Treatment of 2nd stage posterior tibial tendon deficiency (PTTD)

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Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154

228 Total ankle arthroplasty combined with subtalar arthrodesis for the patient with rheumatoid arthrit H. Kurokawa ∗ , Y. Tanaka, S. Morita, A. Taniguchi, T. Kumai Department of Orthopaedics. Nara Medical University, Japan Introduction: Patients with rheumatoid arthritis(RA) often have degenerative changes in the tibiotalar and the talocalcaneal joints simultaneously. This study evaluated the clinical and radiographic outcomes after total ankle arthroplasty (TAA) with and without talocalcaneal arthrodesis. Methods: Twenty patients suffering from RA were involved in this study. Eleven patients were treated by TAA combined with talocalcaneal arthrodesis (TC fusion group), and nine patients were treated only by TAA(conventional TAA group). The mean followup periods were 69 and 60 months respectively. Clinical outcomes were investigated using subjective scoring system(The Japanese Society for Surgery of the Foot; JSSF scale) and objective questionnaire(Ankle Osteoarthritis Scale; AOS). Alignment of the implant was investigated using radiography, and ranges of motion (ROM) of the ankle were measured by the goniometer. Results: The varus inclination angle of the tibial component increased 2.4◦ in TC fusion group since just after the operation, that was significantly larger than that of conventional TAA group (0.8◦ ). Changes of opening angle of the tibial component and ROM didn’t show the significant difference between two groups. At the final follow-up, JSSF scale in TC fusion group were 77 respectively, and those in conventional TAA group were 84, those were significantly improved compared with preoperative scores. Conclusions: Clinical results improved in both groups at the final follow-up, however varus inclination increased in TC fusion group, that would be caused by the loss of subtalar motion. http://dx.doi.org/10.1016/j.fas.2017.07.317

229 Non-radiographic measurement of hallux valgus angle using self-photography S. Yamaguchi 1,∗ , Seiji Kimura 2 , R. Nakagawa 2 , A. Sadamasu 2 , R. Akagi 2 , Y. Sato 3 , T. Sasho 4 , S. Ohtori 2 1 College of Liberal Arts and Sciences, Chiba University, Japan 2 Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan 3 Chiba University Hospital Clinical Research Center, Japan 4 Center for Preventive Medical Sciences, Chiba University, Japan

Introduction: The purposes of this study were to clarify (1) the hallux valgus angle measurement repeatability using selfphotography of the feet (pHVA), (2) the repeatability of the self-photography, and (3) the association between the pHVA and the hallux valgus angle measured using radiography (rHVA). Methods: Subjects took photographs of their own feet using a digital camera. pHVA was measured with the contour of the foot on the photograph. Subjects also underwent radiography of their feet, and the rHVA was measured. The intra-and interobserver

repeatability of the pHVA measurements made by 2 examiners was assessed. The subjects took the photographs twice, and the repeatability of self-photography was examined. Furthermore, the association between the pHVA and rHVA was assessed using single linear regression and multiple linear regression models. Results: One hundred feet of 50 asymptomatic subjects and 225 ft of 127 symptomatic subjects were enrolled. The intra- and interobserver repeatability of the pHVA measurement was almost perfect. The 95% minimum detectable change values were less than 2◦ . The repeatability of self-photography was also almost perfect, and the minimum detectable change value was 6.3◦ . pHVA was significantly associated with rHVA (R2 = 0.88, p < 0.001), although the pHVA was lower than the rHVA by 5.0◦ . Furthermore, body mass index and age, as well as pHVA, were independent predictors of rHVA. Conclusions: Measurement of pHVA using self-photography was highly reproducible, and the pHVA was significantly associated with the rHVA. pHVA can be a useful non-radiographic method to quantify hallux valgus deformity. http://dx.doi.org/10.1016/j.fas.2017.07.318

230 Treatment of 2nd stage posterior tibial tendon deficiency (PTTD) M. Napiontek ∗ , T. Jaszczak Ortop Poliklinika, Poland Introduction: This study aims to analyse the outcomes of lateral column lengthening by opening wedge osteotomy of the calcaneus combined with posterior tibial tendon reconstruction in adults with PTTD and as well influence of this method on deformity correction, pain relief and subtalar range of motion. Materials and methods: Nine patients (9 ft, 8 females and 1 male) with the 2nd stage of PTTD according to Bluman’s classification were included in to the study. Age at operation ranged from 47 to 69 years (mean 52). Operative technique consists of: 1. Lengthening of gastrocnemius. 2. Opening wedge osteotomy of anterior part of calcaneus. 3. Tendon plasty of posterior tibial muscle by suturing and connecting with FDL, Z-plasty shortening or split plasty. 4. Lack stabilisation of the foot by plates, screws or K wires were. Follow-up ranged from 12 to 42 months (mean 24). The assessment of all feet based on modified AOFAS and subjective scale. Results: In all patients pain relief as well full correction of the valgus and abduction deformity were observed and confirmed both scales. Additionally preservation of the foot function (positive heel rising test) was noted. This type of osteotomy caused diminished ROM of subtalar joint. On X-rays full bone healing and restoration of radiographic parameters were observed. Conclusions: Opening wedge osteotomy of the calcaneus combined with gastrocnemius lengthening and posterior tibial tendon plasty in 2nd stage of PTTD improved clinical and radiographic correction. This technique can be used without fixed implants and temporary K-wires stabilization. http://dx.doi.org/10.1016/j.fas.2017.07.319