[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-407989-105":59,"doc-detail-407989-en":122},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":115,"head_meta":117,"extra_data":119,"updated_unix":121},105,"en","valgus-stress-radiography-as-a-criterion-for-total-ankle-arthroplasty-without-medial-malleolar-osteotomy-a-report-of-three-severe-varus-cases","Valgus Stress Radiography as a Criterion for Total Ankle Arthroplasty Without Medial Malleolar Osteotomy - A Report of Three Severe Varus Cases","","Total ankle arthroplasty (TAA) is used for ankle arthritis, but severe varus deformity can complicate implant alignment and increase early loosening risk. Medial malleolar osteotomy may enable better positioning, yet it introduces risks such as nonunion and delayed rehabilitation. This case report describes three severe varus cases (preoperative talar tilt >15°) treated with TAA without medial malleolar osteotomy, using preoperative valgus stress radiography to select patients. With a provisional valgus-stress correction threshold of talar tilt ≤10°, all patients achieved pain relief, improved mobility, and satisfactory radiographic alignment at one year, though two patients developed suspected or nondisplaced medial malleolar fractures.",{"@graph":69,"@context":114},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/valgus-stress-radiography-as-a-criterion-for-total-ankle-arthroplasty-without-medial-malleolar-osteotomy-a-report-of-three-severe-varus-cases/407989/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/valgus-stress-radiography-as-a-criterion-for-total-ankle-arthroplasty-without-medial-malleolar-osteotomy-a-report-of-three-severe-varus-cases/407989.png","ImageObject",300,407,{"name":92,"@type":93},"Franzy","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108],{"name":109,"@type":110,"acceptedAnswer":111},"What were the outcomes and complications reported at follow-up?","Question",{"text":112,"@type":113},"At one year, all three patients achieved pain relief, improved mobility, and satisfactory radiographic alignment without implant loosening. Minor complications included two suspected or nondisplaced medial malleolar fractures that healed without intervention or unloading.","Answer","https://schema.org",{"og:url":83,"og:type":116,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":118,"canonical":83},"index,follow",{"doc_id":120,"site_id":62},407989,1790671993,{"code":4,"msg":5,"data":123},{"doc_id":120,"user_id":124,"nickname":92,"user_avatar":125,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":126,"file_id":127,"file_url":128,"file_type":129,"file_size":130,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":131,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":132,"faqs":133,"seo_title":134,"seo_description":67,"update_tm":135,"read_time":46,"preview_page_count":4},2336478945519,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Review began 11/16/2025  \nReview ended 11/27/2025  \nPublished 12/01/2025  \n© Copyright 2025  \nEtani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98222  \nOpen Access Case Report  \nValgus Stress Radiography as a Criterion for Total Ankle Arthroplasty Without Medial Malleolar Osteotomy: A Report of Three Severe Varus Cases  \nYuki Etani 1, Takaaki Noguchi 2 , Seiji Okada 2, Ken Nakata 3 , Kosuke Ebina 2  \n1. Department of Sports Medical Biomechanics, The University of Osaka Graduate School of Medicine Faculty of Medicine, Suita, JPN 2. Department of Orthopaedic Surgery, The University of Osaka Graduate School of Medicine Faculty of Medicine, Suita, JPN 3. Department of Health and Sport Sciences, The University of Osaka Graduate School of Medicine Faculty of Medicine, Suita, JPN  \nCorresponding author: Takaaki Noguchi, [noguchi.takaaki.eyt@osaka-u.ac.jp](noguchi.takaaki.eyt@osaka-u.ac.jp)  \nAbstract  \nTotal ankle arthroplasty (TAA) is performed for ankle arthritis; however, in cases with severe varus deformity, malalignment of implant positioning, and early loosening can be problematic. Medial malleolarosteotomy is often performed in such cases to facilitate proper implant positioning, but it carries risks including nonunion and delayed rehabilitation. This study reports three cases of TAA for severe varus ankle deformity (preoperative talar tilt >15°) performed without medial malleolar osteotomy, using preoperative valgus stress radiography as the selection criterion. Based on our clinical experience, we hypothesized that in cases where varus deformity can be corrected (talar tilt ≤10°) under valgus stress (a provisional threshold defined empirically), acceptable short-term outcomes might be achieved without osteotomy. Accordingly, three elderly women (aged 73-78 years; one with rheumatoid arthritis, two with osteoarthritis) meeting this criterion underwent TAA and were followed for one year. Standard rehabilitation was initiated in all but one case, requiring a tailored rehabilitation program due to concomitant surgery. Minor complications included two suspected or nondisplaced medial malleolar fractures, both healing without medical intervention or unloading. At final follow-up, all patients achieved pain relief, improved mobility, and satisfactory radiographic alignment without implant loosening. Preoperative valgus stress radiography may assist in identifying selected patients who can undergo TAA without medial malleolar osteotomy. However, the high incidence of medial malleolar fracture in this small cohort indicates that the provisional 10° cutoff should be interpreted with caution and may not be sufficiently conservative. Larger studies are needed to determine a safer and more appropriate threshold for omitting medial malleolar osteotomy.  \nCategories: Orthopedics  \nKeywords: ankle, osteoarthritis, rheumatoid arthritis, total ankle arthroplasty, varus  \nIntroduction  \nTotal ankle arthroplasty (TAA) is an established surgical option for end-stage ankle osteoarthritis (OA) and rheumatoid arthritis (RA), and is considered particularly suitable for elderly patients or those with low functional demand [1,2] . However, its applicability in patients with severe varus deformity (talar tilt >15°) has been questioned, as such cases are associated with higher complication and revision rates [3,4] . To address this issue, medial malleolar osteotomy in conjunction with TAA has been advocated to correct coronal malalignment and facilitate proper implant positioning [5] . Although effective in certain cases, this procedure carries risks such as displacement or nonunion at the osteotomy site and implant failure [6] .  \nAvoiding medial malleolar osteotomy when it is not strictly necessary may lead to better ou","cbCaig2ijpBFKqzp","https://ap.wps.com/l/cbCaig2ijpBFKqzp","pdf",1584486,"English","# Abstract\n# Introduction\n# Case Presentation\n## Patients and preoperative assessment\n## Surgical approach and rehabilitation\n## Complications and follow-up","[{\"question\":\"What were the outcomes and complications reported at follow-up?\",\"answer\":\"At one year, all three patients achieved pain relief, improved mobility, and satisfactory radiographic alignment without implant loosening. Minor complications included two suspected or nondisplaced medial malleolar fractures that healed without intervention or unloading.\"}]","Valgus Stress Radiography as a Criterion for Total Ankle Arthroplasty Without Medial Malleolar Osteotomy - A Report of Three Severe Varus Cases | PDF",1790577534]