الفهرس 
Anatomy of the foot and ankleOnly 14 pages are availabe for public view
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Abstract
One of the most common foot complains in the adolescent age group is the flat-foot deformity. Clinical evaluation of flat-foot primarily depends on differentiation between the two main types: the flexible and the rigid types. The optimal management of the flat-foot problems requires careful assessment of the deformity. It is essential to recognize the location and degree of mal-alignment. For patients with a flexible flat-foot, usually not problematic and rarely needs treatment, various soft tissue procedures and bony osteotomies may be used to restore alignment while preserving joint motion. However, for patients with a rigid deformity, such procedures are indicated less often, and arthrodesis is usually necessary.
Triple arthrodesis is a powerful and reliable procedure for stabilization and correction of painful rigid flat-foot deformities with a low rate of complications. The ability to achieve a stable and corrected hind-foot alignment is closely associated with patient outcomes and therefore careful patient selection and pre-operative evaluation are critical to achieve a successful result. To date, this procedure is highly successful in correcting deformity and relieving both mechanical and arthritic pain.
Many approaches had been described in the literature either through a lateral incision or through a medial incision, but the approach of choice to provide a good exposure to all the three joints (the calcaneo-cuboid, the talonavicular and the subtalar joints) is the combination of a lateral sinus tarsi incision, which allows exposure of the subtalar joint, calcaneo-cuboid joint and lateral aspect of the talonavicular joint, and a medial incision, which provides exposure of the talonavicular joint.
The aim of this study was to evaluate the clinical, functional and radiological outcome of triple arthrodesis for the treatment of symptomatic rigid flat-foot deformity in adolescent patients.
A prospective study on 16 feet of 16 patients underwent triple arthrodesis procedure for symptomatic rigid flat-foot in adolescent‟s patients. The mean age was 16.5 ± 1.71 (range, 14 – 19) years. All patients in this study were males. Eight (50%) patients were operated on right side and eight (50%) on left and their mean follow-up period was 6 months.
The inclusion criteria were: Painful idiopathic rigid flat-foot in adolescent age group (from ten to nineteen years old), chronic hind-foot pain with associated primary degenerative disease involving multiple hind-foot joints and symptomatic unresectable tarsal coalition.
The exclusion criteria were: Flexible flat-foot, neurovascular problems, advanced tibialis posterior dysfunction, active infection, severe peripheral vascular disease, non-cooperative and mentally unstable patients.
They were evaluated clinically by the AOFAS. Pain was evaluated by VAS. Radiological evaluation was made by the AP T1stMTA, Ap TNCA, Lat T1stMTA and Lat CPA pre and post-operatively.
The mean AOFAS was improved from 37 ± 4.32 (range, 30 – 47) to 89.19 ± 2.17 (range, 84 – 91). The mean VAS was improved from 9.19 ± 0.66 (range, 8 – 10) to 0.5 ± 0.73 (range, 0 – 2). Radiographic criteria revealed improvement and statistically significant difference. On the Lat view, the mean Lat CPA was improved from 8 ± 2.1 (range, 5 - 12) ° to 12.88 ± 1.86 (range, 9 - 16) ° with mean correction 4.88°, the mean
Summary
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Lat T1stMTA was improved from 10.88 ± 3.5 (range, 6 - 18) ° improved to 4.06 ± 1.34 (range, 2 - 7) ° with mean correction 6.82 °. On the AP view, the mean AP TNCA was improved from 14.5 ± 7.28 (range, 9 - 32) ° to 1.19 ± 0.75 (range, 0 - 2) ° with mean correction 13.31°, the mean AP T1stMTA was improved from 15.44 ± 4.18 (range, 11 - 25) ° improved to 2.88 ± 1.31 (range, 1- 5) ° with mean correction 12.56 °. The degree of satisfaction was evaluated regarding Scoring System by Coughlin, thirteen (81.2%) patients were excellent and three (18.8%) were good.
Post-operative complications were few. There were two (12.5%) patients with wound dehiscence on the lateral wound, one (6.25%) superficial infection on the lateral wound and lastly three (18.75%) post cast ankle stiffness.