Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for StageⅡB Adult- acquired Flatfoot Deformity

Category: Basic Sciences/Biologics Introduction/Purpose: To investigate the effect of cuboid osteotomy lateral column lengthening (LCL) for the correction of stage? B adult-acquired flatfoot deformity in cadaver. Methods: Six cadaver specimens were compressively loaded to 350 N. Flatfoot models were established and each was evaluated radiographically and pedobarographically in the following conditions: (1) intact foot, (2) flatfoot, (3) cuboid osteotomy LCL (2, 3, 4, and 5 mm). Results: Compared with the flatfoot model, the 2-,3-,4-, and 5-mm LCLs showed significant correction of talonavicular coverage on anteroposterior radiographs and talus-first metatarsal angle on both anteroposterior and lateral radiographs. As the graft increased in size incrementally, lateral forefoot pressure increased consistently, and medial pressure decreased significantly except for the 2-mm LCL. Compared with the intact foot, the above angles of the LCLs showed no significant difference except for the 2- mm LCL. In terms of forefoot pressure, medial pressure of the 2-mm LCL and lateral pressure of the 3-, 4- and 5-mm LCLs showed statistical differences, but lateral pressure of the 3-mm LCL was not much more than the intact foot as compared to the 4- and 5-mm LCLs, which was still less than medial pressure. Conclusion: Cuboid osteotomy LCL procedure avoids damage to subtalar joint and has a good effect on correction of stage? B adult-acquired flatfoot deformity with a 3 mm lengthening in cadavers.

Download Full-text

Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity: A Cadaveric Study

BioMed Research International ◽

10.1155/2017/4383981 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Haichao Zhou ◽

Haoyang Ren ◽

Chunguang Li ◽

Jiang Xia ◽

Guangrong Yu ◽

...

Keyword(s):

Lateral Pressure ◽

Biomechanical Analysis ◽

Stage Ii ◽

Good Effect ◽

Lateral Column ◽

Metatarsal Angle ◽

Significant Difference ◽

Significant Correction ◽

Lateral Column Lengthening ◽

Adult Acquired Flatfoot Deformity

Purpose. To investigate the effect of cuboid osteotomy lateral column lengthening (LCL) for the correction of stage II B adult-acquired flatfoot deformity in cadaver. Methods. Six cadaver specimens were loaded to 350 N. Flatfoot models were established and each was evaluated radiographically and pedobarographically in the following conditions: (1) intact foot, (2) flatfoot, and (3) cuboid osteotomy LCL (2, 3, 4, and 5 mm). Results. Compared with the flatfoot model, the LCLs showed significant correction of talonavicular coverage on anteroposterior radiographs and talus-first metatarsal angle on both anteroposterior and lateral radiographs (p<.05). Compared with the intact foot, the above angles of the LCLs showed no significant difference except the 2 mm LCL. In terms of forefoot pressure, medial pressure of the 2 mm LCL (p=.044) and lateral pressure of the 3, 4, and 5 mm LCLs showed statistical differences (p<.05), but lateral pressure of the 3 mm LCL was not more than the intact foot as compared to the 4 and 5 mm LCLs, which was less than medial pressure. Conclusion. Cuboid osteotomy LCL procedure avoids damage to subtalar joint and has a good effect on correction of stage II B adult-acquired flatfoot deformity with a 3 mm lengthening in cadavers.

Download Full-text

Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00522 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0052

Author(s):

Yunfeng Yang

Keyword(s):

Lateral Pressure ◽

Biomechanical Analysis ◽

Stage Ii ◽

Good Effect ◽

Lateral Column ◽

Metatarsal Angle ◽

Significant Difference ◽

Significant Correction ◽

Lateral Column Lengthening ◽

Adult Acquired Flatfoot Deformity

Category: Midfoot/Forefoot Introduction/Purpose: To investigate the effect of cuboid osteotomy lateral column lengthening (LCL) for the correction of stage II B adultacquired flatfoot deformity in cadaver Methods: Six cadaver specimens were loaded to 350 N. Flatfoot models were established and each was evaluated radiographically and pedobarographically in the following conditions: (1) intact foot, (2) flatfoot, and (3) cuboid osteotomy LCL (2, 3, 4, and 5 mm). Results: Compared with the flatfoot model, the LCLs showed significant correction of talonavicular coverage on anteroposterior radiographs and talus-first metatarsal angle on both anteroposterior and lateral radiographs ( p < .05). Compared with the intact foot, the above angles of the LCLs showed no significant difference except the 2mmLCL. In terms of forefoot pressure, medial pressure of the 2mmLCL ( p = .044) and lateral pressure of the 3, 4, and 5mmLCLs showed statistical differences ( p < .05), but lateral pressure of the 3 mm LCL was not more than the intact foot as compared to the 4 and 5 mm LCLs, which was less than medial pressure. Conclusion: Cuboid osteotomy LCL procedure avoids damage to subtalar joint and has a good effect on correction of stage II B adult-acquired flatfoot deformity with a 3 mm lengthening in cadavers.

Download Full-text

Porous Titanium Wedges in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity

Foot & Ankle Specialist ◽

10.1177/1938640017735890 ◽

2017 ◽

Vol 11 (4) ◽

pp. 347-356 ◽

Cited By ~ 1

Author(s):

Spencer H. Moore ◽

S. Evan Carstensen ◽

M. Tyrrell Burrus ◽

Truitt Cooper ◽

Joseph S. Park ◽

...

Keyword(s):

Case Series ◽

Deformity Correction ◽

Porous Titanium ◽

Common Procedure ◽

Lateral Column ◽

Metatarsal Angle ◽

Valgus Angle ◽

Significant Correction ◽

Lateral Column Lengthening ◽

Adult Acquired Flatfoot Deformity

Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult-acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 to October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo–first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was measured. Patients were followed from a minimum of 6 months up to 4 years (mean 16.1 months). Postoperative radiographs demonstrated significant correction in all 3 radiographic criteria and the hindfoot valgus angle. We had no cases of nonunion, no wedge migration, and no wedges have been removed to date. The most common complication was calcaneocuboid joint pain (14.7%). Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications. Levels of Evidence: Level IV: Case series

Download Full-text

Porous Titanium Wedges are an Alternative in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00184 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0018

Author(s):

Samuel Carstensen ◽

Spencer Moore ◽

Joseph Park ◽

M. Truitt Cooper ◽

Venkat Perumal

Keyword(s):

Deformity Correction ◽

Porous Titanium ◽

Treatment Modalities ◽

Posterior Tibial Tendon ◽

Lateral Column ◽

Metatarsal Angle ◽

Valgus Angle ◽

Significant Correction ◽

Lateral Column Lengthening ◽

Adult Acquired Flatfoot Deformity

Category: Hindfoot Introduction/Purpose: Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. Methods: A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 – October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo-first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was also obtained. Results: Patients were followed from a minimum of six months up to 48 months (mean 16.1 months). Patients underwent concomitant procedures including medial displacement calcaneal osteotomy (94.1%), flexor digitorum longus transfer (70.6%), posterior tibial tendon tenolysis (64.7%), gastrocnemius recession (20.6%), and cotton osteotomy (4.9%). Postoperative radiographs demonstrated significant correction in all three radiographic criteria as well as the hindfoot valgus angle compared to their preoperative measurements. There were no cases of nonunion, no wedge migration, no infections, and no patients required removal of hardware. The most common complication was calcaneocuboid joint pain (14.7%). Conclusion: AAFD is a problem with various treatment modalities. Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications.

Download Full-text

A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity

Foot & Ankle International ◽

10.1177/10711007211051359 ◽

2021 ◽

pp. 107110072110513

Author(s):

Yin-Chuan Shih ◽

Chui Jia Farn ◽

Chen-Chie Wang ◽

Chung-Li Wang ◽

Pei-Yu Chen

Keyword(s):

Subtalar Joint ◽

Case Series ◽

Stage Ii ◽

Posterior Tibial Tendon ◽

Lateral Column ◽

Metatarsal Angle ◽

Lateral Column Lengthening ◽

Adult Acquired Flatfoot Deformity ◽

The Mean

Background: Lateral column lengthening (LCL), originally described by Evans, is an established procedure to correct stage II adult acquired flatfoot deformity (AAFD). However, the relative position between the facets is violated, and other problems may include nonunion, malunion, and calcaneocuboid (CC) joint subluxation. Herein, we report a modified extra-articular technique of LCL with hockey-stick osteotomy, which preserves the subtalar joint as a whole, increases bony apposition to enhance healing ability, and preserves the insertion of the calcaneofibular ligament to stabilize the posterior fragment to promote adduction of the forefoot. Methods: We retrospectively recruited 24 patients (26 feet) with stage II AAFD who underwent extra-articular LCL. The mean age was 55.7 ± 15.7 years, and the mean follow-up period was 33.4 ± 12.1 months. Associated procedures of spring ligament repair/reconstruction and posterior tibial tendon plication or flexor digitorum longus transfer were routinely performed and may also include a Cotton osteotomy, heel cord lengthening, or hallux valgus correction. Clinical and radiographic outcomes at the final follow-up were compared with the preoperative assessments. Results: All patients achieved calcaneus union within 3 months of operation. The VAS pain score improved from 5.3 ± 0.75 preoperatively to 1.2 ± 0.79 at the final follow-up ( P < .001), and the AOFAS Ankle-Hindfoot Scale from 63.5 ± 8.5 to 85.8 ± 4.8 points ( P < .001). The radiographic measurements significantly improved in terms of the preoperative vs final angles of 8.9 ± 5.3 vs 15.2 ± 3.6 degrees for calcaneal pitch ( P < .001), 20.5 ± 9.2 vs 4.9 ± 4.8 degrees for Meary angle ( P < .001), 46.5 ± 5.2 vs 41.9 ± 3.2 degrees for lateral talocalcaneal angle ( P < .001), 23.9 ± 8.5 vs 3.9 ± 3.1 degrees for talonavicular coverage angle ( P < .001), and 18.2 ± 9.2 vs 7.3 ± 5.0 degrees for talus-first metatarsal angle ( P = .002). The CC joint subluxation percentage was 7.0% ± 5.4% preoperatively compared with 8.5% ± 2.4% at the final follow-up ( P = .101). No case showed progression of CC joint arthritis or CC joint subluxation (>15% CC joint subluxation percentage). One case showed transient sural nerve territory paresthesia, and 1 had pin tract infection. Three cases had lateral foot pain, which could be relieved by custom insoles. Conclusion: Modified extra-articular LCL as part of AAFD correction is a feasible alternative technique without subtalar joint invasion and may be associated with less CC joint subluxation compared with the Evans osteotomy. Level of Evidence: Level IV, retrospective case series.

Download Full-text

Radiographic Union of Evans Osteotomy Without Fixation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00358 ◽

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.

Download Full-text

Union Rates and Deformity Correction Using the Hintermann Osteotomy in Type IIb Flatfoot Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00221 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0022

Author(s):

Brian P. Gallagher ◽

Walter C. Hembree ◽

Lew C. Schon

Keyword(s):

Articular Cartilage ◽

Clinical Signs ◽

Deformity Correction ◽

Degenerative Changes ◽

Stage Ii ◽

Lateral Column ◽

Metatarsal Angle ◽

Significant Correction ◽

Lateral Column Lengthening ◽

Radiographic Union

Category: Ankle; Hindfoot Introduction/Purpose: Multiple Lateral column lengthening procedures have been described for the correction of the abduction component of stage II flatfoot deformity. The Hintermann osteotomy, although technically difficult, offers powerful lengthening of the lateral column with low risk of violating the articular cartilage of the subtalar joint as compared to the more widely performed Evans osteotomy. This study reports on the radiographic and clinical outcomes of the Hintermann osteotomy performed by a single surgeon. Methods: Patients who underwent reconstruction for stage II flatfoot deformity with a Hintermann lateral column lengthening were restrospectively identified. The talus-1st metatarsal angle, percent talus uncoverage, calcaneal pitch, lateral column length, CC joint subluxation, and distance from CC joint to the osteotomy were measured on pre and postop radiographs. Radiographic union was also assessed. The Kellgren-Lawrence scale was used to assess degenerative changes at the ST, CC, and TN joints. Charts were reviewed for comorbidities, clinical evidence of union, time to protected weightbearing, time to unrestricted weightbearing, signs of peroneal irritation, clinical signs of osteoarthritis progression, and complications. A paired students t test was used to identify differences in radiographic parameters. Results: Twenty-six patients (30 feet) met inclusion criteria. All osteotomies achieved union with only 1 (1/30) instance of delayed union. Average duration before clinical and radiographic union was 12.6 weeks (9-37). The AP Talus-1st metatarsal angle decreased on average of 12.3 degrees (STD 9.1) (p<0.0001). Percent talus uncoverage decreased on average 17.7 percent (STD 11.5%) (p<0.0001). Subluxation at the CC joint was found to increase on average 1.63mm (STD 1.99) (p<0.01). Only 3 patients (10%) had radiographic progression of osteoarthritis at either the CC or ST joint. No patients showed clinical signs of osteoarthritis and none went on to fusion. One patient had lateral hardware pain necessitating plate removal. Conclusion: The Hintermann osteotomy is a powerful tool for lateral column lengthening. In this series there was significant correction of the preoperative abduction deformity with no nonunions. Degenerative changes in the surrounding hindfoot joints were rare. One benefit of the Hintermann osteotomy is its ability to preserve the articular cartilage of the anterior and middle facets.

Download Full-text

Triple Arthrodesis with Lateral Column Lengthening for Treatment of Severe Planovalgus Deformity

Foot & Ankle International ◽

10.1177/107110079501600703 ◽

1995 ◽

Vol 16 (7) ◽

pp. 395-400 ◽

Cited By ~ 51

Author(s):

Greg A. Horton ◽

Brad W. Olney

Keyword(s):

Indication For Surgery ◽

Triple Arthrodesis ◽

Lateral Column ◽

First Metatarsal ◽

Ambulatory Status ◽

Foot Length ◽

Primary Indication ◽

Metatarsal Angle ◽

Solid Fusion ◽

Lateral Column Lengthening

Triple arthrodesis with lateral column lengthening through the calcaneocuboid joint was performed on 22 feet in 14 patients. The primary indication for surgery was severe symptomatic planovalgus deformity unresponsive to conservative measures. All patients achieved solid fusion within 12 weeks. No patient had a decline in ambulatory status. Excellent correction of deformity was achieved and maintained with an average correction of the talus first metatarsal angle of 25° in both the AP and lateral planes. Triple arthrodesis with lateral column lengthening provides for reliable arthrodesis and allows correction of severe planovalgus deformity while maintaining foot length.

Download Full-text

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.

Download Full-text