Talectomy and tibio-calcaneal fusion using Wright Ortholoc posterior TTC fusion plate
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Pes planus is the deformity of the foot characterised by loss of the medial longitudinal arch with the foot under loading. More often than not, the hindfoot also lies in valgus deriving the term pes planovalgus. Secondary features of this deformity are that there may be a compensatory supination deformity of the midfoot and the Achilles tendon tightens and effectively becomes shorter in length.
There are multiple causes of pes planovalgus that can broadly be separated into congenital (eg tarsal coalition, hypermobility syndromes) and acquired groups. In adults, acquired pes planovalgus is most often seen with posterior tibial tendon dysfunction or with inflammatory arthopathies. Careful assessment of the patient’s symptoms and signs is necessary to guide the treatment options available for each individual patient.
Talectomy and tibiocalcaneal fusion is not a common procedure for pes planovalgus. Historically, it is more often associated with the management of fixed equinovarus deformities in childhood (eg arthrogryposis, post CTEV), Charcot arthropathy or post-traumatic deformity (invariably secondary to the loss of the talus). In this particular case, a 65 year old lady with rheumatoid arthritis presented with a stiff, painful flat foot. All footwear modifications had failed to relieve her symptoms.
Author:Mr Mark Davies FRCS(Tr & Orth)
Institution: The Northern general hospital, Sheffield, UK.