Evolving the Treatment of Flat Foot Away From Triple Fusion

by Vince Vacketta, DPM

Is there anything with less consensus than treatment algorithms for progressive collapsing foot deformity (PCFD)? While the “make the foot stiff and straight” triple arthrodesis was once considered the gold standard for advanced PCFD, new research further supports the idea that it may be time for more dynamic and functional options. 

Less is more with PCFD fusions

In their recent study, Kim et al. retrospectively evaluated surgical outcomes in patients who underwent isolated subtalar joint arthrodesis compared to those who underwent isolated triple or double arthrodesis. The authors found equivalent radiographic correction in both deformity matched cohort groups, regardless of the number of fusions performed. 

They also discovered a statistically significant increase in post-operative ankle valgus among the multiple fusion group. Simply put, despite the additional sacrifices in physiologic and financial cost to obtain the greater theoretical corrective power with the triple arthrodesis, outcomes were worse in subjects receiving the “kitchen sink triple arthrodesis.”