Total Ankle Arthroplasty as a Correction Tool for Foot Deformities: Analyzing the Impact on Medial Column Alignment Adaptation Through Weightbearing Computed Tomography

Background: While weightbearing computed tomography (WBCT) has been instrumental in analyzing total ankle arthroplasty (TAA) positioning, there is a notable gap in the literature regarding adaptive changes in the foot’s medial column after TAA. This study aims to bridge this gap by comparing preoperative and postoperative alignments of the foot’s medial column and analyzing if a correlation exists between TAA coronal alignment correction and medial column alignment adaptation. Methods: Sixty patients who underwent a lateral approach TAA for end-stage osteoarthritis (OA) between January 2021 and April 2023 were included in this retrospective study. Patients were divided into varus (n = 30) and valgus (n = 30) groups. Preoperative and postoperative WBCT scans were analyzed to measure medial column alignment. Statistical analysis evaluated alignment corrections and correlations. Results: Both groups showed significant plantarflexion of the second tarsometatarsal (TMT) angle, with a median adaptation of −1 degree (IQR −3, 0; P <.01) in the valgus group and −1 degree (IQR −3, 0; P =.03) in the varus group. The varus group exhibited increased plantarflexion of the first TMT angle (median −1 degree, IQR −1, −2; P =.03). Both groups demonstrated increased adduction of the medial column. The talonavicular coverage angle adaptation averaged 7.2 ± 14 degrees (P <.01) in the valgus and 9 ± 12 degrees (P <.01) in the varus group. The talo–first metatarsal axial angle adaptation was 5 ± 13 degrees (P =.03) in the valgus group and 9.5 ± 15 degrees (P =.08) in the varus group. Conclusion: WBCT analysis revealed significant medial column adaptation post-TAA in varus and valgus alignments. However, no correlation was found between hindfoot correction and forefoot adaptation, making it challenging to predict the need for additional realignment surgeries. Future studies should explore the relationship between tibiotalar correction and medial column alignment to improve outcomes and the influence of total ankle design on medial column adaptation. Level of Evidence: Level III, retrospective case control study.