Tibiotalocalcaneal arthrodesis is indicated in severe combined arthritis of the upper and lower ankle joints and otherwise untreatable malpositioning of the hindfoot.
Currently available arthrodesis nails have a hindfoot valgus bend which allows the anatomy to be more faithfully reproduced and respected. Anatomical investigations show the endangered structures during retrograde arthrodesis nailing. The valgus bend of the arthrodesis nail necessitates a corresponding correctly placed opening in the calcaneus and talus as the entry point for the nail. A locking screw in the calcaneus running from posterior to anterior increases the stability and is now taken into consideration for nearly all designs of arthrodesis medullary nails. The compression mechanism can be used for apposition and pressing the arthrodesis surfaces together and locking in the hindfoot should be carried out in an angle stable fashion. Augmentation of the locking screws in the calcaneus with bone cement can be an option as a salvage procedure in revision cases.