Medial-Single-Incision Double Arthrodesis “Diple” for Adult-acquired Flatfoot Deformity

Abstract

Adult-acquired flatfoot deformity is a progressive pathologic condition that results in a rigid, painful, arthritic flatfoot that is debilitating and affects daily function. Traditionally, the condition is treated with a Triple arthrodesis of the subtalar joint, talonavicular joint, and the calcaneocuboid joint through dual incisions. This approach is effective in restoring the medial arch and correcting excessive hindfoot valgus. However, the lateral incision is associated with wound-healing problems in up to one third of patients, while the calcaneocuboid joint is often asymptomatic and not arthritic. The medial-single-incision “Diple” arthrodesis is a valuable, efficient, and safe alternative to the traditional dual incision Triple arthrodesis. The Diple arthrodesis is performed through a single medial incision and is a fusion of the subtalar joint and talonavicular joint but sparing the calcaneocuboid joint. The advantages of the Diple arthrodesis is significantly reduced wound complication, decreased operating time, comparable union rates, and extensive intraoperative visualization. Furthermore, maintenance of the calcaneocuboid joint allows for improving accommodation on uneven surfaces along with prevention of adjacent joint degeneration. In this paper, we describe our experience with the medial-single-incision Diple arthrodesis in patients with adult-acquired flatfoot deformity. Level of Evidence: Diagnostic Level V—expert opinion and surgical technique. See Instructions for Authors for a complete description of levels of evidence.