Page 22 - 2020 Summer CMTA Report

JOINT FUSION crooked foot while preserving don transfers. Since only one joint
(continued from page 21) motion. While a triple arthrodesis is fused, more motion is preserved
foot became more deformed and can be transformative, the more than would be with a triple
almost fixed in its crooked, painful motion one can keep the better. arthrodesis. The most common
position. Fortunately, he came just Anyone told they need a triple problem of any fusion surgery is
in time for his deformity to be arthrodesis should first consider a that the bones don’t fuse and a
corrected without a fusion. While second opinion with an orthope- non-union develops. Fortunately,
a fusion, if needed, would have dic foot and ankle surgeon to see that is very rare.
straightened out his crooked foot, if it can be avoided. Fusions of joints other than
the preservation of motion is Joint instability, rather than those discussed above are rarely
preferable, especially in someone deformity, is probably the most needed in CMT patients. A fusion
with so much life ahead. common reason for a fusion in my of the ankle should rarely be done,
If a fixed deformity has devel- practice. When the muscles that especially not for a drop-foot.
oped, patients can still be helped control a joint are paralyzed, the Modern ground-reaction energy-
with a triple arthrodesis, a proce- joint loses function and becomes storing braces only work when the
dure in which the three major unstable. This can happen with ankle moves. An ankle fusion
joints in the hind foot—the any joint, but it is particularly takes away the chance of ever
subtalar, talonavicular and problematic when the paralysis in using one of these braces. Only in
calcaneocuboid joints—are fused a CMT patient involves both per- rare cases of extreme deformity or
(figure 1) in a corrected position so oneal muscles. The peroneals are arthritis should an ankle fusion be
the foot is flat on the ground. It’s the muscles and tendons on the considered. Most ankle deformity
not ideal, but it’s much better than outside of the ankle that keep it can be corrected without a fusion
having a rigid foot that doesn’t lie stable and prevent it from collaps- and patients with CMT often tol-
flat and causes pain with every ing inward with each step. erate ankle arthritis quite well
step. Ankle motion is preserved Typically, the peroneus brevis because of the decreased feeling
and the patient can walk with no (PB) is weak, while the peroneus that results from the neuropathy.
obvious limp from the fusion. longus (PL) remains strong. In In summary, a fusion of one
that case, a tendon or more of the joints in the hind
transfer of the PL to foot can correct the severe defor-
the PB provides suf- mity or paralysis that causes joint
ficient lateral instability. If the surgery is done
strength and stability well, the patient will do well and
(see part 2). When may be able to get out of a brace
both muscles are completely. An ankle fusion for a
paralyzed or very drop-foot, however, should usually
weak, however, a be avoided. In that case, a ground
subtalar fusion may reaction brace will provide better
be the best option. function. h
Only one joint is In the final part of our four-part
fused—the one series, we will discuss the surgical
comprising the talus correction of crooked toes.
and calcaneus. One
Figure 2: A subtalar fusion fuses only one joint. or two screws are
used to stabilize the On a personal note, I want
to thank all of my patients.
The good news is that a triple fusion (figure 2). This provides I dislocated my ankle on Easter,
arthrodesis is rarely needed any- complete stability to the hind foot broke three bones, and required
more, especially in people under and prevents the foot from con- surgery. In my darkest hours,
your examples of bravery and
30. It seems like the word that stantly twisting inward while
perseverance gave me strength.
early intervention can prevent walking. Some of my happiest I’m still improving but back to
more serious problems is getting patients have had a subtalar work with three CMT surgeries
this week. Stay safe out there.
out. The procedures discussed in fusion, especially when combined
—Glenn
parts 1 and 2 in the previous two with soft tissue releases and ten-
CMTA Reports will balance a
Follow Dr. Pfeffer on Instagram at @Charcotmarietoothsurgery.

22 THE CMTA REPORT SUMMER 2020