Triple arthrodesis and subtalar joint arthrodesis. For the treatment of end-stage posterior tibial tendon dysfunction.

The current literature clearly supports the use of subtalar and triple arthrodeses for the treatment of end-stage PTTD. There is debate, however, regarding whether or not an isolated fusion is preferable to the triple arthrodesis. Complete evaluation of the patient's deformity and symptoms is imperative before choosing to perform a rearfoot fusion. If the deformity can be isolated to the STJ, then perhaps a limited fusion is appropriate. With the close interrelationship of the subtalar and midtarsal joints, however, it is the authors' opinion that chronic dysfunction of the posterior tibial tendon infrequently causes isolated STJ pathology. Perhaps earlier intervention in the process of tendon degeneration, before multiple joint adaptations, would warrant an isolated fusion. We anticipate further research into the advantages of STJ and double arthrodeses over the triple arthrodesis. Clearer identification of the patients in whom these limited fusions are warranted is necessary, especially with respect to adult flatfoot secondary to PTTD. Currently, isolated and combined hindfoot fusions continue to be valuable salvage procedures in the treatment of end-stage arthritic deformities.