[Realignment, fusion, and staple fixation of the chopart joint in neurogenic foot deformities.].

GOAL OF SURGERY

Restoration of a plantigrade foot in adolescents suffering from a neurogenic foot deformity with an important, irreversible malposition of the talocalcaneonavicular joint complex.

INDICATIONS

Severe, non reducible hindfoot deformity which cannot be corrected through soft tissue procedures alone. Important tarsal instability. Progressive forefoot deformities.

CONTRAINDICATIONS

Presence of supple club foot deformities. Severe deformities necessitating removal of a bone wedge. Important degenerative changes of the subtalar joint. Presence of skin infection or sores.

POSITIONING AND ANAESTHESIA

Supine with buttock of operated side slightly elevated. General or regional anaesthesia. Tourniquet at thigh.

SURGICAL TECHNIQUE

Two skin incisions, one overlying the talonavicular and the other the calcaneoucuboid joint. Subperiosteal dissection until both approaches meet. Arthrodesis of the calcaneoucuboid and talonavicular joints after resection of articular cartilage and correction of deformity. Temporary fixation with Kirschner wires, visual control of correction and permanent fixation with titanium staples. Long leg cast which is split immediately. Additional tendon surgery may be necessary

POSTOPERATIVE MANAGEMENT

Elevation of foot. Low molecular heparin. Well molded fibreglass cast after 2 weeks and heel added 2 weeks later. Orthopaedic shoes 10 to 12 weeks postoperatively.

POSSIBLE COMPLICATIONS

Injury of neurovascular structures. Pressure sores. Thrombophlebitis. Wound dehiscence, deep infection. Displacement or breakage of staples. Absence of bony fusion.

RESULTS

Between August 1990 and April 1993 the technique was performed 20 times in a total of 15 patients. Follow-up 14 to 36 months. A bony fusion occurred in all patients at 12 weeks. Eighteen times the functional result was good to satisfactory and these patients were free of pain. The following complications were observed: hindfoot varus (2), transient loss of sensation of foot (1), necrosis of the wound edges (2) and breakage of the staple (1).