Treatment of the Arthritic Valgus Ankle
Section snippets
Ankle Alignment
The alignment of the hindfoot can be divided into 3 anatomic aspects: supramalleolar, tibiotalar (orientation of the line of the tibiotalar joint), and inframalleolar.1, 2, 3, 4, 5, 6, 7, 8 The medial distal tibial angle (MDTA) is used to quantify supramalleolar alignment. In a radiographic study9 it measured 92.4 ± 3.1° (range 88–100°) and in a cadaver study it measured 93.3 ± 3.2° (range 88–100°).10 The mortise view should be used for measurements of the MDTA because it depends on
Treatment options in the arthritic valgus ankle
Patients with an arthritic valgus ankle should be individually assessed and all concomitant pathologic conditions should be considered and addressed if necessary. Examples include: deltoid ligament insufficiency, dysfunction of the posterior tibial tendon, contracted heel cord, osseous deformities and/or defects of the distal tibia, shortening and/or deformity of the fibula, and inframalleolar deformities. Given the wide range of potential concomitant pathologic conditions, a generic approach
Literature review: TAR experience in patients with valgus deformity
The first clinical report addressing the feasibility and clinical outcomes of TAR recognized preoperative varus or valgus deformity as a possible source of prosthesis failure. Newton93, 94 performed 50 TAR procedures using the Newton Ankle Implant (a nonconstrained cemented prosthesis including high density polyethylene tibial and Vitallium talar components). Valgus or varus deformity of the talus greater than 20° was noted as an absolute contraindication for TAR.93, 94 In a later study,95
Summary
A clinically and radiologically well-aligned hindfoot and proper position of prosthesis components are the keys to long-term prosthesis stability and reliable functional outcomes in patients who undergo TAR. In patients with preoperative coronal deformities (valgus or varus), alignment and biomechanics should be restored. Our clinic typically strives to obtain a medial distal tibial angle of 90° and neutral inframalleolar alignment (as assessed using the Saltzman view). A moderate preoperative
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Outcomes of Total Ankle Replacement with Preoperative Varus Deformity
2024, Foot and Ankle ClinicsImaging of the Ankle Ligaments and Cartilage Injuries as an Aid to Ankle Preservation Surgery
2023, Seminars in Ultrasound, CT and MRICorrection of the Valgus Ankle with a Joint Sparing Supra-Malleolar Osteotomy: The Modified Wiltse Technique
2022, Foot and Ankle ClinicsJoint Preserving Surgery for Valgus Ankle Osteoarthritis
2022, Foot and Ankle ClinicsCitation Excerpt :In JPS, it is very important to appropriately analyze the etiology and biomechanics of the case since neglecting or not recognizing all pathobiomechanical issues might deteriorate the condition and lead to end-stage ankle OA in the long-term.4,5 Valgus ankle OA can be classified based on the clinical etiology, level of deformity, severity, and tissue initiating the deformity (eg, bone, ligament, muscle, or combined).2,3,6 Regarding the clinical etiology grouping, the most common cause of ankle OA is posttraumatic (80% of cases) and often due to lower leg fractures.
The authors have nothing to disclose.