpler terms, the paper is discussing different ways to surgically fix a foot that’s collapsing in on itself, aiming to maintain as much natural foot movement as possible.

FAQs

  1. What is the impact of fusing the talonavicular joint on hindfoot motion?
  2. What are some alternative arthrodesis constructs that can spare the talonavicular joint?
  3. When might isolated subtalar fusions be considered in surgical management of foot deformity?

Doctor’s Tip

A doctor may advise a patient considering joint fusion to explore alternative arthrodesis constructs that spare the talonavicular joint, such as naviculocuneiform or isolated subtalar fusions. These alternatives may help maintain some hindfoot motion through the talonavicular joint and potentially reduce the risk of accelerating adjacent-joint arthrosis. Additionally, they may recommend considering concomitant reconstructive procedures in severe cases to address deformities effectively. It is essential to discuss these options thoroughly with your doctor to determine the best course of action for your specific condition.

Suitable For

Patients who are typically recommended joint fusion for progressive collapsing foot deformity include those with severe deformities that have not responded to conservative treatments, such as orthotics and physical therapy. Patients with significant pain, instability, and limited mobility in the hindfoot may also benefit from joint fusion. Additionally, patients with subfibular impingement deformities or sinus tarsi impingement may be candidates for isolated subtalar fusions. Patients with adult-acquired flatfoot deformity or other conditions that result in progressive collapsing foot deformity may also be recommended for joint fusion surgery. It is important for patients to consult with a foot and ankle specialist to determine the most appropriate treatment plan for their specific condition.

Timeline

Before joint fusion:

  • Patient experiences pain, instability, and deformity in the affected foot
  • Conservative treatments such as orthotics, physical therapy, and bracing may be attempted
  • As symptoms worsen and deformity progresses, surgical intervention may be recommended

After joint fusion:

  • Patient undergoes surgical procedure to fuse the affected joint(s)
  • Recovery period involves immobilization and physical therapy to promote healing and regain strength and function
  • Over time, patient may experience improved stability and decreased pain in the affected foot
  • Long-term outcomes include potential limitations in range of motion and increased stress on adjacent joints, which may require further treatment or management.

What to Ask Your Doctor

  1. What is the purpose of joint fusion for my condition?
  2. Are there alternative treatments to joint fusion that I should consider?
  3. What are the potential risks and complications associated with joint fusion surgery?
  4. How long is the recovery process after joint fusion surgery?
  5. Will I still be able to participate in physical activities and sports after joint fusion surgery?
  6. What type of physical therapy or rehabilitation will be recommended after joint fusion surgery?
  7. How successful is joint fusion surgery in relieving pain and improving function in patients with my condition?
  8. Are there any long-term effects or limitations to consider after undergoing joint fusion surgery?
  9. How many joint fusions have you performed for this specific condition, and what is your success rate?
  10. Are there any specific factors about my condition or medical history that may affect the outcome of joint fusion surgery?

Reference

Authors: Conti MS, Ellis SJ. Journal: Foot Ankle Clin. 2021 Sep;26(3):591-607. doi: 10.1016/j.fcl.2021.05.005. Epub 2021 Jun 19. PMID: 34332737