CLINICAL EVENTS CALENDAR
- Apr 08,2010Apr 11,2010Update 2010: Reconstructive Surgery of the Foot & Ankle04/08/2010 - 10:4304/11/2010 - 10:43website:
Podiatry Institute
Crowne Plaza Ravinia, Atlanta, GA - Apr 17,2010Apr 20,20102010 SAWC Spring04/17/2010 - 11:2304/20/2010 - 11:23website:
Gaylord Palms Hotel and Convention Center
Orlando, FL - Apr 29,2010May 02,2010Surgical Pearls by the Sea: Current Trends in Foot and Ankle Surgery04/29/2010 - 10:4405/02/2010 - 10:44website:
Podiatry Institute
Newport Marriott, Newport, RI - May 13,2010May 15,2010Wine Country Podiatric Symposium: Escape to Napa Valley05/13/2010 - 10:4505/15/2010 - 10:45website:
Podiatry Institute
Napa Valley Marriott Hotel & Spa, Napa Valley, CA
Non-Accredited Education
Managing the Diabetic Foot: A Clinical and Economic View Complimentary Archived Webcast
Non-Accredited
Understanding Collagen Dressings and their Benefit in Wound Care![]()
Complimentary Archived Webcast
non-accredited
A Closer Look At The Modified Hoke Arthrodesis For Flatfoot Deformity

For many years, I have employed a modification of the traditional Hoke procedure in the management of flatfoot deformity. Surgeons generally employ medial column stabilization in flatfoot deformity to augment other pronation limiting surgical interventions such as arthroereisis, tendo-Achilles lengthening (TAL), calcaneal osteotomy, etc.
The technique I have utilized is a wedge resection of the anterior navicular together with osteotomy/resection of the posterior articular surfaces of the medial and middle cuneiforms, and osteotomy of the lateral cuneiform. The procedure is simple to perform and it is powerful in the correction of abduction and dorsiflexion deformity. One can also correct some frontal plane rotational deformity.
Surgeons can perform the resection with a long oscillating or sagittal saw blade. Initially, you would perform conservative resection and expand the resection for further correction if necessary.
One may expand the procedure to include a Lapidus type resection when indicated, particularly when it comes to stabilizing deformities secondary to Charcot’s joint disease.
The standard incision is a universal medial longitudinal incision (Figure 1). No undermining of the skin or “anatomical dissection” is necessary. Perform subperiosteal/capsular dissection to expose the navicular-cuneiform joint or the first metatarsocuneiform joint when necessary (Figure 2). Proceed to perform a wedge resection of the anterior navicular and posterior cuneiforms, extending into the lateral cuneiform (Figure 3).
The wedge is wider medially (Figure 4) and plantarly (Figure 5,6) so when the deformity is reduced, adduction and plantarflexion correction occurs (Figure 7). It is prudent to be conservative with initial resection. You can obtain greater correction as needed. One may accomplish fixation by a variety of means, utilizing standard bone staples (Figure 8), Wright compression staples (Figure 9), OSStaples (Figure 10) or screws (Figure 11). Deformity correction in Charcot’s joint disease may necessitate orthobiologic enhancement (Figure 15), non-locking or locking plates (Figures 16,17) or supplementary external fixation, particularly when you perform an additional metatarsocuneiform arthrodesis (Figures 18-19).
Typically, four to six weeks of immobilization is required.
In my opinion, the key to success is extension of the osteotomy/arthrodesis into the lateral cuneiform. One should initially ensure satisfactory resection of the surfaces to be resected. Then proceed to carefully remove greater amounts of bone for additional correction as required. In a pinch, for example, when you encounter poor quality bone, you may employ crossed Steinmann pins or a small external fixator.
Gretna, Louisiana
CME Showcase
"Current Concepts In Healing Chronic Diabetic Foot Ulcerations"
A Complimentary On-Demand CE/CME Webcast This activity is supported by an educational grant from Advanced Biohealing. To access this Webcast, visit www.naccme.com/program/n-550/ |


















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