Radiographic changes of the mid-tarsal joint after calcaneal lengthening for planovalgus foot deformity

Abstract Background Several risk factors for adult acquired flatfoot deformity (AAFD) have been identified in literature. To this date, little attention has been paid to the lateral ligament complex and its influence on AAFD, although its anatomic course and anatomic studies suggest a restriction to flatfoot deformity. The aim of this study was to assess the influence of the anterior talofibular ligament (ATFL) on AAFD and on radiologic outcome following common operative correction by lateral calcaneal lengthening. Methods We reviewed all patients that underwent lateral calcaneal lengthening for correction of AAFD between January 2008 and July 2018 at our clinic. Patients were grouped according to the preoperative MRI findings into those with an intact ATFL and those with an injured ATFL. Two independent readers assessed common radiographic flatfoot parameters on preoperative and postoperative radiographs. Results Sixty-four flatfoot corrections in 63 patients were included, whereby the ATFL was intact in 29 cases, and in 35 cases the ligament was injured. An ATFL lesion was overall radiologically associated with increased flatfoot deformity with a statistically significant difference between the two groups for preoperative talometatarsal-angle (p = 0.002), talocalcaneal-angle (p = 0.000) and talonavicular uncoverage-angle (p = 0.005). No difference between the two groups could be observed regarding the success of operative correction or operative consistency after lateral calcaneal lengthening. Conclusion The ATFL seems to influence the extent of AAFD. In patients undergoing lateral calcaneal lengthening, the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.

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Calcaneal Sliding Osteotomy Versus Calcaneal Lengthening Osteotomy for Valgus Foot Deformity Correction in Children With Cerebral Palsy

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001790 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Susan A. Rethlefsen ◽

Alison M. Hanson ◽

Tishya A.L. Wren ◽

Robert M. Kay

Keyword(s):

Cerebral Palsy ◽

Deformity Correction ◽

Foot Deformity ◽

Children With Cerebral Palsy ◽

Lengthening Osteotomy ◽

Calcaneal Lengthening

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Radiographic Analysis of Surgically Treated Flatfoot Deformity in Children with Cerebral Palsy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00285 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0028

Author(s):

Alicia Kerrigan ◽

Waleed Kishta

Keyword(s):

Cerebral Palsy ◽

Surgical Intervention ◽

Pes Planovalgus ◽

Foot Deformity ◽

Radiographic Parameters ◽

Radiographic Measurements ◽

Children With Cerebral Palsy ◽

Before And After ◽

Lengthening Osteotomy ◽

Calcaneal Lengthening

Category: Midfoot/Forefoot Introduction/Purpose: Pes planovalgus is the most common foot deformity in children with cerebral palsy (CP). Many of these patients become functionally limited and require surgical intervention. The objectives of this study are to apply previously validated radiographic parameters to radiographs of children with CP who have undergone surgical intervention for pes planovalgus deformity and to assess if these radiographic parameters show improvements post-operatively. Furthermore, this study aims to determine which of these parameters can most accurately be used to quantify correction post-surgery. Methods: A retrospective review was performed to identify patients aged five to 17 with a diagnosis of CP who underwent lateral calcaneal lengthening osteotomy for pes planovalgus between 2006 and 2015 at London Health Sciences Center. The previously validated radiographic measurements were applied to pre-operative and post-operative radiographs. A normality test was performed to observe whether participants were normally distributed with regard to the severity of their deformity. Paired T-test and Wilcoxon signed-rank test were used to compare changes in radiographic measurements from before and after surgery. Results: Seventeen patients met the inclusion criteria. The average age of selected patients was 13.06 years (range 9.42-16.75 years). This included 11 males and six females, all with spastic CP (12 diplegic, five hemiplegic). Of these patients, 11 underwent bilateral surgery and six underwent unilateral surgery (28 feet). These patients were followed post-operatively for a mean of 7.97 months (range 1.5-20 months). In comparing the radiographs from before and after surgery, statistically significant changes were seen in five out of the seven measurements. Talonavicular coverage angle was found to have the most significant change post-correction. Conclusion: The previously validated radiographic parameters used to assess foot and ankle deformity can be applied to the surgically treated pes planovalgus foot in patients with CP. It was found that five out of the seven measurements used to assess foot deformity changed significantly with surgical intervention. Talonavicular coverage angle was found to be the most accurate measure for post-surgical correction. This is the first study to apply these parameters to CP patients with surgically treated flatfoot deformity. Lateral calcaneal lengthening osteotomy significantly improves these radiographic measures.

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The Role of the Anterior Talofibular Ligament in Acquired Flat Foot Deformity and in the Operative Correction by Lateral Calcaneal Lengthening

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00237 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0023

Author(s):

Lukas Jud ◽

Arnd Viehöfer ◽

Sarvpreet Singh ◽

Stefan Zimmermann ◽

Tobias Götschi ◽

...

Keyword(s):

Surgical Outcome ◽

The Other ◽

Lateral Ligament ◽

Anterior Talofibular Ligament ◽

Foot Deformity ◽

Flat Foot ◽

Postoperative Result ◽

Significant Difference ◽

Calcaneal Lengthening

Category: Hindfoot Introduction/Purpose: Different factors are well known influencing the development of adult acquired flatfoot (AAF) deformity. So far less attention was paid to the lateral ligament complex. The idea that the anterior talofibular ligament (ATFL) probably influences AAF could be obvious concerning its anatomical course. Goal of this study is to assess the influence of ATFL on AAF and on operative AAF correction by lateral calcaneal. Methods: We reviewed all patients that undergone lateral calcaneal lengthening in AAF from 01/01/2008 to 07/31/2018 in our clinic. Patients were grouped in patients with intact ATFL and in those with injured ligament. Two independent readers performed assessment of common radiographic flatfoot parameters in preoperative and postoperative radiographs. Results: Statistical significant difference between two groups could be observed for preoperative talonavicular uncoverage angle (p=0.018) and talocalcaneal angle (p=0.032), with more severe AAF in patients with injured ATFL. The other common radiographic parameters showed no significant difference, although a tendency to a more severe AAF could be observed within the group with damaged ATFL. No difference could be observed in surgical outcome or consistency after lateral calcaneal lengthening between two groups. Conclusion: ATFL seems to take impact in AAF concerning talonavicular uncoverage angle and talocalcaneal angle. In patients undergoing lateral calcaneal lengthening the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.

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