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Triple Arthrodesis: Charcot Marie Tooth Disease


- See: Triple Arthrodesis: Discussion:

- Discussion:
    - reserved for the most intractable problems and can only be done close to or at the time of skeletal maturity;
    - when osseous correction of the midfoot is needed, we prefer to maintain the talonavicular, calcaneocuboid, and talocalcaneal joints by using calcaneal and midfoot osteotomies supplemented with plantar releases and tendon transfers;
    - other comprehensive management approaches for cavovarus foot have been described;
    - in pts who have reached skeletal maturity, who have severe deformity, and who are so severely affected neurologically that they walk w/ difficulty and cannot run, a triple arthrodesis can be performed;
    - individuals who are able to run, however imperfectly, are frequently not pleased with the result of a triple arthrodesis, as this procedure limits function, although the appearance can be good;
    - we try to avoid the necessity for triple arthrodesis with use of the soft-tissue and osseous procedures described, even in young adults;
    - it is not appropriate to withhold treatment of a cavovarus foot until child has reached skeletal maturity and is old enough for a triple arthrodesis;
    - triple arthrodesis is no longer recommended for these pts because of high percentage of unsatisfactory long term results generally related developement of ankle instability and DJD;
- Complications:
    - severe impairment of function, need for orthoses, recurrent deformity, & degenerative changes in ankle & midfoot regions were documented in a high percentage of patients;
    - degenerative changes in joints of ankle and midfoot, pseudarthrosis, talar osteonecrosis, and residual deformity were seen often