One hundred and one tibiotalar arthrodeses were performed using a single
surgical technique that has not been previously reported. The average
follow-up was ten years (range, two to twenty-five years). The rate of
pseudarthrosis was 5 per cent, four to five times less than in other recent
large reports. Pseudarthrosis occurred only in patients with a sensory
deficit. Secure fusion was radiographically documented in 95 per cent and
the functional clinical result was good to excellent in 90 per cent. The
ideal fusion position was found to be neutral or slight equinus angulation,
and varus-valgus angulation equal to that of the contralateral side. More
than 7 degrees of varus angulation of the heel was associated with
symptomatic lateral metatarsalgia in all feet in which it occurred.
Radiographic measurement documented an average 85 per cent (11-degree)
increase in postoperative tarsal motion. Neither symptoms nor function
correlated with the degree of tarsal hypermobility.