Comparison of Radiographic Outcomes Between Dynamic Medial Column Stabilization and Lateral Column Lengthening

Background: Lateral column lengthening (LCL) is a commonly performed procedure for patients with stage II adult-acquired flatfoot deformity (AAFD) to correct forefoot abduction. This procedure is frequently completed concomitantly with both soft-tissue and bony procedures, including a medial slide calcaneal osteotomy to further reduce hindfoot valgus. The purpose of this study is to investigate and identify the radiographic outcomes of a modified step-cut LCL utilized as an alternative approach for correction of stage II AAFD. Methods: A retrospective radiographic review was performed on 15 feet in 14 patients who underwent correction of stage II AAFD using a step-cut LCL between August 2009 and January 2012. Two independent examiners utilizing 6 radiographic parameters evaluated preoperative and postoperative weight-bearing radiographs of the foot. Results: At a mean follow-up of 13.4 (range 12-16) weeks, weight-bearing radiographs demonstrated a significant median decrease in the lateral talometatarsal angle of 14.4° (P < .001), lateral talocalcaneal angle of 7° (P < .001), anteroposterior talometatarsal angle of 14.5° (P < .001), anteroposterior talocalcaneal angle of 5.5° (P < .001), and talonavicular coverage angle of 26.5° (P < .001). Additionally, a significant median increase in calcaneal pitch of 8.5° (P < .001) was noted. Conclusion: This study demonstrates statistically significant improvement of radiographic outcomes with use of a modified step-cut LCL as an alternative approach for correction of stage II AAFD. Levels of Evidence: Level IV: Retrospective case series

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Radiographic Outcomes in the Treatment of Type II Adult Acquired Flatfoot Deformity Following Lateral Column Lengthening with a Titanium Wedge versus Autograft or Allograft

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00370 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0037

Author(s):

Casey M. O’Connor ◽

Afshin Anoushiravani ◽

Kyle Richardson ◽

Matthew Anderson ◽

Andrew J. Rosenbaum

Keyword(s):

Surgical Procedure ◽

Weight Bearing ◽

Bone Substitutes ◽

Wedge Osteotomy ◽

Foot Deformity ◽

Flat Foot ◽

Lateral Column ◽

Radiographic Outcomes ◽

Patient Reported ◽

Lateral Column Lengthening

Category: Midfoot/Forefoot Introduction/Purpose: Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction occurring in patients with stage IIB Adult Acquired Flat Foot Deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus which is then filled with autograft, allograft, or a titanium wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes in the setting of stage IIB AAFD with the use of LCL. Methods: All patients who underwent LCL from October 2008 until October 2018 were retrospectively reviewed. Preoperative weight bearing radiographs, initial postoperative radiographs and 1-year weight bearing radiographs were reviewed. The following radiographic measurements were recorded: talonavicular uncoverage angle, incongruency angle, and calcaneal pitch. Results: A total of 44 patients were included in our study. The mean age of the cohort was 54 (range 18-74). The study cohort was divided into two groups. There were 17 (38.7%) patients that received a titanium wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (p=0.006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (p=0.013). There were no significant differences in post-operative talonavicular uncoverage angle, incongruency angle or calcaneal pitch at 6 months or 1 year. Conclusion: Adult acquired flat foot deformity is a difficult disorder to treat surgically. Lateral column lengthening is a common surgical procedure used to treat forefoot abduction that occurs. Our results show that at 6 months and 1 year no radiographic difference exists between autograft/allograft bone substitutes versus titanium wedge in LCL. Future research should evaluate the differences in patient reported outcomes between autograft/allograft versus titanium wedge bone substitutes. [Table: see text]

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Radiographic Outcomes Following Lateral Column Lengthening With a Porous Titanium Wedge

Foot & Ankle International ◽

10.1177/1071100715577788 ◽

2015 ◽

Vol 36 (8) ◽

pp. 953-960 ◽

Cited By ~ 10

Author(s):

Christopher E. Gross ◽

Jeannie Huh ◽

Joni Gray ◽

Constantine Demetracopoulos ◽

James A. Nunley

Keyword(s):

Porous Titanium ◽

Lateral Column ◽

Radiographic Outcomes ◽

Lateral Column Lengthening

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00045 ◽

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

Foot & Ankle International ◽

10.1177/1071100717732723 ◽

2017 ◽

Vol 39 (1) ◽

pp. 18-27 ◽

Cited By ~ 16

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.

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

Foot & Ankle International ◽

10.1177/107110079801900605 ◽

1998 ◽

Vol 19 (6) ◽

pp. 370-373 ◽

Cited By ~ 48

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

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Incidence of Plantar Lateral Foot Pain before and after the Use of Trial Metal Wedges in Lateral Column Lengthening

Foot & Ankle International ◽

10.3113/fai.2011.0665 ◽

2011 ◽

Vol 32 (7) ◽

pp. 665-673 ◽

Cited By ~ 19

Author(s):

Scott J. Ellis ◽

Benjamin R. Williams ◽

Rohit Garg ◽

Graham Campbell ◽

Helene Pavlov ◽

...

Keyword(s):

Foot Pain ◽

Lateral Column ◽

Before And After ◽

Lateral Column Lengthening

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

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2006.11.004 ◽

2007 ◽

Vol 22 (4) ◽

pp. 472-477 ◽

Cited By ~ 28

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

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Lateral Column Lengthening

Essential Foot and Ankle Surgical Techniques ◽

10.1007/978-3-030-14778-5_19 ◽

2019 ◽

pp. 189-196

Author(s):

Kyle S. Peterson ◽

David Larson ◽

Roberto A. Brandão

Keyword(s):

Lateral Column ◽

Lateral Column Lengthening

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Lateral Column Lengthening with Calcaneocuboid Fusion: Range of Motion in the Triple Joint Complex

Foot & Ankle International ◽

10.1177/107110079501601111 ◽

1995 ◽

Vol 16 (11) ◽

pp. 729-733 ◽

Cited By ~ 75

Author(s):

Jonathan T. Deland ◽

James C. Otis ◽

Kyung-Tai Lee ◽

Sharon M. Kenneally

Keyword(s):

Range Of Motion ◽

Subtalar Joint ◽

Clinical Investigation ◽

Three Dimensions ◽

Lateral Column ◽

Joint Range Of Motion ◽

Lateral Column Lengthening ◽

Joint Range

Lengthening the lateral column of the foot has been shown to correct flatfoot deformity. In adults, however, lengthening leads to calcaneocuboid arthritis. Lateral column lengthening with calcaneocuboid fusion, which lengthens the lateral column of the foot and prevents calcaneocuboid arthritis, was investigated in a cadaver model to determine the remaining range of motion in the talonavicular and subtalar joints. Inversion/eversion motion was produced by tendon pulls and the range of motion was measured in three dimensions using a magnetic space tracker. After lateral column lengthening with calcaneocuboid fusion, 48% of talonavicular and 70% of subtalar joint range of motion were preserved. Analysis of the inversion and eversion ranges of motion suggests that the lengthening fusion limits eversion more than inversion. These findings demonstrate the need for clinical investigation of this procedure, which could preserve motion in the talonavicular and subtalar joints, correct deformity, and obviate calcaneocuboid arthritis.

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