Adaptive foot remodeling and tibiocalcaneal arthrodesis for long-standing ankle valgus deformity after childhood arthrodesis: A rare case report

Abstract

Ankle valgus deformity is a recognized late complication after fibular loss or ankle arthrodesis in childhood. We report a 26-year-old man with severe ankle valgus that progressed over more than 20 years after ankle arthrodesis performed at age 5 for infectious destruction, with near-complete fibular loss. He presented with progressive deformity, difficulty walking, and recurrent medial ulceration. Imaging showed a fused tibiotalar joint in approximately 45° of valgus, with marked compensatory hindfoot and midfoot remodeling preserving a relatively plantigrade foot. A three-dimensional-printed model guided a tibial axis-shifting osteotomy combined with tibiocalcaneal arthrodesis, restoring a collinear tibia-to-calcaneus axis while preserving the foot’s remodeled architecture. At 24 months, fusion was solid, pain had resolved, and the patient ambulated independently. This case illustrates adaptive foot remodeling after childhood ankle arthrodesis and supports tibial translation with tibiocalcaneal arthrodesis as a salvage option for long-standing, severely remodeled ankle valgus.