1st Orthopaedic Clinic, 1St Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
BMC Musculoskelet Disord. 2010 Feb 27;11:38. doi: 10.1186/1471-2474-11-38.
The foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot deformities include talonavicular joint destruction and tibialis posterior tendon dysfunction, mainly due to its rupture.
Between 2002 and 2005 we performed isolated talonavicular arthrodesis in 26 patients; twenty women and six men. Tibialis posterior tendon dysfunction was diagnosed preoperatively by physical examination and by MRI. Talonavicular fusion was achieved via screws in eight patients, memory staples in twelve patients and a combination of screws and memory staples in six cases. The average duration of immobilization after the surgery was four weeks, followed by rehabilitation. Full weight bearing was allowed two to three months after surgery.
The mean age of the group at the time of the surgery was 43.6 years. MRI examination revealed a torn tendon in nine cases with no significant destruction of the talonavicular joint seen on X-rays. Mean of postoperative followup was 4.5 years (3 to 7 years). The mean of AOFAS Hindfoot score improved from 48.2 preoperatively to 88.6 points at the last postoperative followup. Eighteen patients had excellent results (none, mild occasional pain), six patients had moderate pain of the foot and two patients had severe pain in evaluation with the score. Complications included superficial wound infections in two patients and a nonunion developed in one case.
Early isolated talonavicular arthrodesis provides excellent pain relief and prevents further progression of the foot deformities in patients with rheumatoid arthritis and tibialis posterior tendon dysfunction.
类风湿关节炎患者常受足部影响。跗跖关节比踝关节更常受累。跗跖关节畸形常导致疼痛性扁平足和跟骨外翻畸形。导致足部畸形早期发展的主要因素包括距跟关节破坏和胫骨后肌腱功能障碍，主要是由于其断裂。
2002 年至 2005 年间，我们对 26 例患者（20 名女性和 6 名男性）进行了单纯距跟关节融合术。术前通过体格检查和 MRI 诊断胫骨后肌腱功能障碍。8 例患者采用螺钉、12 例患者采用记忆钉、6 例患者采用螺钉和记忆钉组合进行距跟关节融合。术后平均固定 4 周，然后进行康复治疗。术后 2 至 3 个月可完全负重。
该组患者的平均年龄为 43.6 岁。MRI 检查显示 9 例有肌腱撕裂，但 X 线未见距跟关节明显破坏。术后平均随访时间为 4.5 年（3 至 7 年）。AOFAS 后足评分从术前的 48.2 分平均提高到最后一次随访时的 88.6 分。18 例患者结果优良（无、轻度偶发性疼痛），6 例患者足部中度疼痛，2 例患者评分显示严重疼痛。并发症包括 2 例浅表伤口感染和 1 例骨不连。
早期单纯距跟关节融合术可缓解疼痛，并防止类风湿关节炎和胫骨后肌腱功能障碍患者足部畸形进一步发展。
