Supramalleolar osteotomy in the management of the rheumatoid hindfoot.

Supracondylar osteotomy is an alternative to other procedures for realignment of the rheumatoid hindfoot. Of 64 hindfoot operations performed since 1964, 12 were supracondylar osteotomies. The specific indication for this procedure was an ankylosed rheumatoid foot with equinovarus deformity and limited range of tarsal motion. Conventional triple arthrodesis in such circumstances creates a rigid foot, further compromising an already damaged ankle. Of the nine feet available for evaluation one to ten years after operation, seven were relieved of pain and two had anterior metatarsalgia from recurrence of equinus deformity. Correction of varus deformity was maintained in all. Ankle motion diminished from a mean of 17 degrees before operation to 7 degrees when reviewed. Five of the eight ankles had bony fusion. Mean rotatory tarsal motion was improved in two and diminished in seven; mean rotation remained constant, at approximately 13 degrees. Whereas ankle joint motion fared badly under the combined onslaught of disease and osteotomy, the preservation of tarsal motion, correction of deformity, and relief of pain make supramalleolar osteotomy a worthwhile alternative procedure under the specific circumstances cited.