Posttraumatic corrective surgery on the foot

Posttraumatic Deformity Correction at the FootH. Zwipp 1

, S. Rammelt1

1
Department of Trauma and Reconstructive Surgery, University Hospital "Carl Gustav Carus" Dresden University of Technology

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Summary
Correction whose foot deformities arise on the one hand by overlooked or inadequately supplied foot injuries, on the other
hand after complicated postoperative courses with avascular bone necrosis, absence of bone healing or infection. In order to
obtain a maximum gain of function, the indication for correction operation prior to the occurrence of arthritis connection of
adjacent joints must be provided. Arthrodesis should be limited to the immediately affected joint.Especially with deformities
of the talus is in principle first to seek a joint-preserving correction. In severe in Translation laterally healed calcaneal a
corrective along the former fracture line should in addition to reorientierenden subtalar arthrodesis done.Correction
operations at the level of Chopart and Lisfranc joint must restore the pillars statics of the foot. Deformities of the metatarsals
and toes to be corrected in symptomatic axis deviations. This paper provides an overview of corrective surgery for post-
traumatic deformities of the individual areas of the foot. For the talus and calcaneus correction options are presented using a
therapy relevant classification.

Abstract
Posttraumatic foot deformities requiring correction result from overlooked or inadequately treated injuries and, on the other
hand, from protracted courses because of avascular necrosis, non-union or infection after primary surgery. To achieve a
maximum benefit, corrective surgery has to be carried out early before arthritic involvement of adjacent joint becomes
evident. As salvage procedures, arthrodeses should be restricted to the affected joints. Especially talus malunion and non-
union should be corrected with preservation of the joints whenever possible to achieve favourable functional outcomes. In
case of calcaneal malunion with consequential lateral translation a reorientating subtalar arthrodesis should be supplemented
by corrective osteotomy of the fracture line. Corrections at the level of Choparts and Lisfrancs (mid-tarsal and
tarsometatarsal) joints must restore the exact relationship between the medial and lateral foot columns. Malunions of the
metatarsals and toes are corrected in cases of symptomatic malalignment. This paper reviews corrective procedures for
posttraumatic deformities at the different foot regions. A therapy-based classification for mal-unions of the talus and
calcaneus is proposed.

key words
Fraktur fehlverheilt - Pseudarthrose - Talus - Kalkaneus - Chopart - Lisfranc - Korrekturoperation - Arthrodese

Key words
Fracture malunion - non-union - talus - calcaneus - mid-tarsal joint - tarsometatarsal joint - deformity correction - arthrodesis

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