Subtalar Arthroereisis Implantation in Acquired Neuropathic Pes Planus: A Preliminary Report Detailing a Minimally Invasive Approach to Healing Medial Column Ulcerations |
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| Institution: | 1. Resident, Podiatric Medicine and Surgery, Division of Podiatric Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA;2. Clinical Fellow, Harvard Medical School, Boston, MA;3. Foot and Ankle Surgeon, Central Vermont Medical Center, Berlin, VT;4. Assistant Clinical Professor of Surgery, Harvard Medical School, Boston, MA;5. Associate Chief, Division of Podiatric Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA;1. Surgical Resident, University of Cincinnati Medical Center, Cincinnati, OH;2. Editor, Columbus, OH;3. Surgeon, Rush Copley Medical Center, Yorkville, IL;4. Chief of Podiatric Surgery and Residency Director, University of Cincinnati Medical Center, Cincinnati, OH;5. Chief of Surgery, OSF Medical Group, Chicago, IL;6. Fellowship Director, Amita Health Saint Joseph Hospital Department of Surgery, Chicago, IL;1. Resident, Center for Wound Healing and Hyperbaric Medicine, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC;2. Medical Student, Georgetown University School of Medicine, Washington, DC;3. Georgetown University School of Medicine, Washington, DC;4. Assistant Professor, Center for Wound Healing and Hyperbaric Medicine, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC;5. Professor, Center for Wound Healing and Hyperbaric Medicine, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC;6. Professor, Department of Plastic Surgery, University of Texas Southwestern, Dallas, TX;1. Surgeon, Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China;2. Professor, Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China;3. Associate Professor, Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China;1. Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX;2. Private Practice, Statistic Consulting, Aurora, CO;3. Private Practice, Imperial Health – Center for Orthopaedics, Lake Charles, LA;4. Private Practice, Orthopaedic & Spine Center of the Rockies, Fort Collins, CO;5. Professor, Department of Orthopedic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX |
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| Abstract: | Ulcerations under the medial column in patients with acquired neuropathic pes planus may be intractable to conservative techniques such as regular debridement, offloading, bracing, and accommodative shoes. When surgery becomes necessary for these patients, the foot and ankle surgeon has the option of exostectomy, medial column beaming, medial column fusion, and external fixation, among others. In the case of a flexible midfoot collapse, the option of arthroereisis for indirect medial column support may be warranted. In this preliminary report, the authors detail a technique of Achilles tendon lengthening, arthroereisis implantation, and advanced cellular tissue product application in an attempt at wound coverage and prevention of recurrence. Three patients presenting with intractable medial column ulcerations of ∼1 year's duration underwent this procedure, and within 7 weeks (range 5 to 7), all medial column ulcerations healed. These patients remained healed at last follow-up (average 29 months; range 8 to 44). This preliminary report provides evidence for a minimally invasive procedure aimed at offloading, healing, and preventing recurrence of medial column ulcerations in patients with flexible neuropathic pes planus. |
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