Limb Salvage With Single-Stage Bilateral Pantalar Arthrodesis for Severe Equinovarus in Parkinson’s Disease: A Case Report

Fixed bilateral equinovarus deformities are uncommon and difficult to manage, particularly in patients with neurodegenerative disorders affecting lower extremity neuromuscular function and gait, such as Parkinson's disease. The purpose of this case report is to present the surgical correction and functional outcomes of a patient with severe, fixed bilateral equinovarus deformities treated with single-stage bilateral pantalar arthrodesis using intramedullary (IM) nail fixation. A 75-year-old man with a history of Parkinson's disease and lumbar spine compression fractures presented with progressing bilateral equinovarus deformity resulting in loss of ambulation. After failing conservative treatment, the patient underwent a single-staged bilateral pantalar arthrodesis. Surgical intervention involved soft tissue releases, osteotomies, and arthrodesis using an IM nail. Postoperative care included non-weight-bearing, pain management, wound care, physical therapy, and custom bracing. Patient outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scores, functional capacity, and gait analysis. The patient progressed from non-ambulatory status to walking with double-upright metal AFO braces. VAS pain score improved from 6/10 preoperatively to 3/10 postoperatively. AOFAS Hindfoot scores increased from 0/100 preoperatively to 49/100 nine months postoperatively, with improvement across pain, function, and alignment domains. Single-stage bilateral pantalar arthrodesis with IM nail fixation is a viable surgical option for patients with severe, fixed equinovarus deformities, especially when conservative measures fail. This technique provides durable correction, pain relief, and functional improvement, despite the inherent risk associated with extensive soft tissue releases and osseous corrections in a bilateral case. Careful patient selection and close postoperative monitoring are essential to achieving successful outcomes.