Wapner's 1998 JAAOS review defines the indications, technique, and expected outcomes of triple arthrodesis (subtalar + talonavicular + calcaneocuboid fusion) in adult patients. It synthesizes six adult outcome series and provides a detailed surgical roadmap for achieving plantigrade alignment. The central message: this is a demanding salvage procedure where alignment quality determines long-term success.
Triple arthrodesis produces secondary ankle and midfoot arthrosis in more than half of patients — not because the surgery fails, but because fusing three joints eliminates the foot's force-dissipating mechanism. Patients need to understand this before they consent.
When you see end-stage hindfoot arthritis or fixed deformity from PTT dysfunction or posttraumatic arthritis, triple arthrodesis is appropriate only after exhausting other options. If disease is limited to the calcaneocuboid joint, stop there: isolated fusion preserves 70% of hindfoot motion.
In the OR, your alignment target is 3-5 degrees of residual heel valgus. Leaving the heel in excessive valgus increases deltoid ligament load by up to 76%. This is how you create the ankle arthritis you are trying to prevent.
Counsel every patient that symptom relief takes 2 to 36 months. A patient who is still uncomfortable at 6 months with a solid, well-aligned fusion is on a normal trajectory, not a complication.
Wapner's 1998 JAAOS review defines the indications, technique, and expected outcomes of triple arthrodesis (subtalar + talonavicular + calcaneocuboid fusion) in adult patients. It synthesizes six adult outcome series and provides a detailed surgical roadmap for achieving plantigrade alignment. The central message: this is a demanding salvage procedure where alignment quality determines long-term success.
Triple arthrodesis produces secondary ankle and midfoot arthrosis in more than half of patients — not because the surgery fails, but because fusing three joints eliminates the foot's force-dissipating mechanism. Patients need to understand this before they consent.
When you see end-stage hindfoot arthritis or fixed deformity from PTT dysfunction or posttraumatic arthritis, triple arthrodesis is appropriate only after exhausting other options. If disease is limited to the calcaneocuboid joint, stop there: isolated fusion preserves 70% of hindfoot motion.
In the OR, your alignment target is 3-5 degrees of residual heel valgus. Leaving the heel in excessive valgus increases deltoid ligament load by up to 76%. This is how you create the ankle arthritis you are trying to prevent.
Counsel every patient that symptom relief takes 2 to 36 months. A patient who is still uncomfortable at 6 months with a solid, well-aligned fusion is on a normal trajectory, not a complication.