{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:08:20Z","timestamp":1760144900742,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Subtalar distraction arthrodesis (SDA) is a surgical procedure designed to treat hindfoot deformities associated with isolated subtalar joint arthritis. In 1996, Fitzgibbons was the first to observe that, in some cases, hindfoot fusion appeared to be associated with the development of tibiotalar valgus tilt. Since then, few studies have addressed this issue. Given that hindfoot fusion can be performed using various techniques, this study investigated the potential tibiotalar joint frontal or sagittal modifications resulting from the modified Grice\u2013Green technique. All the consecutive patients who underwent the modified Grice\u2013Green procedure were included. The patient records were reviewed to extract demographic data. Weight-bearing foot and ankle radiographs were assessed to measure the talar tilt angle and the tibiotalar ratio on the same picture archiving and communication system by three independent observers. A total of 69 patients met the criteria for inclusion. The mean talar tilt showed no substantial changes, since the increase from 1.46 \u00b1 1.62 preoperatively to 1.93 \u00b1 2.19 at a minimum of 8 months postoperatively was not statistically significant (p = 0.47). The average preoperative tibiotalar ratio significantly increased from 33.4 \u00b1 4.4% to 35 \u00b1 4% postoperatively (p = 0.007), although remaining within the normal range, indicating a possible realignment of the posterior facet of the subtalar joint. In conclusion, this study highlights the effectiveness of the modified Grice\u2013Green procedure in achieving a favorable realignment without impacting the ankle joint, particularly regarding tibiotalar valgus tilt.<\/jats:p>","DOI":"10.3390\/life14060692","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T07:38:39Z","timestamp":1716881919000},"page":"692","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Subtalar Distraction Arthrodesis on Ankle Joint: Radiological Insights from Modified Grice\u2013Green Procedure"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9279-4722","authenticated-orcid":false,"given":"Elena","family":"Artioli","sequence":"first","affiliation":[{"name":"1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"},{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9974-4787","authenticated-orcid":false,"given":"Antonio","family":"Mazzotti","sequence":"additional","affiliation":[{"name":"1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"},{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5461-4778","authenticated-orcid":false,"given":"Edoardo","family":"Cassanelli","sequence":"additional","affiliation":[{"name":"1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5378-4908","authenticated-orcid":false,"given":"Laura","family":"Langone","sequence":"additional","affiliation":[{"name":"1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3578-0946","authenticated-orcid":false,"given":"Michele","family":"Astolfi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7701-9760","authenticated-orcid":false,"given":"Pejman","family":"Abdi","sequence":"additional","affiliation":[{"name":"1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0867-1338","authenticated-orcid":false,"given":"Simone Ottavio","family":"Zielli","sequence":"additional","affiliation":[{"name":"1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6486-6300","authenticated-orcid":false,"given":"Alberto","family":"Arceri","sequence":"additional","affiliation":[{"name":"1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesare","family":"Faldini","sequence":"additional","affiliation":[{"name":"1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"},{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.fcl.2018.04.008","article-title":"Subtalar Distraction Arthrodesis","volume":"23","author":"Espinosa","year":"2018","journal-title":"Foot Ankle Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1055\/s-0039-3400452","article-title":"Mini Bone Block Distraction Subtalar Arthrodesis (SAMBB) in the Management of Acquired Adult Flatfoot with Subtalar Arthritis: A Modification to the Grice\u2013Green Procedure","volume":"7","author":"Mosca","year":"2019","journal-title":"Joints"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1177\/107110079801900802","article-title":"Isolated Subtalar Arthrodesis","volume":"19","author":"Mann","year":"1998","journal-title":"Foot Ankle Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6503","DOI":"10.1007\/s00402-023-04946-3","article-title":"Surgical Management of Clubfoot Overcorrection: A Case Series","volume":"143","author":"Faldini","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1053\/j.jfas.2011.10.001","article-title":"Allograft Cellular Bone Matrix as an Alternative to Autograft in Hindfoot and Ankle Fusion Procedures","volume":"51","author":"Hollawell","year":"2012","journal-title":"J. Foot Ankle Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"389","DOI":"10.3928\/0147-7447-19960501-08","article-title":"Bone Graft in Hindfoot Arthrodesis: Allograft vs Autograft","volume":"19","author":"McGarvey","year":"1996","journal-title":"Orthopedics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.fcl.2015.02.004","article-title":"Distraction Subtalar Arthrodesis","volume":"20","author":"Jackson","year":"2015","journal-title":"Foot Ankle Clin."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.foot.2012.10.004","article-title":"The Subtalar Distraction Bone Block Arthrodesis Following the Late Complications of Calcaneal Fractures: A Systematic Review","volume":"23","author":"Schepers","year":"2013","journal-title":"Foot"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"927","DOI":"10.2106\/00004623-195234040-00020","article-title":"An Extra-Articular Arthrodesis of the Subastragalar Joint for Correction of Paralytic Flat Feet in Children","volume":"34 A","author":"GRICE","year":"1952","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1302\/0301-620X.50B2.372","article-title":"A Modification of the Grice Subtalar Arthrodesis","volume":"50","author":"Seymour","year":"1968","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/BPB.0000000000000264","article-title":"Modified Grice-Green Subtalar Arthrodesis Performed Using a Partial Fibular Graft Yields Satisfactory Results in Patients with Cerebral Palsy","volume":"25","author":"Tokyay","year":"2016","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"415","DOI":"10.3928\/0147-7447-19960501-11","article-title":"Valgus Tilting of the Ankle Joint after Subtalar (Hindfoot) Fusion: Complication or Natural Progression of Valgus Hindfoot Deformity?","volume":"19","author":"Fitzgibbons","year":"1996","journal-title":"Orthopedics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6087","DOI":"10.1007\/s00402-023-04906-x","article-title":"Incidence and Predictors of Valgus Tibiotalar Tilt after Progressive Collapsing Foot Deformity Reconstruction Using Subtalar Fusion with Concomitant Procedures","volume":"143","author":"Kim","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1177\/1071100717690439","article-title":"Incidence and Radiographic Predictors of Valgus Tibiotalar Tilt After Hindfoot Fusion","volume":"38","author":"Weisenthal","year":"2017","journal-title":"Foot Ankle Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E139","DOI":"10.5435\/JAAOS-D-20-00189","article-title":"Understanding Radiographic Measurements Used in Foot and Ankle Surgery","volume":"30","author":"Lau","year":"2022","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1177\/107110070602700202","article-title":"Ankle Alignment on Lateral Radiographs. Part 1: Sensitivity of Measures to Perturbations of Ankle Positioning","volume":"27","author":"Tochigi","year":"2006","journal-title":"Foot Ankle Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.2106\/JBJS.K.01638","article-title":"Lengthening of the Gastrocnemius-Soleus Complex: An Anatomical and Biomechanical Study in Human Cadavers","volume":"95","author":"Firth","year":"2013","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Rochon, J., Gondan, M., and Kieser, M. (2012). To Test or Not to Test: Preliminary Assessment of Normality When Comparing Two Independent Samples. BMC Med. Res. Methodol., 12.","DOI":"10.1186\/1471-2288-12-81"},{"key":"ref_20","first-page":"e11794","article-title":"Raiders of the Lost Correlation: A Guide on Using Pearson and Spearman Coefficients to Detect Hidden Correlations in Medical Sciences","volume":"12","author":"Rovetta","year":"2020","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S1083-7515(03)00083-4","article-title":"2nd Operative Treatment of the Difficult Stage 2 Adult Acquired Flatfoot Deformity","volume":"6","author":"Pomeroy","year":"2001","journal-title":"Foot Ankle Clin."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2473011418S0021","DOI":"10.1177\/2473011418S00215","article-title":"Effect of Achilles Tendon Lengthening on Ankle and Subtalar Joint Orientation and Load Distribution Utilizing a Novel Cadaveric Model to Simulate Weight Bearing","volume":"3","author":"Duggal","year":"2018","journal-title":"Foot Ankle Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.2106\/00004623-199709000-00023","article-title":"Adult Acquired Flatfoot Deformity. Treatment of Dysfunction of the Posterior Tibial Tendon","volume":"79","author":"Mann","year":"1997","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.fcl.2012.03.011","article-title":"Update on Stage IV Acquired Adult Flatfoot Disorder. When the Deltoid Ligament Becomes Dysfunctional","volume":"17","author":"Smith","year":"2012","journal-title":"Foot Ankle Clin."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1002\/jor.25543","article-title":"Joint Coverage Analysis in Progressive Collapsing Foot Deformity","volume":"41","author":"Knutson","year":"2023","journal-title":"J. Orthop. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.fas.2015.09.002","article-title":"Talolisthesis in End Stage Ankle Arthrosis","volume":"22","author":"Christensen","year":"2016","journal-title":"Foot ankle Surg. Off. J. Eur. Soc. Foot Ankle Surg."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/6\/692\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:49:33Z","timestamp":1760107773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/6\/692"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,28]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["life14060692"],"URL":"https:\/\/doi.org\/10.3390\/life14060692","relation":{},"ISSN":["2075-1729"],"issn-type":[{"type":"electronic","value":"2075-1729"}],"subject":[],"published":{"date-parts":[[2024,5,28]]}}}