Hindfoot Arthrodesis

Abstract

Arthrodeses are powerful time-tested methods to definitively correct arthritis, instability, and rigid deformity of the hindfoot. As with all fusions, joint exposure should be optimized to allow complete removal of articular cartilage and preparation of the subchondral bone. Alignment of the hindfoot should maintain the heel in approximately 5° of valgus, while fusions through the transverse tarsal joint should allow the forefoot to rest in a plantigrade position. Bony defects and malalignment can be corrected with bone grafting and bone blocks, respectively. Fixation can be obtained in multiple ways but should seek to maximize compression and stability across the fusion site. Various surgical approaches have been described, including single and dual incisions as well as arthroscopic techniques. Success rates for these types of fusions are typically above 90%. Special consideration should be given to patients undergoing fusion with concomitant severe hindfoot valgus, prior total ankle arthroplasty, as well as malunited talar or calcaneal fractures.