1. Dr.Rajiv Shah
‘Foot &Ankle Orthopaedics’
Foot & Ankle Surgeon
President, Indian Foot & Ankle Society
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Aetiology
Idiopathic
Post trauma
Post polio
Primary OA
RA, Seroneg.
Neuromuscular
Nerve injury
Tarsal coalition
Flat foot

3. 3
Diagnosis
Lateral foot pain
Inability to walk on
uneven ground
Tender sinus tarsi
Decreased ROM
Stiffness
Deformity
Diagnostic
injection

4. 4
Radiology
 Ankle series
 Foot series
 Broden views
 Axial view
 Saltzmann
view
 Reduced joint
space
 Osteophytes
Post calcaneal malunion
arthritis
Loss of heel height
Loss of talar declination
Loss of longitudinal
medial arch
(RA, PTTD)

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Goals of arthrodesis
Painless
Stable
In functional position
Plantigrade foot
Position of arthrodesis
0-5 degree ankle
valgus
NeutralTN + CC joints
Forefoot - plantigrade

6. Subtalar fusion
In-situ
No deformity
No loss of height
Distraction
Loss of height
Post calcaneal or
talar body
malunion
Fusion plus
osteotomy
Associated with
deformity

7. Subtalar
fusion
No deformity
No height loss
In-situ
Varus/Valgus
Distraction
Medial/lateral
graft
Loss of height Posterior graft

8. 8
Before arthrodesis
Motion of surrounding joints
Alignment of foot & ankle
Status of soft tissue
Neurovascular status of limb
Tendoachilles tightness
Proximal joints – knee, hip, SI & spine

9. 9
Subtalar arthrodesis
 Broad, cancelleous, bleeding surfaces in
close approximation
 Rigid fixation with compression
 Drilling of subchondral bone &
feathering of surfaces
 Sos augmentation
Tips & tricks

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Subtalar arthrodesis
 Long, well planned incision
 Good soft tissue mobilization
 Care of nerves
 Gentle retraction with K-wires
Tips & tricks

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Subtalar arthrodesis
Always correct deformity,
never fuse in situ
Tips & tricks

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Subtalar arthrodesis
Alignment proceeds
proximal to distal
Tips & tricks

13. 13
Subtalar arthrodesis
Removal of bone to correct
deformity shall always
precede removal of articular
cartilage
Tips & tricks

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Subtalar arthrodesis
FHL marks limit of medial
preparation
Tips & tricks

15. 15
Subtalar arthrodesis
 Distraction with
lamina spreader
 Hinterman’s retractor
 Skin closure – may be difficult,
think before hand
Tips & tricks

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Subtalar arthrodesis
 Excised bone is used for
deformity correction in
distraction subtalar
arthrodesis
Tips & tricks

17. 17
Subtalar arthrodesis
SinusTarsi
Lateral extensile
Approaches

18. 18
Subtalar arthrodesis  Posterior
approach

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Subtalar arthrodesis + osteotomy
 Valgus (less common): transverse, easy to slide
 Varus (more common): harder to slide
 LateralTranslation
 Dwyer
 Malerba (step cut)
 InferiorTranslation: restore loss of height
 Transverse
 May need to lengthen Achilles or gastroc recession

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