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.

Effect of Lateral Column Lengthening on Subtalar Motion in a Cadaveric Model

2020 ◽  
pp. 107110072097018
Author(s):  
Mitchell C. Harris ◽  
Brittany N Hedrick ◽  
Jacob R. Zide ◽  
Danielle M. Thomas ◽  
Claire Shivers ◽  
...  
Keyword(s):  
Deformity Correction ◽  
Porous Titanium ◽  
Testing System ◽  
Materials Testing ◽  
Lateral Column ◽  
3 Dimensional ◽  
Fresh Frozen ◽  
Lateral Column Lengthening ◽  
Cadaveric Model ◽  
Paired T Test

Background: Although 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 was 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 3-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 5 Nm. Abduction/adduction, supination/pronation, and plantarflexion/dorsiflexion about the talus were recorded. Specimens then underwent LCL via a calcaneal neck osteotomy, which was maintained with a 12-mm 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 (10.9 vs 11.8 degrees, P = .48), supination/pronation (3.5 vs 2.7 degrees, P = .31), or plantarflexion/dorsiflexion (1.6 vs 1.0 degrees, P = .10) were identified following LCL. Conclusion: No significant changes in subtalar motion were observed following lateral column lengthening in this biomechanical cadaveric study. Clinical Relevance: Although these findings do not obviate concerns of clinical subtalar stiffness following lateral column lengthening for planovalgus deformity correction, they suggest that diminished postoperative subtalar motion, when it occurs, may be due to soft tissue scarring rather than alterations of joint anatomy.

scholarly journals Do We Really Need to Worry About Calcaneocuboid Subluxation During Lateral Column Lengthening for Planovalgus Foot Deformity?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Brittany Hedrick ◽  
Anthony Riccio ◽  
Matthew Siebert ◽  
Claire Shivers ◽  
Mitchell Harris ◽  
...  
Keyword(s):  
Articular Surface ◽  
Three Dimensional ◽  
Porous Titanium ◽  
Ct Imaging ◽  
Plain Radiography ◽  
Matched Pair ◽  
Cross Sectional ◽  
Lateral Column ◽  
Lateral Column Lengthening ◽  
Rotatory Subluxation

Category: Midfoot/Forefoot; 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, the procedure has been implicated in iatrogenic calcaneocuboid (CC) subluxation and subsequent degenerative changes at the CC articulation. The purpose of this study is to characterize alterations at the CC joint following lateral column lengthening (LCL) as well as to determine if Steinman pin stabilization of the CC joint prior to distraction maintains a normal CC relationship. Methods: Seven matched pairs of fresh frozen cadaveric feet underwent pre-procedure plain radiography and cross-sectional computed tomography (CT) imaging. LCL via a calcaneal neck osteotomy was then performed. One foot of each matched pair had a single smooth Steinman pin placed centrally across the CC joint prior to osteotomy distraction. Distraction across each osteotomy was then performed and maintained with a 12mm porous titanium wedge. Repeat imaging was obtained and compared to pre-procedure studies to quantify sagittal and rotational differences at the CC articulation Results: Following LCL, plain radiography demonstrated statistically significant increases in the percentage of the calcaneal articular surface dorsal to the superior aspect of the cuboid in both the pinned (8.2% vs 17.6%, p=0.02) and unpinned (12.5% vs 16.3%, p=0.04) specimens. No difference in the percentage of subluxation was found between the two groups following LCL. CT imaging demonstrated statistically significant increases in rotation between the calcaneus and cuboid following LCL in both the pinned (7.6O +- 5.6O, p=0.01) and unpinned (17O +- 12.3O, p=0.01) specimens. Though a greater degree of rotation was present in the unpinned specimens following LCL, this difference was not statistically significant (p=0.28). Conclusion: Both sagittal and rotatory subluxation seem to occur at the CC joint following LCL regardless of pin stabilization. As a single pin would be expected to limit pure translation while having little effect on rotation, it is possible that the rotational changes identified on three-dimensional imaging are interpreted as dorsal translation when viewed two dimensionally using plain radiography. Consideration should therefore be given to CC stabilization with two pins during LCL to prevent this rotatory subluxation.

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

2017 ◽  
Vol 11 (4) ◽  
pp. 347-356 ◽  
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

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

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.

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.

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

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.

Three-Dimensional Morphometric Modeling Measurements of the Calcaneus in Adults with Stage IIB Posterior Tibial Tendon Dysfunction: A Pilot Study

2018 ◽  
Vol 12 (4) ◽  
pp. 316-321 ◽  
Author(s):  
Kempland C. Walley ◽  
Evan P. Roush ◽  
Christopher M. Stauch ◽  
Allen R. Kunselman ◽  
Kaitlin L. Saloky ◽  
...  
Keyword(s):  
Distal Tibia ◽  
Three Dimensional ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Anterior Process ◽  
Clinical Criteria ◽  
Lateral Column ◽  
Posterior Tibial ◽  
Group Assignment ◽  
Lateral Column Lengthening

Background: The pathophysiology of adult-acquired flatfoot deformity (AAFD) is not fully explained by degeneration of the posterior tibial tendon alone. While a shortened or dysplastic lateral column has been implicated in flatfoot deformity in pediatrics, there is no study that has quantified the degree of dysplasia in adults with a stage IIb flatfoot deformity, or if any exists at all. Methods: An institutional radiology database was queried for patients with posterior tibial tendon dysfunction (PTTD) who had computed tomography (CT) performed. Controls were patients receiving CT scan for an intra-articular distal tibia fracture without preexisting foot or calcaneal pathology. Clinical notes, physical examination, and weightbearing radiographs were used to find patients that met clinical criteria for stage IIb PTTD. Morphometric measurements of the calcanei were performed involving the length of the calcaneal axis (LCA), height of the anterior process (HAP), and length of the anterior process (LAP). All measurements were performed independently by separate observers, with observers blinded to group assignment. We considered a difference of ±4 mm as our threshold. Results: 7 patients and 7 controls were available for reconstruction and analysis. On average, the LCA was 3.1 mm shorter in patients with stage IIb PTTD compared with controls ( P < .05). The LAP was shorter in PTTD patients compared with controls 3.4 mm ( P < .001). Conclusions: Our results support the hypothesis that the calcaneus of adult patients with stage IIb AAFD is dysplastic when compared with healthy controls, which further supports the utility of lateral column lengthening. Levels of Evidence: Level III: Case-control study

Calcaneal Lengthening: Investigation of Deformity Correction in a Cadaver Flatfoot Model

2005 ◽  
Vol 26 (2) ◽  
pp. 166-170 ◽  
Author(s):  
Timothy A. DuMontier ◽  
Alexis Falicov ◽  
Vincent Mosca ◽  
Bruce Sangeorzan
Keyword(s):  
Soft Tissues ◽  
Three Dimensional ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Cadaver Study ◽  
Lateral Column ◽  
Dimensional Changes ◽  
Computed Tomographic ◽  
Structural Bone Graft ◽  
Calcaneal Lengthening

Background: Evans showed that lengthening the lateral column by inserting structural bone graft into the anterior calcaneus could correct abduction and valgus deformity in flatfoot. To better understand the mechanism of correction and the three-dimensional effect of this procedure a cadaver study was done. Methods: Three cadaver flatfoot models were used. Computed tomographic (CT) scans were made of each specimen before and after lengthening. Data from these scans were used to determine the center of volume of the talus, navicular, cuboid, and calcaneus. The angular and translational motions for each bone were determined. Results: On average, relative to the talus, the navicular moved 18.6 degrees of rotation in adduction, 2.6 degrees of rotation in pronation, and 3.4 degrees in plantarflexion. The average translation was 5.6 mm medial, 0.4 mm posterior, and 1.8 mm plantar. The cuboid moved an average of 24.2 degrees of rotation in adduction and lengthening, 13.9 degrees in pronation, and 1.9 degrees in plantarflexion. The average translation was 9.4 mm medial, 2.6 mm distal, and 1.5 mm plantar. The calcaneus moved an average of 4.4 degrees of rotation in adduction, 0.1 degrees of rotation in eversion, and 1.3 degrees of plantarflexion. The average translation was 3 mm medial and 0.7 mm posterior with no plantar translation. Conclusions: The mechanism of Evans calcaneal lengthening involves adduction and plantarflexion of the midfoot relative to the hindfoot. The cuboid and navicular appear to move as a unit. The shape of the talar head, axis of the subtalar joint, degree of initial deformity, competence of plantar soft tissues, such as the long plantar ligament, and adequate length of the Achilles tendon are important. Knowing what qualitative three-dimensional changes take place allows a better understanding of the mechanics of the procedure and its possible applications.

Radiographic Outcomes Following Lateral Column Lengthening With a Porous Titanium Wedge

2015 ◽  
Vol 36 (8) ◽  
pp. 953-960 ◽  
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

A Biomechanical Comparison of Locking and Nonlocking Plates for the Fixation of Calcaneal Fractures

2006 ◽  
Vol 27 (3) ◽  
pp. 196-201 ◽  
Author(s):  
David J. Redfern ◽  
Miguel L.R. Oliveira ◽  
John T. Campbell ◽  
Stephen M. Belkoff
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Testing Machine ◽  
Three Dimensional ◽  
Materials Testing ◽  
Mineral Density ◽  
Calcaneal Fractures ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Analysis System

Background: Locking plate systems have been developed in an attempt to increase the strength of fracture fixation and, in so doing, allow earlier mobilization and rehabilitation. The purpose of our study was to compare the mechanical integrity of the locking plate and traditional nonlocking plate fixation for calcaneal fractures in a cadaver model. Our hypothesis was that the locking plate construct provides stronger fixation than the nonlocking plate construct. Methods: We created a Sanders type-IIB fracture in 10 pairs of fresh-frozen cadaver feet (bone mineral density, 0.50 ± 0.14 g/cm2 age, 69 ± 16 years). One foot of each pair was fixed with a nonlocking calcaneal plate (Synthes, Paoli, PA), and the contralateral foot was fixed with the Locking Calcaneal Plate (Synthes, Paoli, PA). The specimens then were cyclically loaded through the tibia from 0 to 700 N at 1 Hz on a materials testing machine to simulate weightbearing. Fragment displacement was measured with a three-dimensional kinematic analysis system. Significance was set at p >0.05. Results: There was no significant difference between the two plating systems with respect to the mean (± SD) number of cycles to failure (locking plate, 3261 ± 2355; nonlocking plate, 2271 ± 2465). Conclusion: In a cadaver model of type-IIB calcaneal fractures, locking plate fixation did not provide a biomechanical advantage over traditional nonlocking plate fixation.

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