Rückfußchirurgie bei entzündlich-rheumatischen Erkrankungen

Due to the special constellation of immunosuppressive drug therapy and generally multimorbid patients, hindfoot surgery for inflammatory rheumatic diseases requires special knowledge. The cause of hindfoot malalignment often lies in instability of the capsuloligamental structures in combination with bony destruction. The stability of the joints is also frequently compromised by tendon involvement. Soft tissue interventions such as tendon transpositions are generally not promising for joint instability in these patients. The goal of restoring a stable hindfoot can often only be achieved by arthrodesis. Due to the accompanying osteoporosis, the primary stability of arthrodesis and osteotomies is lower than in degenerative foot deformities. In addition, coordination is often greatly reduced due to sarcopenia with or without polyneuropathy. The forefoot pathology must always be included in the treatment of the hindfoot deformities. Deformities of the knee joint also play a decisive role in the position of the hindfoot fusion. The limb axis should be corrected from proximal to distal.