Foot and ankle fusions in Charcot-Marie-Tooth disease

Summary

We reviewed 15 patients with Charcot-Marie-Tooth disease who were treated with foot or ankle fusions. Altogether, 26 feet were treated with fusions and the average follow-up time was 14 years. In half of the patients the principal symptom leading to fusion operation was instability of the ankle. In four patients, in two of them bilaterally, soft tissue corrections were performed before the fusion. In 21 cases, a subtalar triple arthrodesis was performed and each time correction to neutral position was the aim. In six feet, the triple arthrodesis was complemented by soft tissue plasties, e.g., plantar release, Achilles elongation, or transposition of tibial or peroneal tendons in order to achieve proper balance. Other primary fusions were a Grice-type fusion in one case, pantalar arthrodesis in one case, talocrural fusion in one case, and interphalangeal fusions in both feet in one patient with extreme claw foot. In four cases the triple arthrodesis failed to fuse (three nonunions and one delayed union), and new fusions were successful in three of them. The one pantalar fusion in the series was done for a 58-year-old man with late onset of the disease who had a very severe cavovarus deformity at the time of the operation, and this fusion failed to unite. In 17 of 26 feet, other operations than the primary fusion were performed, and five feet were operated on three or four times. In four feet the result was judged as excellent, in 15 good, in four fair, and in three poor. There were not more poor results in patients followed up for more than 15 years than in those whose follow-up was shorter. Evaluation of the surgical results in the present series suggests that triple arthrodesis can preserve acceptable function in the majority of patients with foot deformities and instabilities which are caused by Charcot-Marie-Tooth disease.