Suggest treatment for talonavicular luxation
Patient: Hi there, i am a brazilian medical doctor and suffer from cerebral palsy.While recovering from a fibular reconstruction at the contra lateral foot(the normal one), i had a lateral talo navicular luxation(the talus in the medial position compared to the mid foot.MRI:no neurovascular demage,neither condral injury.Only some calcaneus,navicular areas of bone edema at paretic foot(.Because i am not recovered from the first surgery, i have to wait some months to go to that surgery.Considering that lateral luxation is very difficult to achieve a non open reduction,probably i ll have to submit myself an artrodesis. I don´t know with it will be a triple one,or a talonavicular,maybe associated with subtalar. I have no signal of osteoarthits.i would like to know how much time i ll need weight bering and the final prognosis(moviments that will not be able to do) . I don,t practice sports ,i just need to return to work with no or mild pain.Iam a psychiatrist.Because of the first surgery i couldn´t discuss that with my ankle specialist.Sincerely yours,leonardo Doctor: Hello and welcome to ‘Ask A Doctor’ service.  I have reviewed your query and here is my advice. Based on your questions it seems that you have decided not to seek any medical help till your fibular reconstruction has improved. If you do seek help right away it might be possible to reduce the Talonavicular joint with pinning and since your non weight bearing currently it won't affect your lifestyle much anyways. If you choose to wait and get TN reduced later there is a chance you might ulcerate due to intrinsic pressure on soft tissue that is being created by navicular, not only you are increasing your chance to get a fusion which might over several years cause arthritis in other joints. Locking TN joint right away will reduce motion in subtalar joint significantly. Regarding if you choose to be under TN fusion I would not recommend getting STJ fusion with it because it will limit your motion significantly. In my opinion you should under Talonavicular reduction with temporary fixation right away before you end up compromising your soft tissue.Hope I have answered your query. Let me know if I can assist you further.Regards, Dr. Samuel Parmar