Changes in the subtalar joint alignment after supramalleolar osteotomy for varus ankle arthritis

BackgroundThe subtalar joint may compensate for tibio-talar deformity, but what would happen to the joint after the deformity was corrected is not well known. Supramalleolar osteotomy (SMOT) is an effective procedure for the treatment of varus deformity of ankle arthritis. The objective of this study was to investigate the subtalar joint alignment pre and postoperatively following SMOT, and the factors which influenced the alignment of the subtalar joint.MethodsThirty-one patients with varus ankle arthritis (Takakura stage 2, 3a and 3b) who were treated using SMOT were retrospectively reviewed. The subtalar and ankle joint alignment was measured on weightbearing radiograph and weightbearing computerized tomography (WBCT).ResultsThe foot and ankle offset (FAO), tibial articular surface angle (TAS), tibio-talar surface angle (TTS), and subtalar vertical angle (SVA) were significantly corrected (P＜0.05). The subtalar inclination angle (SIA) decreased in 19 patients and increased in the other 12 cases after the SMOT (P＜0.001). The shift of subtalar joint (ΔSIA) showed an inverse correlation with the preoperative FAO (P＜0.001, r = −0.621).ConclusionsThe shift of subtalar joint after SMOT could maintain the neutral position of the hindfoot and showed a negative correlation with the preoperative FAO. The ΔSIA was greater in the severer preoperative hindfoot deformity.Level of evidenceLevel IV, case series.     

Lower limb alignment in patients with primary valgus ankle arthritis: A comparative analysis with patients with varus ankle arthritis and healthy controls

BackgroundWhile it is commonly acknowledged that the combined effect of lower limb orientation and ankle and hindfoot alignment play a fundamental role in ankle arthritis, supramalleolar/lower limb alignment has received less attention in valgus ankle arthritis. The purpose of this study was to analyze the lower limb alignment of patients with valgus ankle arthritis with primary origin, compared to that of varus ankle arthritis and normal controls. We hypothesized that patients with valgus ankle arthritis would have the opposite pattern of lower limb alignment as those with varus ankle arthritis.MethodsA retrospective radiographic analysis was performed on 61 patients (62 ankles, mean age, 59.3 ± 12 years) with primary valgus ankle arthritis. On preoperative radiographs, seven parameters, including talar tilt angle, medial distal tibial angle (MDTA), talar center migration, anterior distal tibial angle, talo-first metatarsal (Meary's) angle, hindfoot moment arm (HMA), and mechanical axis deviation (MAD), were measured and compared to those of primary varus ankle arthritis (n = 55; mean age, 59.7 ± 8.1 years) and control patients (n = 59; mean age, 29.3 ± 7.3 years).ResultsThe valgus group had a significantly lower mean MDTA than the control group (p < 0.0001), indicating a varus distal tibial plafond in comparison to the control group. Meary's angle and HMA were significantly lower in the valgus group compared to the varus group (p < 0.05 and p < 0.0001, respectively), indicating a lower medial longitudinal arch and valgus hindfoot alignment. On whole limb radiographs, the valgus group showed a greater MAD than the control group, indicating varus lower limb alignment (p < 0.05). However, the MAD did not differ significantly between the valgus and varus groups (p = 0.7031).ConclusionOur findings indicate that a significant proportion of ankles with primary valgus arthritis have a varus tibial plafond and a varus lower limb mechanical axis. This study contributes to our understanding of primary valgus ankle arthritis and suggests that lower limb alignment should be analyzed and considered throughout valgus ankle arthritis realignment procedures.     

Secondary surgery after total ankle replacement: The influence of preoperative hindfoot alignment

The aim of this study was to evaluate the need for secondary surgery in total ankle replacement (TAR) in ankles with hindfoot malalignment.MethodsOne hundred and ninety-six ankles (186 patients) underwent ankle arthroplasty. The mean follow up was 4.2 years. Preoperative hindfoot alignment was measured and revisions or reoperations were analysed.ResultsThere were 41 revisions (21%). The most common reasons for revision were instability (13), aseptic loosening (11) and technical errors (8). In the preoperative varus group the revision rate was 31% and in the valgus and neutral groups 17%, respectively. The results improved with time and experience.ConclusionThe demands in the TAR procedure are much higher in preoperatively varus malaligned ankles and the need to accomplish alignment at the prime operation is crucial. The surgery is challenging and has a long learning curve and should be performed by experienced foot and ankle surgeons.     

Eccentric ankle arthritis in the sagittal plane: a novel description of anterior and posterior ankle arthritis

BackgroundTo report radiographic characteristics of anterior and posterior ankle arthritis, which demonstrates the eccentric narrowing of either aspect of the tibiotalar joint in the sagittal plane.MethodsRadiographic analysis of 19 ankles with anterior arthritis and 16 ankles with posterior arthritis was performed, which were defined as having both (1) eccentric narrowing of the anterior or posterior tibiotalar joint space on lateral radiographs and (2) talar tilt angle less than 4 degrees on anteroposterior radiographs. Measured radiographic parameters were: Talar tilt angle, medial distal tibial angle (MDTA), talar center migration (TCM), anterior distal tibial angle (ADTA), tibial axis-to-talus ratio (TT ratio), talo-first metatarsal (Meary) angle, hindfoot alignment angle (HAA), hindfoot moment arm, and mechanical axis deviation (MAD). An Intergroup comparison analysis, including a normal control group, was also performed.ResultsThe TT ratio was significantly different between each group, indicating a distinct talus position in the sagittal plane. The anterior group had a significantly larger TCM than the control group and lower ADTA compared to other groups, indicating medial translation of the talus and anterior opening of the tibial plafond. The posterior group demonstrated a significantly higher Meary angle and lower HAA compared to other groups and lower MDTA compared to the control group, indicating lower medial longitudinal arch, valgus heel alignment, and varus tibial plafond. The MAD was significantly higher in both the anterior and posterior groups than the control group, indicating varus lower limb alignment.ConclusionAnterior ankle arthritis demonstrated anteromedial translation of the talus and anterior opening of the tibial plafond. Posterior ankle arthritis was associated with the lower medial longitudinal arch and hindfoot valgus, indicating an association with flatfoot deformity. Both anterior and posterior ankle arthritis were associated with varus lower limb alignment.     

The use of three-dimensional biometric Foot and Ankle Offset to predict additional realignment procedures in total ankle replacement

BackgroundDecision to perform associated corrective alignment procedures in patients undergoing total ankle replacement (TAR) is commonly made intraoperatively. The Foot and Ankle Offset (FAO) can evaluate multiplanar deformity and be an effective instrument in surgical planning. This study objective was to assess the ability of this tool to predict the need for additional realignment procedures at the time of TAR.MethodsIn this retrospective study, we enrolled 21 patients who underwent TAR and had preoperative WBCT studies. Two independent and blinded observers calculated the preoperative FAO using dedicated software. FAO measurements were compared between the different alignment groups (physiological alignment, valgus and varus). A multivariate regression analysis was used to assess the correlation between performed realignment procedures and FAO values.ResultsMean preoperative FAO was 4.4% (95%CI = 1.4–7.5). The number of osseous realignment procedures needed was found to correlate positively and significantly with FAO (p = .001). The number of osseus procedures needed was significantly higher in patients with valgus malalignment (p = .009). Patients with valgus malalignment needing a medial column procedure had a relative risk of 6.3 when compared to varus malalignment patients (p = .02).ConclusionThe number of additional bony realignment procedures performed at the time of TAR significantly correlated with preoperative FAO and that the number of osseus procedures needed was significantly higher in patients with valgus malalignment. Such biometric tools may enhance the preoperative assessment and surgical planning for patients undergoing TAR, with the potential to optimize surgical outcomes.     

Incidence of ankle arthrodesis and total ankle replacement between 1997 and 2018: A nationwide registry study in Finland

BackgroundSurgical treatment options for end-stage ankle osteoarthritis (OA) include ankle arthrodesis (AA) and total ankle replacement (TAR). We investigated the national incidence of AA and TAR and assessed trends in the surgical management of ankle OA in Finland between 1997 and 2018.MethodsThe Finnish Care Register for Health Care was used to calculate the incidence of AA and TAR based on sex and different age groups.ResultsThe mean age (SD) of patients was similar, 57.8 (14.3) years for AA and 58.1 (14.0) for TAR. TAR showed a 3-fold increase from 0.3 per 100 000 person-years in 1997 to 0.9 per 100 000 person-years in 2018. The incidence of AA operations decreased during the study period from 4.4 per 100 000 person-years in 1997 to 3.8 per 100 000 person-years in 2018. TAR utilization increased notably at the expense of AA between 2001 and 2004.ConclusionTAR and AA are both widely used procedures in the treatment of ankle OA, with AA being the favored option for most patients. The incidence of TAR has remained constant for the past 10 years, indicating appropriate treatment indications and utilization.     

Preoperative incongruent subtalar joint predicts less favorable clinical outcome in total ankle arthroplasty

BackgroundThis study aimed to determine the clinical effect of incongruent subtalar joint space on total ankle arthroplasty (TAA).MethodsThirty-four consecutive patients who underwent TAA were grouped according to the status of subtalar joint incongruency. A comparison of clinical and radiographic parameters between groups as well as multiple regression analysis was performed to identify contributing factors to the final functional outcome.ResultsThe final American Orthopaedic Foot and Ankle Society (AOFAS) score was significantly higher in the congruent group compared to that of the incongruent group (p = 0.007). There were no significant differences between the two groups in measured radiographic angles. In multiple regression analysis, the female sex (p = 0.006) and incongruency of the subtalar joint (p = 0.013) were found to be significant contributing factors to the final AOFAS score.ConclusionsA thorough preoperative investigation should be taken into the state of the subtalar joint for TAA.     

Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis

BackgroundThis pilot study investigated whether semi-rigid and soft orthoses had an effect on pain, disability and functional limitation in participants with chronic rheumatoid hindfoot involvement.MethodsParticipants with chronic hindfoot pain were randomly assigned to 2 groups, commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses. The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention, which lasted for 3 months. Following a 2 week washout period, each group was switched over to the other type of orthoses.ResultsNine female participants (mean age 52.2 years (SD 9.1); mean weight 71 kg (SD 12.64); mean height 160 cm (SD 5.18)) with a mean RA duration of 11.7 years (SD 7.83), and a mean ankle/subtalar joint pain duration of 5.7 years (SD 2.62), completed the programme. Mean improvement in FFI score for both orthoses resulted in the same statistical significance (p = 0.001). Statistically significant reduction in pain, disability and functional limitation was observed for both interventions, together with improvement in the Ritchie Articular Index score.ConclusionBoth Subortholene and EVA orthoses significantly reduced pain, disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis.     

Effect of Total Knee Arthroplasty on Coronal Alignment of the Ankle Joint

BackgroundThe effect of total knee arthroplasty (TKA) on the ankle joint is not entirely clear. The purpose of this study is to assess postoperative changes in the coronal alignment of the ankle joint in patients undergoing TKA for various degrees of knee deformity.MethodsThis retrospective study included 107 patients who had undergone TKA for primary osteoarthritis. In all cases, preoperative coronal alignment deformity of the knee was corrected in an attempt to restore the native mechanical axis of the knee. Patients were stratified into 3 groups according to the degree of knee coronal alignment correction achieved intraoperatively: group 1 (<10° varus/valgus correction, n = 60), group 2 (≥10° varus correction, n = 30), and group 3 (≥10° valgus correction, n = 17). Knee/ankle alignment angles were measured on full-length, standing anteroposterior imaging preoperatively and postoperatively and included the following: hip-knee-ankle angle, tibial plafond inclination (TPI), talar inclination (TI), and tibiotalar tilt angle.ResultsSignificant changes in ankle alignment, specifically with regard to TPI (9.5° ± 6.9°, P < .01) and TI (8.8° ± 8.8°, P = .03) were noted in the ≥10° valgus correction group compared to the other 2 groups. Regardless of the degree of knee deformity correction, TKA did not lead to significant changes in the tibiotalar tilt angle.ConclusionA correction of ≥10° in a genu valgum deformity can affect ankle joint alignment, leading to alterations in TPI and TI. These findings need to be taken into consideration in assessing candidates for TKA as a possible cause of postoperative ankle pain.     

Computer-assisted surgery (CAS) based correction of posttraumatic ankle and hindfoot deformities—Preliminary results

The first clinical experiences with a computer assisted surgery based (CAS) guided correction arthrodeses at ankle, hindfoot and midfoot were evaluated.MethodsTime spent, accuracy, surgeons’ rating (Visual Analogue Scale [VAS], 0–10 points) were analyzed. The accuracy was assessed by ISO-C 3D (Siremobile™, Siemens, Germany).Results10 patients were included (ankle, n = 3; subtalar joint, n = 6; ankle and subtalar joint, n = 2; Lisfranc joint, n = 1). Time needed for preparation was 500 s (400–900). The correction process took 45 s (30–60). All angles/translations were achieved as planned before surgery (≤ ±1°/±1 mm). The ratings of the three involved surgeons were: feasibility, 9.5 (9–10); accuracy 9.8 (9.5–10); clinical benefit 9 (8–10).ConclusionsCAS guided correction of posttraumatic deformities of the ankle and hindfoot region provides very high accuracy and a fast correction process. The significance of the introduced method may be high in those cases, because the improved accuracy may lead to an improved clinical outcome.     

Linear mixed modeling on the effects of varus knee surgery on the ankle joint weight-bearing axis

BackgroundVarus knee correction may affect the ankle and subtalar joints and impact the prognosis of ankle arthritis because the weight-bearing load on the lower extremity extends from the hip to the foot. We aimed to evaluate the changes in the mechanical axis and the weight-bearing axis of the ankle after varus knee surgery.MethodsPatients with a varus knee were followed up after undergoing high tibial osteotomy or total knee replacement arthroplasty. The inclusion criteria were age (>18 years) and a history of preoperative and postoperative scanograms. The postoperative change to the ankle joint axis point on the mechanical axis and weight-bearing axis according to the hip–knee–ankle angle correction was adjusted by multiple factors using a linear mixed model.ResultsOverall, 257 limbs from 198 patients were evaluated. The linear mixed model showed that the change in the ankle joint axis point on the mechanical axis was not statistically significant after high tibial osteotomy and total knee replacement arthroplasty (p = 0.223). The ankle joint axis point on the weight-bearing axis moved laterally by 0.9% per degree of postoperative hip–knee–ankle angle decrease (p < 0.001).ConclusionsVarus knee correction could affect the subtalar joint and the ankle joint. Our findings require consideration when utilized during pre- and postoperative evaluations using the weight-bearing axis of patients undergoing varus knee correction.     

Subtalar joint alignment in ankle osteoarthritis

Background

Although it has been proposed that in mid-stage ankle osteoarthritis, the subtalar joint can compensate for deformities above the ankle joint, the evidence is weak. We thus investigated subtalar joint alignment in different stages of ankle osteoarthritis using weightbearing computed tomography (CT) scans.

Coronal plane ankle alignment, gait, and end-stage ankle osteoarthritis

Objective

Unilateral ankle osteoarthritis (OA) is a debilitating condition which may lead to limb deformity, severe pain, and functional disability due to tibiotalar malalignment and gait dysfunction. The purpose of this study was to determine if coronal plane alignment (varus, valgus, or neutral) of the ankle resulted in different spatial-temporal gait mechanics, clinically-assessed function, and self-reported function in patients with end-stage ankle OA.

Methods

Following informed consent, 96 patients with end-stage unilateral ankle OA were radiographically categorized as having varus, valgus, or neutral tibiotalar alignment. Each subject completed the foot and ankle disability index (FADI) questionnaire to assess self-reported function. The spatial-temporal parameters of interest (stance time, step length, stride length, stride width, single-support time, double support time, and walking speed) were assessed while the subject walked at a self-selected speed.

Results

The varus group performed the timed up and go test significantly faster than the other groups (P = 0.05). All other variables were similar between the three alignment groups.

Conclusion

There was little difference in gait mechanics and function between patients with end-stage OA based on coronal plane ankle alignment suggesting that factors other than coronal plane alignment contribute to diminished function.     

Coronal Hindfoot Alignment in Midfoot Charcot Neuroarthropathy

Coronal plane hindfoot malalignment produces abnormal compensatory forces within the midfoot and forefoot. The primary aim of this study is to compare radiographic hindfoot alignment in patients with a midfoot Charcot event, and identify patterns associated with breakdown. A retrospective review of 43 patients (48 limbs) with midfoot Charcot neuroarthropathy were compared between the coronal hindfoot alignments and Charcot joint involvement. Coronal hindfoot alignment was classified as neutral (n = 15), valgus (n = 16), and varus (n = 17) utilizing the Saltzman hindfoot alignment radiograph. Charcot joint breakdown was classified as isolated tarsometatarsal joint (n = 8), combination of tarsometatarsal and naviculocuneiform joints (n = 22), and midtarsal joints including talonavicular and calcaneocuboid joints (n = 18). Patients exhibiting varus hindfoot alignment had 5.8 times greater risk of breakdown at the tarsometatarsal and naviculocuneiform joints (odds ratio 5.8, 95% confidence interval 1.7-22.9, p < .01). Hindfoot varus induces external rotation of the talus, resulting in compensation through the naviculocuneiform and tarsometatarsal joint, which correlates with our findings of a 6-fold increase in naviculocuneiform and tarsometatarsal joint collapse. Patients exhibiting valgus hindfoot alignment had 27 times greater risk of breakdown at the midtarsal joint (odds ratio 27.0; 95% confidence interval 5.6-207.0, p < .01). Hindfoot valgus induces internal rotation of the talonavicular joint, which correlates with our findings of a 27-fold increase in midtarsal joint breakdown. Varus and valgus hindfoot alignment are associated with different midfoot injury patterns, which may have implications in surgical management and allow for focused surveillance in neuropathic patients presenting with early-stage clinical findings consistent with Charcot neuroarthropathy.     

Risk factors for periprosthetic joint infection following total ankle replacement

BackgroundIdentifying preoperative patient characteristics that correlate with an increased risk of periprosthetic joint infection (PJI) following total ankle replacement (TAR) is of great interest to orthopaedic surgeons, as this may assist with appropriate patient selection. The purpose of this study is to systematically review the literature to identify risk factors that are associated with PJI following TAR.MethodsUtilizing the terms “(risk factor OR risk OR risks) AND (infection OR infected) AND (ankle replacement OR ankle arthroplasty)” we searched the PubMed/MEDLINE electronic databases. The quality of the included studies was then assessed using the AAOS Clinical Practice Guideline and Systematic Review Methodology. Recommendations were made using the overall strength of evidence.ResultsEight studies met the inclusion criteria. A limited strength of recommendation can be made that the following preoperative patient characteristics correlate with an increased risk of PJI following TAR: inflammatory arthritis, prior ankle surgery, age less than 65 years, body mass index less than 19, peripheral vascular disease, chronic lung disease, hypothyroidism, and low preoperative AOFAS hindfoot scores. There is conflicting evidence in the literature regarding the effect of obesity, tobacco use, diabetes, and duration of surgery.ConclusionsSeveral risk factors were identified as having an association with PJI following TAR. These factors may alert surgeons that a higher rate of PJI is possible. However, because of the low level of evidence of reported studies, only a limited strength of recommendation can be ascribed to regard these as risk factors for PJI at this time.     

Semi-automated 3-dimensional analysis of the normal foot and ankle using weight bearing CT – A report of normal values and bony relationships

BackgroundFoot and ankle deformities have translational and rotational components in multiple planes, at multiple levels. Semi-automatic segmentation is a relatively new technology, which when used with weight-bearing CT (WBCT), can build an accurate model of the foot and calculate the orientation and relationships of bones under physiological load. However, few papers report reference values using these techniques. We report normative values for key bony relationships based on semi-automated analysis of WBCT.MethodsThis was a single-centre, retrospective analysis of 100 feet without deformity from 55 adult patients undergoing WBCT as part of routine clinical activity (mean age 40.5 ± 17.3 years). Imaging was analysed using Bonelogic 2.1 (DISIOR, Finland). Semi-automatic segmentation was used to compute the various bony axes in 3-dimensional space. Selected coronal, axial and sagittal plane relationships were then calculated for bones of the hindfoot, midfoot and forefoot.ResultsData is presented on axial and sagittal plane relationships between the metatarsals in the forefoot, and the metatarsals and cuneiforms in the midfoot. In the hindfoot, the calcaneal pitch, talar-first-metatarsal angles, talonavicular coverage angles and Saltzman angles are reported. Coronal plane axes and their relationships are reported at multiple levels from hindfoot to forefoot. Results are presented as mean values with standard deviations and 95% confidence intervals.ConclusionsWe present an observational analysis of the normal values from non-deformed feet. We highlight the major relationships in the axial, sagittal and coronal planes as obtained by semi-automated analysis of WBCT. This data may serve as a reference for future research.Level of evidenceBasic science study     

Lower limb alignment in healthy Japanese adults

BackgroundKnowledge regarding the normal alignment of the lower limb is important when considering alignment for total knee arthroplasty. However, few studies have explored the lower limb alignment of healthy Japanese subjects.MethodsBetween July and October 2020, we performed whole leg standing radiography of 120 legs of 60 healthy adult Japanese volunteers aged <50 years in the closed-leg stance. The measurement parameters were hip knee ankle angle (positive for varus), percentage of constitutional varus (hip knee ankle angle ≥ 3°), mechanical axis deviation ratio, mechanical lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle (positive for lateral opening), and tibial joint line angle (positive for medial inclination).ResultsThe mean measured values for all volunteers, men and women, were as follows: hip knee ankle angle (°), 2.3, 2.6, and 2.0; mechanical axis deviation ratio, 35.8, 35.6, and 36.9; mechanical lateral distal femoral angle (°), 86.7, 87.0, and 86.7; medial proximal tibial angle (°), 85.6, 85.0, and 86.2; joint line convergence angle (°), 0.6, 0.3, and 0.8; and tibial joint line angle (°), ?1.0, ?0.7, ?1.4, respectively. The percentage of constitutional varus was 35.8% overall, 35.8% in men and 35.3% in women. Only the medial proximal tibial angle was smaller in men than that in women (p = 0.003).ConclusionsThe mechanical lateral distal femoral and medial proximal tibial angles were smaller, hip knee ankle angle was larger, and percentage of constitutional varus was higher in Japanese subjects than those reported for subjects in other countries. Our findings improve the understanding of Japanese-specific alignments when considering alignment for lower limb surgery, especially, total knee arthroplasty.     

关节镜监视下踝关节植骨融合术的疗效分析

目的：探讨关节镜辅助下踝关节清理、植骨融合术的手术方法和临床疗效。方法：2001年1月至2009年5月,采用关节镜辅助踝关节植骨融合术治疗踝关节病变25例,男18例,女7例;年龄32～70岁,平均47.5岁;左踝10例,右踝15例;其中创伤后骨关节炎13例,地方性大骨节病10例,类风湿性关节炎2例。手术前后采用疼痛视觉模拟评分（VAS）对踝关节疼痛进行评定,根据美国足踝关节协会评分系统（AOFAS）从疼痛、自主活动、最大步行距离、地面步行、步态、活动度、稳定性及踝关节对线等方面进行评价。结果：25例均获随访,时间20～35个月,平均27.5个月。术后踝关节无疼痛,步态明显改善,无神经血管损伤、感染和固定失败等并发症,平均骨性融合时间为11.7周（8～15周）。术后VAS评分为（1.20±0.82）分,较术前的（8.60±0.96）分明显降低（t=27.326,P=0.000）;术后AOFAS评分中客观项目均较术前改善,术后AOFAS评分为（82.44±4.96）分,较术前的（36.44±9.90）分明显增加（t=-19.178,P=0.000）。结论：关节镜监视下踝关节植骨融合术操作简单,术中创伤小,术后恢复快、并发症少,是踝关节融合的理想方法。     

Expanding Indications of Primary Arthrodesis in Selected Individuals for Managing Complex Hindfoot Trauma During COVID-19 Pandemic

BackgroundDuring the COVID-19 pandemic, public health measures to encourage social distancing have been implemented, including cancellation of outdoor activities, organized sports, and schools/colleges. Neglected hindfoot fractures have emerged as a consequence with increased frequency. Similarly, complex ankle and pilon fractures that require staged management, prolonged hospital stay, and soft-tissue care have emerged as a potential concern as prolonged exposure to healthcare setting adds to risk of acquiring as well as transmitting COVID-19 infection. The authors present their experience with expanding these indications for hindfoot arthrodesis as they encounter a greater number of neglected ankle and hindfoot trauma.MethodsThis was a retrospective observational study of collected data from the trauma unit of our hospital. Inclusion criteria included all trauma classified by the AO/OTA as occurring at locations 43, and who underwent subtalar and ankle arthrodesis. This included distal tibia, malleolar, talus, and calcaneus fractures. These patients were followed up to at least 6 months till complete fracture union.ResultsA total of 18 patients underwent arthrodesis of either the ankle or subtalar joint between March and October 2020. Mean age of patients undergoing arthrodesis of the hindfoot was 69.2 years (43–84 years). Indications for the procedure included Displaced and comminuted intra-articular distal tibia fractures in elderly (6 patients), Malunited ankle fractures (2 patients), Neglected Ankle fractures managed conservatively (3 patients), Calcaneus fractures (5 patients), and neglected Talus body fracture (2 patients). All patients were followed up to at least 6 months and everyone went onto successful painless union between 3 and 6 months of the arthrodesis procedure without any significant complications.ConclusionIn summary, COVID-19 pandemic has led to a change in paradigm of trauma management and foot and ankle management is no different than other musculoskeletal trauma systems. The authors propose an expansion of indications for hindfoot arthrodesis in managing complex hindfoot trauma in pandemic situation.