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One of the most challenging problems facing orthopedic surgeons is persistent pain after surgery and certainly is just as frustrating following hindfoot fusion. The hindfoot joints consist of the subtalar, talonavicular, and calcaneocuboid (CC) joints. These joints are commonly fused for degenerative changes, deformity correction, inflammatory or neuropathic arthropathy, tarsal coalition, or primarily after trauma. Goals of hindfoot fusion are a painless plantigrade foot capable of fitting in shoes without orthotics or a brace. Many believe that deformity correction is achievable without inclusion of the CC joint. Managing patient expectations is important when counseling a patient especially regarding potential complications., Competing Interests: Disclosure J.K. Ellington is a paid consultant for Medshape, Inc., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Nitinol compression implants are fast and simple to insert and have a high radiographic union rate for midfoot and hindfoot arthrodeses. Applications of nitinol technology in orthopedic surgery are rapidly expanding with the improved and broadened portfolio of implants available., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Nitinol has been shown to generate durable compression under loading via pseudoelastic shape memory. The purpose of this study was to evaluate the effectiveness of a hindfoot arthrodesis nail with an internal pseudoelastic nitinol compression element. Patients who had undergone tibiotalocalcaneal arthrodesis from 2013 to 2016 were identified at 2 tertiary referral centers (12-week follow-up minimum). Patients managed with a tibiotalocalcaneal nail with an internal nitinol compression element were identified for review. Sagittal computed tomographic scan reformats were reviewed to calculate a percentage of joint surface bony union. Intraoperative and postoperative radiographs were compared to calculate postoperative screw position change generated by the nitinol element, a surrogate for postoperative unloading of compressive forces. Thirty-three patients were included in analysis and 81% of patients had successful union of both tibiotalar and subtalar joints. Overall, 90% of all arthrodesis surfaces united. The union rate of arthrodesis surfaces among patients without Charcot osteoarthropathy was 94%. A history of Charcot was identified as a risk factor for subtalar nonunion (p = .04) and was associated with less complete computed tomography-based tibiotalar union: 94% versus 71% (p < .01). The posterior-to-anterior screw translated an average of 3.9 mm proximally relative to the rigid portion of the nail from intraoperative to initial postoperative radiographs (p < .0001). High rates of computed tomography-confirmed union were demonstrated in the face of challenging clinical scenarios. Shortening of the pseudoelastic nitinol element occurs early in the postoperative period, indicating continued unloading of the nitinol compression element through the arthrodesis sites after initial implantation., (Copyright © 2018 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Hallux rigidus is the most common arthritic malady to afflict the foot. A host of nonoperative measures can alleviate pain, and with failure of conservative treatment, joint preserving and joint sacrificing procedures can be used to treat persistent symptoms. Although arthrodesis is an effective pain-relieving operation, loss of motion at the hallux metatarsophalangeal joint may limit the patient's function and can be an unacceptable solution. Various types of interposition arthroplasty can offer a motion-preserving alternative to arthrodesis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The preferred surgical approaches to subtalar fusion are the sinus tarsi incision, the medial incision, and the extensile lateral approach. The choice of one over the other depends on the underlying pathology, previous surgeries, associated foot pathologies, soft tissue quality, and medical comorbidities. This article reports on several cases of subtalar joint fusion., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Hammertoe and clawtoe deformities are common forefoot problems. The deformity exists owing to the underlying pathoanatomy. Hallux valgus, longer metatarsals, and intrinsic imbalance are the most common etiologies. Understanding the cause of the deformity is important to be able to successfully treat the condition, whether nonoperative or with operative intervention. When nonoperative measures fail, PIP correction is best obtained through arthroplasty or arthrodesis. The key to successful PIP correction is obtaining a well-aligned toe and reducing pain as demonstrated by Coughlin and Mann.15 When choosing a technique, the author prefers PIP joint arthrodesis because it has several advantages, including a decreased risk of recurrence and a more predictable toe posture. The authors prefers an intramedullary device to avoid the well-known complications of K-wires. The best surgical correction and fixation techniques are still to be determined. Each patient much be evaluated thoroughly and treatment should be tailored to the patient’s deformity, comorbidities, expectations and surgeon’s experience.