Failed Triple Arthrodesis/Flat Foot Surgery Repaired with Ankle Fusion and Revision of Triple


This petite 74 yo female had a tough 5 years. She has hx of DM-II.

She had a previous malunited triple by a non foot and ankle surgeon that over time became un-braceable. She had periods where her A1C drifted too high to allow safe recon, and COVID delayed surgery as she needed ECF placement post-op.

She is semi-neuropathic. Her talus had both features of AVN and Charcot. When the MSK radiologist that interpreted her films and I chatted he felt strongly AVN was not certain, and neither was Charcot.

Given the patient’s basic desire to have a limb she could stand on, and reliably wear a brace without the tendency to develop sores, I felt an ankle fusion and a multiplanar midfoot osteotomy would best allow correction.

At 11 weeks post op her ankle fusion is united, and she is full weight bearing in a walking boot. She is starting physical therapy to work on muscle tone and transition to shoe and AFO.

We used fully threaded screws to allow better purchase in osteopenic bone. Using screws also allowed smaller incisions than plating would.