Alkaramany Eslam, Gallagher Brian P, Abbasi Pooyan, Guyton Gregory P
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
Foot Ankle Int. 2025 Sep;46(9):1025-1029. doi: 10.1177/10711007251344916. Epub 2025 Sep 16.
Previous investigations have speculated that stiffening the lateral column of the hindfoot in triple arthrodesis can increase lateral plantar pressure with resulting lateral column pain. It is unclear whether sparing of the calcaneocuboid joint in hindfoot arthrodesis yields lower lateral column plantar forefoot pressures vs triple arthrodesis including the calcaneocuboid joint.
Tendon loading and axial pressure were applied to 9 cadaveric legs according to standard cadaveric models. Medial and lateral forefoot pressures were recorded using a pressure-sensitive plate. Specimens were tested in native state, after sequential subtalar and talonavicular fixation, and after added calcaneocuboid fixation. All fixation was performed in situ in a neutral foot position. Testing was performed both on a neutral sensor plate and on a plate with 10 degrees of lateral slope.
In neutral position, pressure under the fifth metatarsal increased significantly from 31.0 ± 22.4 kPa in the native state to 63.1 ± 33.0 kPa ( = .018) after CC-sparing fusion and to 54.7 ± 27.9 kPa ( = .023) after triple arthrodesis. In the everted position, there was no significant difference in pressure under the fifth metatarsal from 56.8 ± 31.8 kPa in the native state to 89.7 ± 55.4 kPa ( = .134) after CC-sparing fusion and to 78.9 ± 42.9 kPa ( = .111) after triple fusion. No statistically significant pressure differences under the fifth metatarsal were found between the arthrodesis groups with loading on a neutral ( = .687) or sloped ( = .393) surface.
In our in situ fusion cadaveric model, both traditional triple arthrodesis and the calcaneocuboid-sparing procedure resulted in significantly higher lateral forefoot plantar pressure compared with the native state, but there was no significant difference in lateral pressure between the procedures on both a flat and a laterally inclined surface. These findings should be interpreted in light of limitations including small sample size, static loading conditions, intact cartilage, and lack of formal radiographic assessment of hindfoot alignment.
Although other considerations may warrant sparing the calcaneocuboid joint during hindfoot fusion, its preservation did not reduce lateral column overload in this model.
以往的研究推测，在三关节融合术中使后足外侧柱变硬会增加足底外侧压力，从而导致外侧柱疼痛。目前尚不清楚在后足融合术中保留跟骰关节与包括跟骰关节的三关节融合术相比，是否会使前足外侧柱足底压力更低。
根据标准尸体模型，对9条尸体下肢施加肌腱负荷和轴向压力。使用压敏板记录前足内侧和外侧压力。在标本处于自然状态、依次进行距下关节和距舟关节固定后以及增加跟骰关节固定后进行测试。所有固定均在足部中立位原位进行。测试在中立传感器板和具有10度外侧倾斜度的板上进行。
在中立位，第五跖骨下方的压力从自然状态下的31.0±22.4kPa显著增加到保留跟骰关节融合术后的63.1±33.0kPa（P = 0.018）和三关节融合术后的54.7±27.9kPa（P = 0.023）。在外翻位，第五跖骨下方的压力从自然状态下的56.8±31.8kPa到保留跟骰关节融合术后的89.7±55.4kPa（P = 0.134）和三关节融合术后的78.9±42.9kPa（P = 0.111）无显著差异。在中立（P = 0.687）或倾斜（P = 0.393）表面加载时，融合术组之间第五跖骨下方未发现统计学上显著的压力差异。
在我们的原位融合尸体模型中，与自然状态相比，传统的三关节融合术和保留跟骰关节的手术均导致前足外侧柱足底压力显著升高，但在平坦和外侧倾斜表面上两种手术之间的外侧压力无显著差异。这些发现应结合包括样本量小、静态加载条件、软骨完整以及缺乏后足对线的正式影像学评估等局限性来解释。
尽管在进行后足融合术时可能有其他考虑因素需要保留跟骰关节，但其保留在本模型中并未减轻外侧柱过载。
