Talonavicular Fusion for Dorsal Subluxation of the Navicular in Resistant Clubfoot

Dorsal rotatory subluxation of the navicular, a common sequela of resistant surgically treated clubfeet, presents a challenging treatment problem. This subluxation typically progresses after posteromedial release. Patients develop a cavovarus foot deformity and complain of pain, gait problems, and difficulty with shoe wear. Previous attempts at soft tissue release and reduction have been largely unsuccessful. We reviewed 13 patients with dorsal rotatory subluxation of the navicular treated with talonavicular arthrodesis. The minimum followup after surgery was 6 months (average, 36 months; range, 6 to 93 months). At last followup 12 of 13 patients were symptom-free. The mean preoperative subluxation of 42% was reduced to a mean of 6% at last followup. We noted improvement in the talo-first metatarsal angle from an average of 18º preoperatively to 8º postoperatively. One patient treated by another surgeon with attempted talonavicular arthrodesis developed a nonunion; we observed no other complications. We believe talonavicular arthrodesis a reasonable option to correct the deformity and symptoms associated with dorsal rotatory subluxation of the navicular in a single surgical setting with a low complication rate.