TITLE:
Double Arthrodesis, Postero-Medial Release and Posterior Tibial Transfer in One Step in Paralytic Inveterate Equine Varus Foot
AUTHORS:
Kalifa Coulibaly, Cheick Oumar Sanogo, Sory Ibrahim Tambassi, Aboubacar Diallo, Soumana Traore, Laye Toure
KEYWORDS:
Arthrodesis, Foot, Ankle, Posterior Tibial Muscle, Equine Varus
JOURNAL NAME:
Surgical Science,
Vol.14 No.2,
February
23,
2023
ABSTRACT: Introduction: Varus equine foot deformity is common in developing countries. The
management of these deformities is surgical in adults. Several surgical
techniques have been described with more or less satisfactory results. To our
knowledge, no study has been performed on the simultaneous association of
double arthrodesis, posteromedial release, and posterior tibial transfer in a
single operation in inveterate paralytic varus equines feet. The purpose of
this work was to evaluate the results obtained. Patients and Method:
This was a retrospective descriptive study from January 01, 2018 to December
31, 2021. It concerned inveterate paralytic varus equines feet operated on by
the simultaneous association in a single
operative time of double arthrodesis of the foot, posteromedial release
of the back foot and transfer of the posterior tibial muscle to the lateral
cuneiform. We identified seven patients with a mean age of 22.1 years with
extremes of 11 years and 36 years. There were three males and four females. The
cause of the deformity was neurological in all cases. All patients had painful
walking discomfort and shoeing difficulties. The average time to management was 13.3 years with extremes of
4 and 25 years. The chronology of the interventional steps was posteromedial
release, arthrodesis, and transfer of the posterior tibial muscle to the
lateral cuneiform. The average postoperative follow-up was 21.7 months with
extremes of 6 and 48 months. The parameters studied were the duration of the
procedure, complications related to the procedure, muscle strength at the last
recoil, consolidation of the arthrodesis, residual pain, patient activity, gait
perimeter, stepping, ankle mobility, residual deformity, footwear, protrusion
of the transferred tendon, and the possibility of walking on the heel. Final
results were graded according to the Angus and Cowell criteria. Results:
No intraoperative complications were noted. An early superficial infection of
the surgical site was noted. It was treated with local care and healed without
sequel. Residual pain was present in one case. Tibiotalar osteoarthritis was
observed in one case, which required a tibiotalar arthrodesis. At the last
follow-up, consolidation of the arthrodesis was effective in all patients. The
posterior tibial muscle was side 5 (n = 4) and 4 (n = 3). The patients’
activity was normal without assistance in
all cases. The walking perimeter was greater than 1 km in six patients. Patient
activity was normal without assistance in all cases. Stepping was absent in all
patients. No difficulty with footwear was noted. According to the Angus and
Cowell criteria, the result was good (n = 6), i.e. 85.7% and bad (n = 1), i.e. 14.3% of cases. Conclusion: This study suggests that
double arthrodesis associated with posteromedial release and transfer of the
posterior tibial in one step in inveterate
paralytic varus equines feet, gives satisfactory results. It allows for easy
shoeing and plantigrade walking without stepping. Complications are essentially
represented by the absence of fusion of the arthrodesis and tibiotalar
arthrosis.