Our Summary

This research article discusses a foot condition called peritalar subluxation, which is a part of a more severe foot disorder known as progressive collapsing foot deformity. This condition affects the stability of the foot, causing bones to move out of place and can lead to foot pain and deformity. This instability allows the talus (ankle bone) to shift and rotate on other foot bones, typically moving towards the inside and front of the foot. This can cause problems like impingement, where the tissues between the bones are pinched.

When the foot begins to stiffen and potentially develop arthritis, the condition can become fixed and more severe. One way to treat this is through a procedure called a subtalar (ST) joint fusion, which involves joining the talus and the heel bone (calcaneus) together. However, this might not fully correct other deformities in the foot.

If the deformity is too pronounced, a different procedure called a naviculocuneiform (NC) fusion could be more effective. This involves fusing the navicular and cuneiform bones of the foot. It’s important to maintain the natural shape of the joint during this procedure to allow for proper foot movement after the surgery.

The research also highlights that care should be taken during the ST fusion process not to correct the talocalcaneal angle too much, as it could cause pain and discomfort. In some cases, such as when the tendon at the back of the ankle is ruptured, a subtalar fusion might not be the best option. In these cases, a tendon transfer - moving a tendon from one part of the foot to another - might be added to the procedure.

This research is based on expert opinion and consensus, rather than direct scientific evidence.

FAQs

  1. What is peritalar subluxation and how does it affect the foot?
  2. What is the difference between a subtalar (ST) joint fusion and a naviculocuneiform (NC) fusion?
  3. Under what conditions might a tendon transfer be considered instead of a subtalar fusion?

Doctor’s Tip

A doctor might advise a patient undergoing joint fusion surgery to follow a proper rehabilitation program to ensure a successful recovery. This may include physical therapy exercises to strengthen the surrounding muscles, improve range of motion, and promote healing. It is important for the patient to follow their doctor’s instructions closely and attend all follow-up appointments to monitor progress and address any concerns. Proper post-operative care and adherence to the rehabilitation program can help optimize the outcome of the joint fusion surgery and improve overall function and mobility in the affected joint.

Suitable For

Patients who are typically recommended joint fusion are those who have severe foot deformities, such as peritalar subluxation or progressive collapsing foot deformity, which have not responded to conservative treatments. These patients may experience foot pain, instability, and deformity that significantly impacts their quality of life and mobility. Joint fusion may be recommended to stabilize the foot, reduce pain, and improve overall function. It is important for patients to consult with a foot and ankle specialist to determine if joint fusion is the appropriate treatment option for their specific condition.

Timeline

Timeline of patient experience before and after joint fusion:

Before joint fusion:

  • Patient experiences foot instability, pain, and deformity due to peritalar subluxation
  • Condition worsens over time, potentially leading to arthritis and fixed deformities
  • Patient may undergo imaging tests to assess the severity of the condition
  • Surgeon recommends joint fusion surgery as a treatment option

After joint fusion:

  • Patient undergoes surgery to fuse the talus and heel bone (ST fusion) or navicular and cuneiform bones (NC fusion)
  • Recovery period involves immobilization of the foot, physical therapy, and pain management
  • Patient gradually regains mobility and function in the foot
  • Follow-up appointments with the surgeon to monitor healing and address any complications
  • Patient may need to adjust to changes in foot movement and function post-surgery

Overall, the timeline of a patient’s experience before and after joint fusion involves a progression from foot instability and pain to surgical intervention and post-operative recovery. The goal of joint fusion surgery is to improve foot stability, reduce pain, and restore function in patients with severe foot deformities.

What to Ask Your Doctor

Some questions a patient should ask their doctor about joint fusion for peritalar subluxation include:

  1. What are the risks and potential complications of a subtalar joint fusion or naviculocuneiform fusion?
  2. How long is the recovery period after the surgery, and what can I expect in terms of pain and mobility during this time?
  3. Will I be able to return to my normal activities and sports after the fusion surgery?
  4. Are there any alternative treatments or procedures that could be considered for my condition?
  5. How successful is joint fusion in correcting peritalar subluxation and preventing further deformity?
  6. Will I need physical therapy after the surgery, and how long will it take for me to fully recover?
  7. What is the expected outcome in terms of pain relief and improvement in foot stability after the fusion surgery?
  8. Are there any long-term implications or considerations I should be aware of after undergoing a joint fusion procedure?
  9. How experienced are you in performing joint fusion surgeries for peritalar subluxation, and what is your success rate with this procedure?
  10. Are there any specific lifestyle changes or modifications I should make after the surgery to support the healing process and prevent future complications?

Reference

Authors: Hintermann B, Deland JT, de Cesar Netto C, Ellis SJ, Johnson JE, Myerson MS, Sangeorzan BJ, Thordarson DB, Schon LC. Journal: Foot Ankle Int. 2020 Oct;41(10):1295-1298. doi: 10.1177/1071100720950738. Epub 2020 Aug 27. PMID: 32851856