I saw an interesting flatfoot in the clinic this morning that presented with significant pes planus on weight bearing. At first glance, the foot seemed amenable to traditional rigid flatfoot surgical correction to include a calcaneal slide and Evans procedure. But the referring doc had ordered an MRI that showed advanced cystic erosion of the subtalar joint. And interestingly, the MRI found the PT tendon to be intact without evidence of a tear. That brought to the fore front the treatment choice of a triple arthrodesis vs traditional flatfoot repair. The patient was a 50 y/o and active at work and social activities such as mowing his lawn. He described moderate pain with work but not enough to limit the time he spends on his feet.
So what to do? I opted for an Arizona Brace for the short term. If the patient can complete a full work day with only limited pain, the brace is still the best call for the short term. Five to ten years from now we might be looking at a triple arthrodesis. But the point of this conversation is to define the integrity of the stj, TN and CC joints. Although not the preferred procedure in most cases, a triple arthrodesis still has a place in the treatment of flatfoot deformity with stj arthritis.
Jeff
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
