scholarly journals Late Abduction Deformity of the Midfoot Following the “Medial Double” (Diple) Procedure for Hindfoot Valgus Deformity

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Arthur Manoli
Keyword(s):  
Valgus Deformity ◽  
High Rate ◽  
Joint Involvement ◽  
Bone Block ◽  
Lateral Side ◽  
Triple Arthrodesis ◽  
Lateral Column ◽  
Calcaneocuboid Joint ◽  
Lateral Incision ◽  
Hindfoot Deformity

Category: Hindfoot Introduction/Purpose: There has been considerable interest in recent years in performing a combined talonavicular and subtalar arthrodesis instead of a standard triple arthrodesis for a rigid hindfoot deformity. The ”medial double” (diple) avoids fusing the calcaneocuboid joint with its lateral incision, common bone block graft and high rate of complications. Although the results of the “medial double” are generally satisfactory, there are no reports of late midfoot abduction deformity, although it was predicted by Evans in 1975. Methods: A 79 year-old-male with long-standing skin psoriasis with joint involvement presented with severe bilateral flatfoot deformities. The left hindfoot was arthritic, deformed and painful. Despite a conservative course of orthotics and ankle braces, the pain persisted. Because there was a psoriatic plaque over the lateral side of the foot, it was decided to perform a ”medial double” arthrodesis with screw fixation, a plantarflexing 1st tarsometatarsal joint fusion for medial column stabilization, and a heel cord lengthening Results: Skin and bony healing were uneventful. Over the subsequent three years a progressive abduction deformity developed through the naviculocuneiform joints and the unfused calcaneocuboid joint. The patient had only occasional pain in the midfoot and wore wide shoewear to accommodate the deformity. Conclusion: A late abduction deformity can develop through the midfoot in patients who have the ‘medial double” procedure for hindfoot valgus. The cuboid settles proximally against the short distal calcaneus, and the naviculocuneiform joints sublux laterally. In patients with hindfoot valgus with severe lateral column shortening secondary to calcaneocuboid joint remodeling, it may be better to perform an actual triple arthrodesis with a bone graft in the calcaneocuboid joint instead of a “medial double.” Alternatively, one could add a naviculocuneiform arthrodesis to the ”medial double” arthrodesis to prevent this complication.

Talonavicular Arthrodesis in the Rheumatoid Foot

Foot & Ankle ◽  
1992 ◽  
Vol 13 (6) ◽  
pp. 313-316 ◽  
Author(s):  
Peter Ljung ◽  
Jakob Kaij ◽  
Kaj Knutson ◽  
Holger Pettersson ◽  
Urban Rydholm
Keyword(s):  
Pain Relief ◽  
Valgus Deformity ◽  
Talonavicular Joint ◽  
Triple Arthrodesis ◽  
Experienced Pain ◽  
Osseous Union ◽  
Hindfoot Deformity ◽  
Staple Fixation

Arthrodesis of the talonavicular joint with a cylindrical dowel was performed in 19 feet in 17 rheumatoid patients with arthritic destruction of the talonavicular joint, but without fixed hindfoot deformity. Osseous union was achieved in 12 feet, but all patients experienced pain relief and no foot showed progressive valgus deformity of the hindfoot during follow-up. Staple fixation seemed to promote osseous union. The procedure, easy to perform and requiring only 6 weeks of immobilization, may, in the absence of fixed hindfoot deformity, supersede triple arthrodesis in rheumatoid patients with hindfoot arthritis.

Calcaneocuboid Joint Involvement in Calcaneal Fractures

1996 ◽  
Vol 17 (9) ◽  
pp. 563-565 ◽  
Author(s):  
Nabil A. Ebraheim ◽  
Ashok Biyani ◽  
Thomas Padanilam ◽  
Greg Christiensen
Keyword(s):  
Calcaneal Fracture ◽  
Joint Involvement ◽  
Calcaneal Fractures ◽  
Chi Square ◽  
Tomographic Images ◽  
Lateral Column ◽  
Computed Tomographic ◽  
Calcaneocuboid Joint ◽  
Lateral Subluxation ◽  
Chi Square Test

The charts and radiographs of 48 surgically treated patients who underwent surgery for calcaneal fractures (right in 25 patients, left in 22, and bilateral in 1) between 1987 and 1994 were retrospectively reviewed. Coronal computed tomographic scans alone were obtained in 33 patients, and both coronal and axial computed tomographic scans were obtained in 9 patients. Three fractures exiting close to the calcaneocuboid joint (CCJ), but not involving the joint, were excluded. Nineteen patients (38.7%) had involvement of the CCJ. The extension of the fracture to the CCJ was apparent in anteroposterior or oblique radiographs or both in 18 patients. There was intra-articular fracture displacement of ≤1 mm in 6 patients, and 13 patients had a step or a gap of ≥2 mm with or without angulation. Eleven patients had joint depression type fractures, 6 had tongue type fractures, and 2 had comminuted fractures. Extension of the calcaneal fracture into the CCJ was significantly more common with the joint depression type calcaneal fractures (chi-square test; P = 0.008). The coronal computed tomographic images showed significant lateral subluxation of posterior facet fragments in 8 patients and considerable comminution of the lateral calcaneal wall with or without lateral subluxation of posterior facet fragment in 10 patients. These patients also had CCJ involvement, thus establishing a strong correlation between lateral subluxation of the posterior facet fragment or comminution of the lateral calcaneal wall and CCJ involvement. CCJ involvement is more common with joint depression type fractures. Extension of the fracture line into the CCJ should be suspected in presence of significant lateral column comminution or lateral talar subluxation.

Biomechanical Analysis of the Calcaneocuboid Joint Pressure After Sequential Lengthening of the Lateral Column

2013 ◽  
Vol 34 (2) ◽  
pp. 261-266 ◽  
Author(s):  
Jiang Xia ◽  
Peng Zhang ◽  
Yun-Feng Yang ◽  
Jia-Qian Zhou ◽  
Qian-Ming Li ◽  
...  
Keyword(s):  
Biomechanical Analysis ◽  
Lateral Column ◽  
Calcaneocuboid Joint

scholarly journals The Captain’s View: A Novel Radiographic View to Assess Axial Alignment of the Calcaneus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0042
Author(s):  
Brian Velasco ◽  
Bruno Moura ◽  
John Kwon
Keyword(s):  
Soft Tissues ◽  
Articular Surface ◽  
Lateral Wall ◽  
Varus Deformity ◽  
High Rate ◽  
Clear Correlation ◽  
Lateral Side ◽  
Axial Alignment ◽  
Wide Range ◽  
Fresh Frozen

Category: Hindfoot, Trauma Introduction/Purpose: The axial alignment of the calcaneus has paramount importance in the management of these fractures. The Harris view has long stood as the recommended radiograph to assess axial alignment. However, given the obliquity at which the radiograph is obtained, it doesn´t represent a true axial view and is subject to inaccuracies secondary to rotational malpositioning of the foot and mismeasurement of angulation. Multiple reports have described the axial alignment as a surgical outcome, but usually this assessment of the residual deformity have no described method. The objectives of this study are to evaluate the capacity of Harris view to assess axial alignment in a cadaveric model and to describe the use of a true AP view of the calcaneus that we have named Captain´s view. Methods: Five below knee amputated fresh-frozen cadaveric specimens were used in the study. For each specimen, the soft tissues over the lateral side were removed to access to the lateral wall. A small wedge of the cuboid was removed to visualize the center of the calcaneocuboid articular surface. LCA-guide and a cannulated drill were used to create a tunnel in the axis of the calcaneus. An oblique osteotomy was performed in order to simulate a non-comminuted fracture. Varus deformity was created by inserting solid radiolucent wedges into the osteotomy to create models of 10, 20, and 30 degrees of varus angulation. Harris and Captain views were obtained for each specimen with 0 (control), 10, 20, and 30 degrees of varus malalignment. Measurements of the deformity were made digitally on each fluoroscopic image. Results: The average degrees of varus in Harris views were 10,9 (5,5-16); 11,5 (8,2-13,6); and 18,3 (13,3-23,6) for 10,20 and 30 degrees of deformity respectively. The average degrees of varus in Captain´s view were 13,0 (7,3-20,9); 18,4 (11,7-23,5); and 28,2 (24,4-31,1) for 10,20 and 30 degrees of deformity respectively. The average degrees of error for varus deformity in Harris views were 4,1 (41%); 8,4 (42%) and 11,6 (39%) for 10,20 and 30 degrees of deformity respectively. The average degrees of error for varus deformity in Captain´s views were 4,8 (48%); 3,6 (18%) and 2,8 (8%) for 10,20 and 30 degrees of deformity respectively. Conclusion: The results of this study show a high rate of mismeasurement for both radiographic views. Despite the average angles have a clear correlation with the severity of varus, the wide range of error observed between specimens make this assessment unreliable and inaccurate. We observed an improvement of accuracy of captain´s view for more severe deformities, but not with Harris views which maintain a 40% mismeasurement in all the settings. Therefore, intraoperative Harris views should not be used in isolation to evaluate axial alignment and Captain´s view provides an additional perspective that can be useful to rule out severe deformities.

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.

Calcaneocuboid Joint Pressures with Lateral Column Lengthening (Evans) Procedure

1997 ◽  
Vol 18 (4) ◽  
pp. 199-205 ◽  
Author(s):  
Paul S. Cooper ◽  
Michael D. Nowak ◽  
James Shaer
Keyword(s):  
Real Time ◽  
Pediatric Population ◽  
Lateral Column ◽  
Calcaneocuboid Joint ◽  
Lateral Column Lengthening

Calcaneocuboid joint pressures were evaluated with eight cadaver specimens. Real-time pressures were recorded using a TekScan 4200 sensor pad at lengths of 0, 5, and 10 mm in both unloaded and 350-newton loaded models. Recorded pressures exceeded 2.3 M Pa in the loaded model at 10 mm lateral column lengthening. Although an acceptable procedure in the pediatric population, application of the Evans lateral column lengthening procedure for management of adult acquired flatfoot may generate excessive pressures leading to joint arthrosis. Lengthening by calcaneocuboid distraction arthrodesis may avoid this problem.

Involvement of valgus hindfoot deformity in hallux valgus deformity in rheumatoid arthritis

2013 ◽  
Author(s):  
Shutaro Yamada ◽  
Makoto Hirao ◽  
Hideki Tsuboi ◽  
Shosuke Akita ◽  
Masato Matsushita ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Hallux Valgus Deformity ◽  
Hindfoot Deformity

scholarly journals PO 18238 - Floating metatarsal associated with comminuted calcaneocuboid joint fracture and turf toe

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 54S
Author(s):  
Bruno Rodrigues de Miranda ◽  
Rui Dos Santos Barroco ◽  
Leticia Zaccaria Prates de Oliveira ◽  
Mahmoud Beerens Abdul Ghani Abdul Ghani ◽  
Antonio Candido de Paula Neto ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Joint Stability ◽  
Rare Injury ◽  
Adequate Treatment ◽  
First Metatarsophalangeal Joint ◽  
Lateral Column ◽  
Calcaneocuboid Joint ◽  
Kirschner Wire Fixation ◽  
Joint Fracture ◽  
Turf Toe

Introduction: The term “floating metatarsal” refers to a rare injury pattern characterized by metatarsal dislocation in both the Lisfranc and metatarsophalangeal joints. The term “turf toe” refers to the rupture of the plantar capsular-ligamentous complex of the first metatarsophalangeal joint. Objective: To report a rare case of floating metatarsal associated with turf toe and comminuted calcaneocuboid joint fracture causing a midfoot abduction deformity. Method: To report the case of a patient who suffered a motorcycle accident and progressed with this rare combination of associated injuries. Results: The patient underwent surgical cleaning, reconstruction of the plantar capsular-ligamentous injury and reduction with Kirschner wire fixation of the first metatarsal and calcaneal fracture, with a local graft for lateral column and calcaneocuboid joint lengthening. The patient progressed well in the 18-month follow-up; fracture union and good joint stability with a slight limitation in range of motion were achieved. Discussion: Floating metatarsal is an injury poorly described in the literature, and its association with turf toe is due to trauma with metatarsophalangeal hyperextension. The patient may postoperatively develop postraumatically acquired hallux rigidus and hallux valgus. Conclusion: The identification of these injuries and a good clinical evaluation are crucial for adequate treatment and the prevention of possible complications.

scholarly journals Graft Collapse and Loss of Fixation in Lateral Column Lengthening

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0017
Author(s):  
Christina E. Freibott ◽  
Seth C. Shoap ◽  
Maria C. Evangelista ◽  
J. Turner Vosseller ◽  
Justin K. Greisberg
Keyword(s):  
Iliac Crest ◽  
Proximal Tibia ◽  
Weight Bearing ◽  
Case Series ◽  
High Rate ◽  
Hindfoot Alignment ◽  
Lateral Column ◽  
Second Surgery ◽  
Lateral Column Lengthening

Category: Ankle Introduction/Purpose: Lateral Column lengthening through an osteotomy of the anterior process of the calcaneus is one of the most effective procedures for restoring arch alignment in the adult acquired flatfoot, without fusing essential joints. Despite remarkable radiographic corrections, previous studies have found persistent lateral hindfoot pain remains a challenge. In this study, we reviewed a large series of patients who underwent lateral column lengthening as part of flat foot reconstructive surgery, using either autograft or allograft. Rates of graft collapse and loss of fixation were determined with two different graft sources. Methods: After Institutional Review Board approval, all patients who underwent lateral column lengthening between 2002 and 2018 were reviewed for clinical and radiographic outcomes. Variables such as age, gender, diagnosis, type of bone graft, subsequent surgery, screw/hardware breakage, length of follow-up, time until weight bearing, and length of radiographic follow-up were recorded. Approximately half the patients had iliac crest allograft for the distraction, and the others had proximal tibial structural autograft. Results: 52 patients met inclusion criteria. The average age was 47±14 years (range 18-86), with 32 women (62%) and 20 men (38%). 25 (48%) patients had a second surgery, most often for hardware removal. Two patients had repair of a nonunion. Twenty- five percent of patients who had proximal tibial autograft had hardware breakage and some degree of graft collapse, whereas none had hardware breakage in the iliac crest allograft group (p<0.05). Twenty-one of the 36 patients in the proximal tibia autograft group underwent a second surgery for persistent lateral column pain, with removal of hardware and bone debridement, compared to only 4 in the allograft group (p<0.05). Conclusion: Proximal tibia autograft performed relatively poorly in this case series, with a higher rate of graft collapse and lateral column pain. The allograft group had less complications, but even in this group, the rate of revision surgery is higher than might be expected for foot surgery in general. Lateral column lengthening is a powerful procedure for restoring hindfoot alignment without sacrificing essential joints, but suffers from a relatively high rate of persistent lateral column pain (which usually is not present prior to surgery) and reoperation.

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