EDITORIAL   

Chirurgia Del Piede 2000 September;24(3):173-86

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

From Grice to endorthesis

Pisani G.

Based on the concepts, indications and technique of Green-Grice's arthrorhysis of the subtalar joint, reference is made to the ''calcaneous-stop'' operation proposed by Recaredo-Alvarez in 1970, which I subsequently modified both in the means of rhysis (calcaneal endorthesis) and the positioning of the means of rhysis itself. This involved the concept of extra-articular and extrasinutarsal rhysis in the treatment of evolutivc childhood splayfoot in which the valgus of the calcaneum is the common denominator of the various anatomic and clinical symptoms (calcaneovalgus, cavovalgus, flatfoot). During the course of twenty years' experience of the use of endorthesis, I am personally convinced that, instead of the mechanical effect, the correction of the deformity occurs through the sole use of endorthesis owing to a proprioceptive mechanism induced by means of the rhysis in the sinus tarsi. Studies of the proprioceptive nervous representation of the sinus itself might support the hypothesis based on clinical observations. This leads to the subsequent passage to the ''biofeedback arthrorhysis'', with screws on the floor of the sinus tarsi, without any mechanical effect, in those dysmorphisms of the foot referred to above, in particular calcaneovalgus, as the outcome of a disorder of the normal ontomorphogenetie ovolutivc process. In 14 cases undergoing on the one hand classic endorthesis and, on the other, the ''biofeedback'' arthrorhysis, the results were fully comparable. It is clear that in other situations (vertical astragalus, sinostotic or spastic or myogenic foot or tarsal dysmetria, etc.) and as a complementary stage, endosinotarsal arthrorhysis provide a better guarantee, in mechanical terms, of the stabilisation of the new talo-calcaneal ratios obtained through corrective surgery. Moreover, the possible damage provoked at the level of the endosinutarsal structures is not relevant in relation to the damage occurring during corrective surgery itself.