Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 May-Jun;11(3):492-497.
doi: 10.1016/j.jcot.2020.03.011. Epub 2020 Mar 30.

Subtalar fusion and exostectomy in calcaneus malunion: How we do it

Mandeep S Dhillon  1 , Sandeep Patel  1 , Karan Jindal  1 , Siddhartha Sharma  1
Affiliations
Review

Subtalar fusion and exostectomy in calcaneus malunion: How we do it

Mandeep S Dhillon et al. J Clin Orthop Trauma. 2020 May-Jun.

Erratum in

Abstract

Calcaneus malunion is a common sequela to calcaneal fractures and is a cause of pain and discomfort. Multiple approaches have been described to address the subtalar joint and the lateral wall. Type 2 malunion is the most commonly encountered problem, and is usually addressed by the sinus tarsi approach. This has some limitations, as exposure for lateral wall excision beneath the peroneal tendons maybe a problem. We have slightly modified the sinus tarsi approach by a more horizontal skin incision, which may even be extended proximally by 1-2 cm; this allows access to the lateral wall on either side of the peroneal tendons. The approach is described in detail.

Keywords: Calcaneus malunion; Sub fibular impingement-sinus tarsi approach; Subtalar fusion.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Skin incision marking-starting from just distal to tip of fibula and extending it distally for 3–4 cm towards base of 4th metatarsal.
Fig. 2
Fig. 2
After incising the peroneal sheath, the peroneal tendons are visible.
Fig. 3
Fig. 3
Peronei tendon retracted posteriorly after incising the floor of sheath.
Fig. 4
Fig. 4
Exposure of the subtalar joint- Note the Peronei retracted posteriorly, Hintermann retractor applied with 1 K wire applied in talus and the other k wire into calcaneus (Inset- C arm picture depicting one k wire in either side of the posterior facet of subtalar joint).
Fig. 5
Fig. 5
Drilling of prepared joint surfaces with 2.0 mm k wire or 1.8 mm drill bit.
Fig. 6
Fig. 6
Exposure for lateral wall exostectomy. In Fig. 6A peronei are retracted anteriorly and the bump is visible. In Fig. 6B peronei are retracted posteriorly and the lateral wall bump is marked with marker and note the osteotome in position for exostectomy.
Fig. 7
Fig. 7
C arm Picture of two parallel adequately spaced and well centered guide wires with the tips in body of talus at subchondral area away from ankle joint line. 7A- Lateral view hind foot, 7B- AP view ankle and 7C harris axial view.
Fig. 8
Fig. 8
Note stab incisions in heel and the screw being advanced through parallel guide wires.
Fig. 9
Fig. 9
Obliteration of subtalar joint depicting good compression. (Inset-Final Harris view and lateral view of Hind foot after screw insertion and compression).
Fig. 10
Fig. 10
Clinical image of foot after suture removal, note the small 3 cm healed scar.
See this image and copyright information in PMC

References

    1. Myerson M.S., Quill G.E. Late complications of fractures of the calcaneus. J Bone Joint Surg. 1993;75A(3):331–341. - PubMed
    1. Ferrao P.N., Saragas N.P., Strydom A. Isolated subtalar arthrodesis. JBJS essential surgical techniques. 2016 Mar 23;6(1) - PMC - PubMed
    1. Stephens H.M., Sanders R. Calcaneal malunions: results of a prognostic computed tomography classification system. Foot Ankle Int. 1996 Jul;17(7):395–401. - PubMed
    1. Greisberg J., Sangeorzan B. Hindfoot arthrodesis. J Am Acad Orthop Surg. 2007 Jan;15(1):65–71. - PubMed
    1. Vulcano E., Ellington J.K., Myerson M.S. The spectrum of indications for subtalar joint arthrodesis. Foot Ankle Clin. 2015 Jun;20(2):293–310. Epub 2015 Apr 11. - PubMed