Lambrinudi-Type Arthrodesis and Plantar Fasciectomy in the Treatment of Rigid Cavovarus Deformity

Background: While using a standard triple arthrodesis in treating rigid cavovarus deformity, the talus often remains extended, leading to anterior ankle impingement and overload. The primary goal of this study was to test our hypotheses that the talus would adopt a more normal flexion position with a Lambrinudi-type triple arthrodesis and that the foot morphology would become more normal by combining it with a plantar fasciectomy. Additionally, the aim was to evaluate whether outcomes differ between neurogenic and non-neurogenic feet. Method: Seventeen patients (17 feet; neurogenic [N], 11 feet; non-neurogenic [NN], 6 feet) who underwent a Lambrinudi-type arthrodesis combined with a plantar fasciectomy at our institution from 2016 to 2023, with at least 2 years of follow-up, were included. We prospectively collected radiographic and clinical data to evaluate changes in foot and ankle morphology. Results: With the numbers available, no significant difference could be detected between the N and NN groups in clinical outcomes. The VAS scale decreased by 6.5 ± 0.3 points after surgery ( P < .0001, Hedges g = 6.6 [4.9-8.4]), and the EFAS score increased by 31.5 ± 0.9 points ( P < .0001, Hedges g = −8.7 [−10.9 to −6.5]). All radiographic measurements improved significantly ( P < .0001 for all), and, with the numbers available, no significant difference could be detected between the 2 groups, except for the talar flexion angle, which showed a tendency of a slightly higher decrease in the N group than in the NN group ( P = .024, Hedges g = −0.8 [−1.5 to −0.1]). The foot length increased from 122 ± 16 mm preoperatively to 134 ± 12 mm postoperatively (plus 10.1%, P < .0001, Hedges g = −0.9 [−1.5 to −0.2]). Conclusion: A Lambrinudi-type arthrodesis combined with a complete plantar fasciectomy was an effective method for correcting a rigid cavovarus deformity in both N and NN feet. It was intended to unload the anterior tibiotalar joint by flexing the talus and changing the flexion forces, and it increased foot length by 10.1%. It also was associated with significant clinical improvements across all measured outcome domains. Level of Evidence: Level IV, prospective case series.