Figure 1. Anteroposterior radiograph of the right ankle.
Figure 2. Lateral radiograph of the right ankle.
A 56-year-old man presents to the office with pain in the right ankle and hindfoot for 4 years. He has tried bracing the joint and undergoing injections in the hindfoot, both of which have provided short-term relief. Anteroposterior and lateral radiographs of the right ankle are obtained (Figures 1 and 2).
Which of the following is the best surgical option for this patient?
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This patient presents with talocalcaneal, or subtalar, arthritis. The most common cause of subtalar arthritis is an injury or fracture that disrupts the articular surface of the joint. Symptoms include a stiff ankle that is particularly painful with side-to-side movements. Immobilization, ice, nonsteroidal anti-inflammatory drugs, and fluoroscopic-guided intra-articular steroid injections may offer symptom relief and delay the need for surgery. When conservative treatments fail, the treatment of choice is arthrodesis, or fusion. Arthrodesis is performed by removing the remaining articular cartilage and compressing the talus and calcaneus together with screws.1,2
A triple arthrodesis fuses the talocalcaneal, talonavicular, and calcaneocuboid joints. This patient does not have arthritis in the talonavicular or calcaneocuboid joint; therefore, an isolated talocalcaneal joint arthrodesis is the best treatment option. The treatment for a talocalcaneal coalition is coalition resection with interposition of the flexor hallucis longus tendon.
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
1. Easley ME, Trnka H, Schon L, Myerson MS. Isolated subtalar arthrodesis. J Bone Joint Surg Am. 2000;82(5):613-624.
2. Hollman EJ, van der Vliet QMJ, Alexandridis G, Hietbrink F, Leenen LPH. Functional outcomes and quality of life in patients with subtalar arthrodesis for posttraumatic arthritis. Injury. 2017;48(7):1696-1700.