Analysis of Radiographic Outcomes Comparing Foot Orthosis to Extra-osseous Talotarsal Stabilization in the Treatment of Recurrent Talotarsal Joint Dislocation

The partial dislocation of the talus on the tarsal mechanism has been recognized as the root cause of multiple foot and lower extremity pathologies. Many conservative and surgical treatments have been utilized to treat this pathologic condition. The purpose of this multi-centered prospective study was to compare weight-bearing radiographic correction achieved in patients with recurrent talotarsal joint dislocation (RTTJD) treated with foot orthoses to that achieved in the same patients through an extra-osseous talotarsal stabilization (EOTTS) procedure. Radiographic data was obtained with no intervention (barefoot), on the orthosis and post-EOTTS from 19 patients (30 feet). Change to the pathologic angles measured for the talar 2nd metatarsal (T2M) on the anteroposterior (AP) view and talar declination (TD) angle on the lateral view were analyzed. The reduction in the angles following the use of orthoses was insignificant in both the transverse and sagittal planes. Following the EOTTS procedure, there was a significant change towards accepted normal weight-bearing radiographic angles in the transverse and sagittal planes. In the transverse plane, the EOTTS procedure resulted in an average 58.92% reduction and in the sagittal plane, a 28.32% reduction compared to pre-operative barefoot measurements. By comparison, the change from barefoot measurements to orthosis was 3.20% and 2.20% respectively. The EOTTS procedure did not result in an increase in pathologic angles or cause any angles that were within the normal range pre-operatively to become pathologic. These results support the hypothesis that the EOTTS procedure is more effective in stabilizing RTTJD as compared to orthoses.