Grice Arthrodesis



- Discussion:
    - extra-articular arthrodesis which is useful in blocking subtalar motion in those patients who have no gross skeletal deformities but have 
           instability of the hindfoot;
    - this arthrodesis is particularlly applicable in children, since there is little interference with future growth of the foot;
    - spastic pes valgus is most common in pts who have spastic diplegia and is generally resistant to orthotic management;
    - subtalar extra-articular arthrodesis that was originally devised by Grice for the management of pes valgus due to flaccid paralysis muscle 
           imbalance has also been widely used in patients who have cerebral palsy;
    - Grice procedure is simple method of obtaining fusion of subtalar joint;
    - it was originally described for use in the immature foot deformed with a hindfoot valgus secondary to CP, poliomyelitis, and other paralytic 
           foot deformities;
    - on occassion it may also be used for degenerative disorders of the hindfoot;
    - this procedure can be used for calcaneocavus, calcaneovalgus, talocalcaneal coalition, congenital vertical talus, and isolated post 
           traumatic arthritis of the sub talar joint;
    - should triple arthrodesis be necessary later in life, it is felt that early correction w/ Grice procedure makes the operation easier because it 
           restores the anatomy more nearly to normal;
    - Grice procedure has been used in the treatment of varus deformities of the hindfoot in children;
    - varus deformity, however, has tended to recur in these cases, and Grice procedure is not currently recommended for varus deformity
    - degree of valgus deformity is difficult to define;
    - progression of deformity is a chief indication for treatment;
    - children w/ the valgus deformity rarely present with pain;
    - goal of operation for growing child is to perform definative procedure on hindfoot that corrects deformity, restores height of foot, and yet 
         does not interfere w/ subsequent growth of the foot;
    - triple arthrodesis, interferes with subsequent growth of the foot, and does not restore the height of the foot

- Radiographs:
    - lateral radiograph of the foot, held in slight equinus and inversion, will confirm whether the valgus deformity of the subtalar joint is fully 
         corrected

- Contraindications:
    - it is necessary that the hindfoot by flexible and corretable passively to a plantigrade position;
    - rigid deformed hindfoot is a contraindication to the Grice procedure;
    - most older children ( > 10 years) & adults with pathologic hindfoot valgus, will show evidence of secondary degenerative changes of the 
         talonavicular and calcaneocuboid joints;
         - these are relative contraindications for the Grice procedure;
    - Grice procedure is not recommended for varus deformities



The Grice procedure. Extra-articular subtalar arthrodesis.

Extra-articular subtalar arthrodesis. A long-term follow-up in patients with cerebral palsy.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, May 23, 2012 1:12 pm