Medial Approach for Hindfoot Arthrodesis with a Valgus Deformity

Background: Surgical correction of valgus deformity of the hindfoot has traditionally been via a lateral incision, often complicated by wound healing problems and sural nerve damage. Potential advantages of a medial approach especially for a valgus deformity include excellent wound healing, no risk of damage to the sural nerve and extensibility of the approach to include additional procedures such as navicular fusion or tendon transfer if indicated. Materials and Methods: We present a retrospective review of 18 consecutive patients with valgus deformity of the hindfoot, all undergoing arthrodesis via a medial approach. Indications included osteoarthritis, tibialis posterior dysfucntion, post-traumatic arthritis and rheumatoid arthritis. Results: All wounds healed by primary intention and there were no postoperative neurovascular complications. The mean preoperative subtalar valgus deformity was 32 (range, 12 to 49) degrees, which was improved to mean postoperative valgus deformity of 17 (range, 10 to 25) degrees. Fusion following the primary surgery was achieved in all but one of the patients (a heavy smoker and post-traumatic arthritis), with the mean time to fusion being 5.6 months. Conclusion: We provide further evidence to support previous documentation in the literature that the medial approach for the correction of hindfoot valgus deformity can be successfully used to achieve excellent exposure of the subtalar joint in order to correct the valgus deformity, avoiding the risks of wound healing and nerve damage associated with a lateral approach. Level of Evidence: IV, Retrospective Case Series