Effect of Calcaneal Osteotomy and Lateral Column Lengthening on the Plantar Fascia: A Biomechanical Investigation

1998 ◽  
Vol 19 (6) ◽  
pp. 370-373 ◽  
Author(s):  
Greg A. Horton ◽  
Mark S. Myerson ◽  
Brent G. Parks ◽  
Yong-Wook Park
Keyword(s):  
Plantar Fascia ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Biomechanical Investigation ◽  
Lateral Column Lengthening

scholarly journals Effect of Lateral Column Lengthening Calcaneal Osteotomy on Radiographic Measurements of Foot Alignment

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0002
Author(s):  
Chris Anthony ◽  
Jessica Goetz ◽  
Adam Kruse ◽  
Andrew Kern ◽  
John Femino
Keyword(s):  
Cyclic Loading ◽  
Interobserver Agreement ◽  
Plantar Fascia ◽  
Flat Foot ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Metatarsal Angle ◽  
Foot Model ◽  
Lateral Column Lengthening ◽  
Foot Alignment

Category: Hindfoot Introduction/Purpose: Lateral column lengthening (LCL) with calcaneal osteotomy has been increasingly used for reconstruction in flexible flat foot reconstruction. The aims of this study were to 1) evaluate the effects of variably sized LCL blocks on the restoration of alignment in an acute flat foot cadaveric model; 2) create a computer algorithm to more objectively measure foot alignment; and 3) develop an acute flat foot model that does not require cyclic loading for creating a type IIB flat foot. Determining if overcorrection with lateral column lengthening can occur would provide guidance surgeons to avoid lateral column overload. A computer guided measurement program could make studies more comparable. An acute flat foot model would clarify the ligament deficiencies necessary to create a type IIB flat foot. Methods: A type IIB flat foot model was used in which the medial and medial-plantar fibers of the calcaneonavicular (CN), the interosseous talo-calcaneal (ITCL) and the cervical (CL) ligaments were transected. Metallic markers were placed in the PF origin. 3D weightbearing CT scans were obtained with the specimens in a custom jig that permitted loading with 100 lbs. (445 N). The jig allowed full pronation under load. Scans were obtained: intact, flat, and with 6, 8 and 10 mm LCL blocks. Simulated AP and lateral radiographs were created using a custom MATLAB program. A custom ImageJ plugin was created which guided measurement of Meary’s angle, naviculo-cuneiform overlap, AP talo-first metatarsal angle, and a novel plantar fascia (PF) distance and PF angle. The program automatically calculated midpoints and perpendicular lines from guided user input. Four observers performed all measurements in blinded and randomized fashion on two occasions greater than 12 weeks apart. Results: The ligament sectioning model reliably produced a type IIB flat foot as noted by talo-navicular sag, increased talar head uncovering (forefoot abduction) and divergence of the talus and calcaneus as seen on the AP weightbearing view (Figure 1). Cyclic loading was not required in any specimens and the remaining medial column ligaments were not sectioned. Intraobserver and interobserver comparisons indicated naviculo-cuneiform overlap and plantar fascia distance had excellent interobserver agreement and Meary’s and plantar fascia angle had good interobserver agreement (Figure 1). Lateral column lengthening trended toward overcorrection at 10 mm suggesting a possible threshold for over-correction. Conclusion: The trend toward overcorrection with 10 mm LCL may indicate a threshold for lateral column overload. Computer guided measurement may improve consistency when comparing studies. The PF measurements are not possible in vivo. The use of a heel centering ring might be a surrogate for the implanted metallic beads. The CL sectioning was essential for creating type IIB flat foot without cyclic loading. The CL has been noted to be a main subtalar stabilizer, but has not entered into mainstream discussions regarding flat foot. Changes that occurred with cyclic loading performed in other flat foot studies have not been defined.

Comparative Outcomes Between Step-Cut Lengthening Calcaneal Osteotomy vs Traditional Evans Osteotomy for Stage IIB Adult-Acquired Flatfoot Deformity

2017 ◽  
Vol 39 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Stuart M. Saunders ◽  
Scott J. Ellis ◽  
Constantine A. Demetracopoulos ◽  
Anca Marinescu ◽  
Jayme Burkett ◽  
...  
Keyword(s):  
Deformity Correction ◽  
Categorical Variables ◽  
Distributed Data ◽  
Level Of Evidence ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Outcome Scores ◽  
Lateral Column Lengthening ◽  
Adult Acquired Flatfoot Deformity ◽  
Lateral Pain

Background: The forefoot abduction component of the flexible adult-acquired flatfoot can be addressed with lengthening of the anterior process of the calcaneus. We hypothesized that the step-cut lengthening calcaneal osteotomy (SLCO) would decrease the incidence of nonunion, lead to improvement in clinical outcome scores, and have a faster time to healing compared with the traditional Evans osteotomy. Methods: We retrospectively reviewed 111 patients (143 total feet: 65 Evans, 78 SLCO) undergoing stage IIB reconstruction followed clinically for at least 2 years. Preoperative and postoperative radiographs were analyzed for the amount of deformity correction. Computed tomography (CT) was used to analyze osteotomy healing. The Foot and Ankle Outcome Scores (FAOS) and lateral pain surveys were used to assess clinical outcomes. Mann-Whitney U tests were used to assess nonnormally distributed data while χ2 and Fisher exact tests were used to analyze categorical variables (α = 0.05 significant). Results: The Evans group used a larger graft size ( P < .001) and returned more often for hardware removal ( P = .038) than the SLCO group. SLCO union occurred at a mean of 8.77 weeks ( P < .001), which was significantly lower compared with the Evans group ( P = .02). The SLCO group also had fewer nonunions ( P = .016). FAOS scores improved equivalently between the 2 groups. Lateral column pain, ability to exercise, and ambulation distance were similar between groups. Conclusion: Following SLCO, patients had faster healing times and fewer nonunions, similar outcomes scores, and equivalent correction of deformity. SLCO is a viable technique for lateral column lengthening. Level of Evidence: Level III, retrospective cohort study.

A biomechanical analysis of the effect of lateral column lengthening calcaneal osteotomy on the flat foot

2007 ◽  
Vol 22 (4) ◽  
pp. 472-477 ◽  
Author(s):  
George A. Arangio ◽  
Vikram Chopra ◽  
Arkady Voloshin ◽  
Eric P. Salathe
Keyword(s):  
Biomechanical Analysis ◽  
Flat Foot ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Lateral Column Lengthening

scholarly journals Radiographic Union of Evans Osteotomy Without Fixation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0035
Author(s):  
Megan R. Miles ◽  
Brian P. Gallagher ◽  
Katherine L. Mistretta ◽  
Nigel N. Hsu ◽  
Haijun Wang ◽  
...  
Keyword(s):  
Allogenic Bone ◽  
Lateral Column ◽  
First Metatarsal ◽  
Calcaneocuboid Joint ◽  
Calcaneal Osteotomy ◽  
Metatarsal Angle ◽  
Flexible Flatfoot ◽  
Lateral Column Lengthening ◽  
Allogenic Bone Graft

Category: Hindfoot; Other Introduction/Purpose: The Evans osteotomy is a lateral column lengthening procedure of the calcaneus that is commonly used to correct flexible flatfoot deformities. There is no consensus on whether fixation is needed to avoid nonunion and calcaneocuboid subluxation when performing this osteotomy. We assessed the nonunion rate and correlated extent of subluxation with graft size in an unfixed Evans osteotomy with an allograft wedge and no pinning of the calcaneocuboid joint at any point in the largest series of the procedure to date. Surgeries were performed in patients undergoing flexible flatfoot reconstruction. Methods: We retrospectively reviewed 120 consecutive patients who had undergone 145 unfixed Evans osteotomies by a single surgeon with allogenic bone graft for flatfoot reconstruction between January 2013 and October 2017, with a mean follow-up of 62.5 (range 9.4-266.7) weeks. The calcaneocuboid joint was not pinned during the procedure. Data were collected using clinical and radiographical examination during regular follow-up. Results: A total of 137 feet (94.5%) underwent a double calcaneal osteotomy with an associated medial displacement calcaneal osteotomy (MDCO). There was one nonunion (0.69%). The mean time to union was 10.8 (range, 6.7-17.9) weeks. There was significant improvement in all radiographic parameters postoperatively, including calcaneal pitch, talonavicular uncoverage, anteroposterior and lateral talo-first metatarsal angle, lateral column length, and naviculocuboid overlap (p<0.05). Minor postoperative calcaneocuboid joint subluxation (1.51 +- 2.3 mm) occurred in 72 of 118 feet (61.0%) and had no correlation with wedge size (r=0.06; 95% CI, -0.13, 0.24; p=0.6). Conclusion: An unfixed Evans osteotomy for symptomatic flatfoot deformity resulted in a significant improvement in the radiographic alignment of the foot with an exceptionally rare nonunion rate. Detectable calcaneocuboid subluxation was common but minimal in extent and was not correlated with wedge size in this series in which wedges were less than 12 mm in the maximum dimension. This report represents the largest series of the Evans procedure to date.

scholarly journals Occupational Outcomes Of Reconstructive Surgery For Adult Acquired Flatfoot Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Michael Finnern ◽  
Claude Anderson ◽  
Paul Ryan
Keyword(s):  
Reconstructive Surgery ◽  
Recovery Period ◽  
The United States ◽  
Active Duty ◽  
Pes Planus ◽  
Lateral Column ◽  
Calcaneal Osteotomy ◽  
Lateral Column Lengthening ◽  
The Military

Category: Hindfoot Introduction/Purpose: Reconstruction of a symptomatic adult flatfoot is an involved operation with a long recovery period. No previous studies have looked at the occupational or functional results of athletically active patients who have undergone this surgery. In the United States military, the rates of return to unrestricted active duty are unknown. Methods: A retrospective review of all active duty military patients who underwent a reconstructive surgery for adult acquired flatfoot surgery at a single institution from January 2001-2015 was performed. Surgical, inpatient, and outpatient databases were searched via CPT and ICD9 codes. Approximately 1300 cases with potential flatfoot reconstructive surgery were identified. Only those patients with the diagnosis of flatfoot treated with both a boney procedure and a soft tissue procedure were included. Patients had to have at least one year follow-up or follow-up to the point of maximum medical benefit as defined by the operative provider. Final disposition of the patients had to have been recorded in the medical record. Three possible outcomes were utilized in the review of this cohort: patient returned to duty without restrictions, patient returned to active duty with restrictions, or patient separated from active duty due all or in part to this medical condition. Results: Fifty patients met inclusion criteria. 30/50 patients (60%) remained on active duty with permanent duty restrictions, and only two of 50 patients (4%) returned to full duty without restrictions. 20/50 (40%) underwent a Medical Evaluation Board (MEB) to separate from the military. A difference was noted in terms of the hindfoot realignment procedure performed: the probability of an MEB is higher for those patients who had a lateral column lengthening procedure than those who were treated with a medializing calcaneal osteotomy. Conclusion: The sample size is the largest study to date of patients with surgical correction for symptomatic pes planus. The results demonstrate that a service member with symptomatic pes planus requiring surgery faces a 96% chance of failure to return to pre-injury level of function. While some (60%) were able to remain on active duty with restrictions, there is a 40% chance that service members will face separation from the military due to their foot pain. Furthermore, patients treated with a lateral column lengthening had a higher probability of being medically discharged than those who had a medializing calcaneal osteotomy.

Biomechanical Effects of Graft Shape for the Evans Lateral Column Lengthening Procedure: A Patient-Specific Finite Element Investigation

2021 ◽  
pp. 107110072110438
Author(s):  
Jiaju Wu ◽  
Hua Liu ◽  
Can Xu
Keyword(s):  
Finite Element ◽  
Plantar Fascia ◽  
Patient Specific ◽  
Level Of Evidence ◽  
Element Analysis ◽  
Lateral Column ◽  
Calcaneocuboid Joint ◽  
Spring Ligament ◽  
Calcaneal Osteotomy ◽  
Calcaneal Lengthening

Background: The Evans calcaneal lengthening osteotomy procedure is widely used for correcting progressive collapsing foot deformity. However, it can result in overcorrection and degenerations of the calcaneocuboid joint. Different shapes of graft have been used in the Evans calcaneal osteotomy, but potential differences in their biomechanical effects is still unclear. The present study was designed to explore the biomechanical effects of graft shape and improve the Evans procedure to avoid or minimize detrimental effects. Methods: Twelve patient-specific finite element models were established and validated. A triangular or rectangular wedge of varying size was inserted at the lateral edge of calcaneus, and the degree of correction was quantified. The stress in spring ligaments and plantar fascia and the contact characteristics of the talonavicular and calcaneocuboid joints were calculated and compared accordingly. Results: The rectangular graft provided a much higher degree of correction than triangular grafts did. However, the contact characteristics of the calcaneocuboid joint and talonavicular joint were abnormal, with clear sensitivity to increased graft size, and the modeled strain of the spring ligament increased. Conclusion: The finite element analysis predicts that the rectangular grafts provide a higher degree of correction, but risks overcorrection compared with triangular grafts. The triangular graft may have a lower degree of disturbance to the biomechanical behaviors of the midtarsal joint. Clinical Relevance: The model shows that both the shape and size of an Evans osteotomy bone wedge can have effects on the contiguous joints and ligamentous structures. Those effects should be considered when selecting a bone wedge for an Evans calcaneal osteotomy. Level of Evidence: Level III, case-control study.

scholarly journals The Effect of Lateral Column Lengthening on Subtalar Motion: Are We Trading Deformity for Stiffness?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Brittany Hedrick ◽  
Anthony Riccio ◽  
Danielle M. Thomas ◽  
Claire Shivers ◽  
Matthew Siebert ◽  
...  
Keyword(s):  
Motion Capture ◽  
Three Dimensional ◽  
Deformity Correction ◽  
Porous Titanium ◽  
Testing System ◽  
Materials Testing ◽  
Lateral Column ◽  
Fresh Frozen ◽  
Lateral Column Lengthening ◽  
Paired T Test

Category: Hindfoot; Other Introduction/Purpose: While lengthening of the lateral column through a calcaneal neck osteotomy is an integral component of flatfoot reconstruction in younger patients with flexible planovalgus deformities, concern exists as to the effect of this intra- articular osteotomy on subtalar motion. The purpose of this study is to quantify the alterations in subtalar motion following lateral column lengthening (LCL). Methods: The subtalar motion of 14 fresh frozen cadaveric feet was assessed using a three-dimensional motion capture system and materials testing system (MTS). Following potting of the tibia and calcaneus, optic markers were placed into the tibia, calcaneus and talus. The MTS was used to apply a rotational force across the subtalar joint to a torque of 5Nm. Abduction/adduction, supination/pronation, and plantarflexion/dorsiflexion about the talus was recorded. Specimens then underwent LCL via a calcaneal neck osteotomy which was maintained with a 12mm porous titanium wedge. Repeat subtalar motion analysis was performed and compared to pre-LCL motion using a paired t-test. Results:: No statistically significant differences in subtalar abduction/adduction (10.9O vs. 11.8O degrees, p=.48), supination/pronation (3.5O vs. 2.7O, p=.31), or plantarflexion/dorsiflexion (1.6O vs 1.0O, p=.10) were identified following LCL. Conclusion:: No significant changes in subtalar motion were observed following lateral column lengthening in this biomechanical cadaveric study. While these findings do not obviate concerns of clinical subtalar stiffness following planovalgus deformity correction, they suggest that diminished postoperative subtalar motion may be due to soft tissue scarring rather than alterations of joint anatomy.

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