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The Journal of Bone and Joint Surgery, Vol 69, Issue 7 1052-1062, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
The optimum position of arthrodesis of the ankle. A gait study of the knee and ankle
P Buck, BF Morrey and EY Chao
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905.
Findings from biomechanical analyses of gait were used to estimate the
optimum position of arthrodesis of the ankle. Nineteen patients who were
followed for an average of 10.4 years (range, four to seventeen years) were
studied. By including the knee in the analysis as well as studying the
effects on gait of different ground conditions, objective data for the
weight-bearing extremities in the transverse, sagittal, and coronal planes
were generated. Genu recurvatum was shown to be associated with a
plantar-flexion position of fusion of the ankle. Laxity of the medial
collateral ligament of the knee was noted in twelve patients (63 per cent).
Among these patients, in three (16 per cent) the laxity was graded as
moderate to severe, possibly due to external rotation of the extremity
during gait to avoid rolling over the rigid plantar-flexed ankle. The
patterns of gait showed that a valgus position of the arthrodesis is more
advantageous and provides more normal gait, particularly on uneven ground.
To attain more normal function of the knee and improve performance on rough
ground, the optimum position of arthrodesis of the ankle appears to be
neutral flexion, slight (zero to 5 degrees) valgus angulation, and
approximately 5 to 10 degrees of external rotation. Posterior displacement
of the talus under the tibia tends to produce a more normal pattern of gait
and decreases the stress at the knee. CLINICAL RELEVANCE: This study has
shown the ideal position of fusion of the ankle to be neutral flexion,
slight (zero to 5 degrees) valgus angulation of the hind part of the foot,
and 5 to 10 degrees of external rotation. This position allows the greatest
compensatory motion at the foot and places the least strain on the knee.
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