The Grice procedure: indications and evaluation of long-term results.

The major indication for the Grice extra-articular subtalar arthrodesis is valgus deformity occurring after poliomyelitis. Unsatisfactory long-term results in valgus deformities secondary to other neuromuscular conditions, myelodysplasia and flexible flat feet would indicate that subtalar arthrodesis is not appropriate in these conditions. The Grice procedure had limited success in patients with cerebral palsy, but only in those mildly afflicted with hemiplegia. With the eclipse of poliomyelitis by other neuromuscular conditions, the extra-articular would appear to have limited indications in modern orthopedic practice. Technical complications surely predispose to poor results and considerable attention must be placed on proper graft position and immediate revision in the event of slippage. Overcorrection into adductovarus and particularly ankle valgus from ankle instability is an important cause of unsatisfactory results. The Grice procedure may provide temporary benefits in certain valgus feet. A significant number of patients subsequently required triple arthrodesis and, although it might be argued that some did obtain temporary benefit at a younger age with the Grice procedure, this operation cannot be construed as an alternative to triple arthrodesis. Furthermore, exactly what significance and symptomatic developments can be attributed to the radiologic degenerative changes to subtalar arthrodesis remains to be delineated by longer follow-up studies.